Chronic Ankle Instability Patients Research Articles

Effect of the Combined Application of Mulligan Taping and Flossing Band on Muscle Activity and Balance Ability in Chronic Ankle Instability Patients

Effect of the Combined Application of Mulligan Taping and Flossing Band on Muscle Activity and Balance Ability in Chronic Ankle Instability Patients

Misencoding of ankle joint angle control system via cutaneous afferents reflex pathway in chronic ankle instability.

This study aimed to investigate how the cutaneous reflexes in the peroneus longus (PL) muscle are affected by changing the ankle joint position in patients with chronic ankle instability (CAI). We also investigated the correlation between the degree of reflex modulation and angle position sense of the ankle joint. The participants were 19 patients with CAI and 20 age-matched controls. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve at the ankle joint in the neutral standing and eversion/inversion standing positions. The suppressive middle latency cutaneous reflex (MLR; ~ 70-120ms) and angle position sense of the ankle joint were assessed. During neutral standing, the gain of the suppressive MLR was more prominent in the CAI patients than in controls, although no significant difference was seen during 30° inversion standing. In addition, the ratios of the suppressive MLR and background electromyography in a neutral position were significantly larger than those at the 15°, 25°, and 30° inversion positions in CAI patients. No such difference was seen in control individuals. Furthermore, the correlations between reflex modulation degree and position sense error were quite different in CAI patients compared to controls. These findings suggest that the sensory-motor system was deteriorated in CAI patients due to changes in the PL cutaneous reflex pathway excitability and position sense of the ankle joint.

Concomitant osteochondral lesions of the talus affect the stair descent biomechanics of patients with chronic ankle instability: A pilot study

BackgroundPrevious studies on the kinematics of patients with chronic ankle instability (CAI) that did not incorporate MRI and arthroscopic assessment could not differentiate between patients with CAI without osteochondral lesion of the talus (OLT) and patients with CAI and OLT and have thus presented contradictory results. Research questionThis study aimed to investigate the kinematic and electromyographic differences between patients with and without OLT. MethodsSixteen subjects with CAI (eight without OLT and eight with OLT confirmed through MRI and arthroscopic assessment) and eight healthy subjects underwent gait analysis in a stair descent setting. The three groups’ patient-reported outcomes; ankle joint range of motion in flexion, inversion and rotation; and muscle activation of the peroneus, tibialis anterior, and gastrocnemius during a gait cycle were analyzed and compared. A curve analysis, namely, one-dimensional statistical parametric mapping, was performed to compare the dynamic ankle kinematics and muscle activation curves over the entire normalized time series. ResultsThe patients with and without OLT had no difference in patient-reported outcomes. The maximal ankle plantarflexion of the patients without OLT and the healthy subjects was significantly larger than that of patients with OLT (p = 0.005). The maximal ankle internal rotation of patients without OLT was significantly larger than that of patients with OLT (p = 0.048). The peroneal activation during 0–6% of the gait cycle of patients with OLT was reduced compared with the healthy subjects. SignificancePatients with CAI and OLT and patients with CAI without OLT have no difference in patient-reported outcomes, but patients with OLT can be differentiated using the post-initial-contact peroneal activation deficit and the restriction of ankle plantarflexion and internal rotation during stair descent. These variables can be utilized to monitor the function of patients with CAI and their possibility of developing OLT.

Acute effects of external visual feedback using cross-line laser on landing neuromechanics and postural control in chronic ankle instability

ABSTRACT Although neuromuscular training (NMT) programmes positively enhance clinical deficits in chronic ankle instability (CAI) patients, the effectiveness of NMTs in restoring movement patterns during jump landing is still questionable. Before developing new prolonged motor-learning interventions, it is important to determine the immediate effects of intervention on movement patterns during jump-landing in patients with CAI. Therefore, the purpose of this study was to determine whether real-time external feedback using a crossline laser device changes the movement patterns during jump-landing and balance tasks in patients with CAI. Eighteen patients with CAI completed three successful single-leg jump-landing tasks and single-leg balance tasks under the conditions of with and without external feedback. Lower-extremity joint angles, moments, and EMG activation of six muscles were collected during the single leg jump-landing task and centre of pressure data were collected during the single-leg balance test. Real-time external feedback allowed to change neuromechanical characteristics in the entire lower-extremity (i.e., ankle, knee, and hip joints) during jump-landing. However, there were no differences in static postural control between the two conditions. Clinicians should carefully consider incorporating a cost-effective laser device into an augmented NMT programme of longer duration to improve movement patterns during functional tasks in patients with CAI.

Biomechanical Effects of Chronic Ankle Instability on the Talar Cartilage Matrix: The Value of T1ρ Relaxation Mapping Without and With Mechanical Loading.

T1ρ mapping has been proposed for the detection of early cartilage degeneration associated with chronic ankle instability (CAI). However, there are limited data surrounding the influence of ankle loading on T1ρ relaxation. To evaluate T1ρ relaxation times of talar cartilage, as an indicator of early degenerative changes, associated with CAI and to investigate the influence of acute axial in situ loading on T1ρ values in CAI patients and healthy controls. Prospective. A total of 9 patients (age=21.8 ± 2.5 years, male/female=2/7) with chronic ankle instability and 18 healthy control subjects (age=22.8 ± 3.6 years, male/female=5/13). 3 T. 3D gradient echo fast low-angle shot (FLASH) sequence augmented with a variable spin-lock preparation period. Ankle T1ρ mapping was performed without and with axial loading of 500 N. The talar cartilage was segmented in five coronal slices covering the central talocrural joint. Median talar T1ρ values were separately calculated for the medial and lateral facets. Mann-Whitney U and Wilcoxon signed-rank tests, significance level: P < 0.05. For the combined cohorts, the statistical analysis yielded significantly lower T1ρ values with loading compared to the no-load measurement for both the lateral (no load: [51.0 ± 4.0] msec, load: [49.5 ± 5.4] msec) as well as the medial compartment (no load: [50.0 ± 5.4] msec, load: [47.8 ± 6.8] msec). In the unloaded scans, the CAI patients showed significantly increased talar T1ρ values ([53.0 ± 7.4] mse ) compared to the healthy control subjects ([48.8 ± 4.1] msec) in the medial compartment. Increased talar T1ρ relaxation times in CAI patients compared to healthy controls suggest that T1ρ relaxation is a sensitive biomarker for CAI-induced early-stage cartilage degeneration. However, the load-induced T1ρ change did not prove to be a viable marker for the altered biomechanical properties of the hyaline talar cartilage. 2 LEVEL OF EFFICACY: Stage 2.

Arthroscopic modified Broström procedure achieves faster return to sports than open procedure for chronic ankle instability.

To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Broström procedure for chronic lateral ankle instability (CLAI) patients. From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Broström procedure (n = 36) and open modified Broström procedure (n = 34). They were evaluated at five time points (preoperation and 3months, 6months, 1year and 2years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications. Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 ± 2.4weeks vs. 18.7 ± 3.1weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3months and 6months postoperatively and VAS at 3months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups. Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6months postoperatively, and no clinical differences were found between arthroscopic and open modified Broström procedure 1year or 2years postoperatively. Arthroscopic modified Broström procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery. ChiCTR1900023999. II.

Effects of balance training on dynamic postural stability in patients with chronic ankle instability: systematic review and meta-analysis of randomized controlled trials

Chronic ankle instability (CAI), which is characterized by deficient postural control, is associated with functional limitations and diminished self-reported quality of life. Recent studies have suggested that balance training can improve postural control, but high-quality evidence-based research to confirm the effect of balance training on dynamic postural stability in CAI patients is lacking. The purpose of this study was to synthesize current evidence regarding the effect of balance training on dynamic postural stability in CAI patients. PubMed, Embase, Web of Science and Cochrane Library databases were searched for clinical trials that evaluated the effect of balance training on posture and balance in CAI patients from their inception to 15 July 2021. All statistical analyses were performed in RevMan 5.4. The risk of bias was assessed by the Cochrane Collaboration's risk of bias tool, and studies that reported statistically comparable outcomes were analyzed in meta-analyses using random effects models. Heterogeneity was assessed using the I2 statistic index. A total of 12 RCTs included in this meta-analysis and revealed that balance training was effective for improving the dynamic posture stability of CAI patients (SMD=0:90; 95% CI: 0.54 to 1.26; P<0:00001, I2=71%; Star Excursion Balance Test). Subgroup analysis (balance training vs. other training) revealed a small negative effect size, but this was not statistically significant (SMD=-0.12, 95% CI=-0.53 to 0.29, P=0.56, I2=9%). Another subgroup analysis (balance training vs. no training) revealed that balance training was more likely to have greater improvement on the dynamic posture stability of CAI patients (SMD=0.94, 95% CI: 0.71 to 1.17; P<0.00001, I2=0%). Balance training yielded a statistically significant and clinically meaningful improvement in dynamic postural stability in CAI patients. Limited evidence indicates that balance training was more effective than other training methods.

Not Only in Sensorimotor Network: Local and Distant Cerebral Inherent Activity of Chronic Ankle Instability-A Resting-State fMRI Study.

BackgroundIncreasing evidence has proved that chronic ankle instability (CAI) is highly related to the central nervous system (CNS). However, it is still unclear about the inherent cerebral activity among the CAI patients.PurposeTo investigate the differences of intrinsic functional cerebral activity between the CAI patients and healthy controls (HCs) and further explore its correlation with clinical measurement in CAI patients.Materials and MethodsA total of 25 CAI patients and 39 HCs were enrolled in this study. Resting-state functional magnetic resonance imaging (rs-fMRI) was used to detect spontaneous cerebral activity. The metrics of amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) of the two groups were compared by two-sample t-test. The brain regions that demonstrated altered functional metrics were selected as the regions of interest (ROIs). The functional connectivity (FC) was analyzed based on the ROIs. The Spearman correlation was calculated between rs-fMRI metrics and clinical scale scores.ResultsCompared with HCs, CAI patients showed higher ALFF and ReHo values in the right postcentral gyrus, the right precentral gyrus, and the right middle frontal gyrus, while lower fALFF values in the orbital-frontal cortex (OFC, p < 0.01 after correction). Increasing FC between the right precentral gyrus and the right postcentral gyrus while decreasing FC between the right precentral gyrus and the anterior cingulum cortex (ACC), the right middle frontal gyrus and the left middle temporal gyrus, and the OFC and left inferior parietal lobule (IPL) was observed. In addition, in the CAI group, the ReHo value negatively correlated with the Cumberland Ankle Instability Tool score in the right middle frontal gyrus (r = −0.52, p = 0.007).ConclusionThe CAI patients exhibited enhanced and more coherent regional inherent neuronal activity within the sensorimotor network while lower regional inherent activity in pain/emotion modulation related region. In addition, the information exchanges were stronger within the sensorimotor network while weaker between distant interhemispheric regions. Besides, the increased inherent activity in the right middle frontal gyrus was related to clinical severity. These findings may provide insights into the pathophysiological alteration in CNS among CAI patients.

Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Brostr\xf6m procedure

The modified Broström procedure (MBP) is an initial treatment for symptomatic chronic ankle instability (CAI) patients. This study aimed to compare the proprioception and neuromuscular control ability of both affected and unaffected ankles at the time of return to sports after MBP for patients with scores of normal controls. 75 individuals (40 who underwent MBP, 35 normal controls) participated. The dynamic balance test scores were significantly higher in the affected ankle of the patients than in the controls (1.5 ± 0.6° vs. 1.1 ± 0.4°, p < 0.003). The time to peak torque for dorsiflexion (60.8 ± 13.9 ms vs. 52.2 ± 17.5 ms, p < 0.022) and eversion (68.9 ± 19.1 ms vs. 59.3 ± 21.1 ms, p < 0.043) was significantly delayed in the affected ankle of the patients than in the controls. The dynamic balance test and time to peak torque in CAI patients remained significantly reduced at the time of return-to-sport after MBP. Clinicians and therapists should be aware of potential deficits in proprioception and neuromuscular control when determining the timing of return to sports after MBP.

Spatiotemporal and kinematic characteristics augmentation using Dual-GAN for ankle instability detection.

Obtaining massive amounts of training data is often crucial for computer-assisted diagnosis using deep learning. Unfortunately, patient data is often small due to varied constraints. We develop a new approach to extract significant features from a small clinical gait analysis dataset to improve computer-assisted diagnosis of Chronic Ankle Instability (CAI) patients. In this paper, we present an approach for augmenting spatiotemporal and kinematic characteristics using the Dual Generative Adversarial Networks (Dual-GAN) to train a series of modified Long Short-Term Memory (LSTM) detection models making the training process more data-efficient. Namely, we use LSTM-, LSTM-Fully Convolutional Networks (FCN)-, and Convolutional LSTM-based detection models to identify the patients with CAI. The Dual-GAN enables the synthesized data to approximate the real data distribution visualized by the t-distributed Stochastic Neighbor Embedding (t-SNE) algorithm. Then we trained the proposed detection models using real data collected from a controlled laboratory study and mixed data from real and synthesized gait features. The detection models were tested in real data to validate the positive role in data augmentation as well as to demonstrate the capability and effectiveness of the modified LSTM algorithm for CAI detection using spatiotemporal and kinematic characteristics in walking. Dual-GAN generated efficient spatiotemporal and kinematic characteristics to augment the training set promoting the performance of CAI detection and the modified LSTM algorithm yielded an enhanced classification outcome to identify those CAI patients from a group of control subjects based on gait analysis data than any previous reports.

Comparison of Outcomes of Arthroscopic Modified Broström Procedure for CLAI in Patients with Solitary ATFL Injury and in Patients with ATFL and CFL Complex Injury

Category:Ankle; ArthroscopyIntroduction/Purpose:ATFL (Anterior talofibular ligament) and CFL (Calcaneofibular ligament) are most commonly injured structures when ankle sprained. There has been debate about whether CFL should be recovered by surgery. Recently, several studies have verified that MBP (Modified Broström procedure) with IER (Inferior extensor retinaculum) augmentation demonstrated good outcomes even in patients with ATFL and CFL complex injury. However, some studies presented that IER augmentation cannot cover CFL injuries because of a different vector. If so, we hypothesized that the patients with solitary ATFL injury would show better outcomes comparing with patients with ATFL and CFL complex injury when same arthroscopic MBP was performed for each group.Methods:208 ankles were included between September 2015 and October 2019. All the patients were underwent arthroscopic MBP with IER augmentation using knotless suture anchor technique. Complete ATFL injuries were determined by arthroscopy and CFL injuries were examined by magnetic resonance image. 26 ankles of which talar tilt angle was less than 9 degrees in ATFL and CFL complex injury group were excluded. Finally, 38 ankles with solitary ATFL injury and 31 ankles with ATFL and CFL complex injury were enrolled. Clinical and radiological outcome were measured and compared between two groups. Clinical outcome was divided into objective and subjective outcome. Objective outcomes were composed of VAS, AOFAS score and FAOS. Subjective outcome was presented as subjective satisfaction score (1: Excellent, 2: Good, 3: Fair, 4: Poor). Improvement of degree of anterior talar translation and talar tilt angle between preoperative and 12 months after surgery was measured as a radiological outcome.Results:P-values of VAS score at preoperative, 3 months, 6 months and 12 months after surgery were 0.3761, 0.2609, 0.3893 and 0.2547 respectively (95% confidence interval[CI]). P-values of AOFAS score at preoperative, 3 months, 6 months and 12 months after surgery were 0.2079, 0.64, 0.6339 and 0.2683 respectively (95% CI). P-values of FAOS and subjective satisfaction score at 12 months after surgery was 0.1379 and 0.6338 respectively (95% CI). P-values of anterior talar translation and talar tilt angle were 0.4371 and 0.0002 respectively (95% CI). The degree of talar tilt angle improvement was -1.91 in solitary ATFL injury group and -5.48 in ATFL and CFL complex injury group.Conclusion:The outcomes of arthroscopic MBP with IER augmentation for chronic lateral ankle instability in patients with Solitary ATFL injury and in patients with ATFL and CFL complex injury showed no differences except talar tilt angle improvement. Though talar tilt angle improvement showed difference between two groups, the degree of improvement was even better in ATFL and CFL complex injury group. It means arthroscopic MBP could be a good treatment options for chronic lateral ankle instability patients regardless of CFL injury.

Optical flow balance perturbations alter gait kinematics and variability in chronic ankle instability patients

BackgroundIndividuals with chronic ankle instability (CAI) have known balance impairments thought to be the result of an inability to reweight sensory information. CAI patients place greater emphasis on visual information during single-limb stance than healthy controls but this evidence is based on removing visual information during static conditions. Research questionDoes perturbed optical flow effect step kinematics and variability in those with CAI differently than healthy controls? What is the relationship among ankle laxity, plantar cutaneous sensation, and susceptibility to perturbed optical flow in those with CAI? Methods17 CAI patients and 17 healthy individuals participated in a crossover experimental study. Participants walked on a treadmill at 1.25 m/s while watching a speed-matched virtual hallway with and without continuous mediolateral (ML) optical flow perturbations. Three-dimensional pelvic and foot kinematics were recorded at 100 Hz for at least 300 consecutive steps in each condition. Step width (SW) and step length (SL) values were calculated from consecutive heel positions. Gait variability was characterized as the standard deviation of step width (SWV), step length (SLV), and ML sacrum motion (SMV) across all steps performed in each condition. ResultsThe CAI group exhibited a greater change in SWV (p = 0.037), SLV (p = 0.040), and ML SMV (p = 0.047) from the perturbed to unperturbed conditions relative to the healthy controls. A condition main effect was also noted for SW (p < 0.001) and SL (p < 0.001) as ML optical flow perturbations resulted in significant changes in SW and SL relative to the normal walking condition. SignificanceWalking with ML optical flow perturbations induced greater variability changes in those with CAI relative to controls. When combined with the existing literature, this finding suggests that CAI individuals have a greater reliance on visual information in both static and dynamic (i.e. walking gait) conditions relative to healthy individuals.

Clinical outcomes of anterior tibiofibular ligament’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients

PurposeTreatment of chronic ankle instability (CAI) for ankle sprain patients remains a challenge. If initial treatments fail, surgical stabilization techniques including ligament reconstruction should be performed. Anterior tibiofibular ligament (ATiFL) distal fascicle transfer for CAI was recently introduced. The goal of the study is to assess the 1-year clinical effectiveness of ATiFL’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ (Fa. Arthrex, Naples).MethodsBetween October 2019 and February 2021, 25 patients (14 males and 11 females) scheduled for ligament reconstruction treatment of CAI were enrolled after propensity score matching. Twelve underwent ligament reconstruction with InternalBrace™ (InternalBrace™ group) and thirteen underwent ATiFL’s distal fascicle transfer (ATiFL’s distal fascicle transfer group). We recorded the American Orthopedic Foot & Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), anterior drawer test grade, patient satisfaction and complications. All results of this study were retrospectively analyzed.ResultsStatistically significant (p = 0.0251, independent-samples t test) differences in the AOFAS can be found between the ATiFL’s distal fascicle transfer group and the InternalBrace™ group. No substantial changes in the VAS (p = 0.1778, independent-samples t test), patient satisfaction (p = 0.1800, independent-samples t test) and anterior drawer test grade (p = 0.9600, independent-samples t test) were found between the two groups. There was one patient with superficial wound infection and one patient with sural nerve injury in the InternalBrace™ group and ATiFL’s distal fascicle transfer group, respectively.ConclusionThis is the first study that assessed a cohort of CAI patients and suggests that the ATiFL’s distal fascicle transfer operation has the potential to attain good-to-excellent clinical outcomes after 1-year recovery. The AOFAS scores were significantly higher for patients with ATiFL’s distal fascicle transfer, indicating that this technique may be considered a viable option for both patients and their surgeon, while long-term outcomes should be investigated in the future.

Effects of balance training with stroboscopic glasses on postural control in chronic ankle instability patients.

To compare (1) the effects of balance training with and without stroboscopic glasses on postural control and (2) the effects of the training on visual reliance in patients with CAI. A randomized controlled clinical trial. Twenty-eight CAI patients were equally assigned to one of 2groups: strobe or control group. The strobe group wore stroboscopic glasses during a 4-week balance training. Static postural control, a single-leg hop balance test calculated by Dynamic Postural Stability Index (DPSI), and the Y-Balance test (YBT) were measured. During the tests, there were different visual conditions: eyes-open (EO), eyes-closed (EC), and strobe vision (SV). Romberg ratios were then calculated as SV/EO, and EC/EO and used for statistical analysis. The strobe group showed a higher pretest-posttest difference in velocity in the medial-lateral direction and vertical stability index under SV compared with the control group (p<.05). The strobe group showed higher differences in EC/EO for velocity in the medial-lateral and anterior-posterior directions, and 95% confidence ellipse area (p<.05), and in SV/EO for velocity in the medial-lateral, 95% confidence ellipse area, and YBT-anterior direction (p<.05). The 4-week balance training with stroboscopic glasses appeared to be effective in improving postural control and altering visual reliance in patients with CAI.

Deactivation of the dorsal anterior cingulate cortex indicated low postoperative sports levels in presurgical patients with chronic ankle instability

BackgroundInjury-related fear contributed to disability in chronic ankle instability (CAI), while there still lacked exploration on the appraisal processes of the injury-related stimuli. This study aimed to compare the neural activities of the appraisal processes of sprain-related stimuli between presurgical chronic ankle instability patients and healthy controls through functional magnetic resonance imaging (fMRI) and evaluate its relationships with the clinical outcomes of orthopedic surgeries.MethodsEighteen presurgical CAI patients and fourteen healthy controls were recruited and underwent an fMRI session with visual stimulation of movies that showing typical ankle sprains accidents or control videos and the corresponding fear ratings. The clinical outcomes were collected at baseline and a minimum of 2 years after surgery; these included the American Orthopaedic Foot and Ankle Society (AOFAS) scores, the Numeric Rating Scale (NRS) scores, and the Tegner Activity Rating Scale scores. The two-sample t-test would be applied to identify which brain regions were influenced by CAI, and the correlation analysis would be applied to measure the relationship between the activation and clinical outcomes.ResultsDorsal anterior cingulate cortex (dACC) was deactivated in CAI patients when compared with healthy controls, and the dACC deactivation strength revealed a moderate correlation with the values of fear ratings for all participants. The deactivation strength was negatively correlated with AOFAS at baseline, with Tegner at follow-up and its improvement.ConclusionsPresurgical CAI patients presented deactivated dACC as a different neural activity of appraisal processes of sprain-related stimuli when compared with healthy controls, which was associated with lower postoperative sports levels. More comprehensive patients care including psychological interventions were needed in the clinical management of chronic ankle instability.

Acute Vibration Feedback During Gait Reduces Mechanical Ankle Joint Loading in Chronic Ankle Instability Patients.

Individuals with chronic ankle instability (CAI) exhibit altered vertical ground reaction forces (vGRF), a laterally shifted center of pressure, and an inverted foot position during walking. These neuromechanical alterations are linked with altered ankle joint loading in this population. Vibration-based gait retraining improves center of pressure positioning but effects on neuromechanical variables influencing joint loading remains unknown. Do patients with CAI exhibit altered vGRF and ankle joint contact forces (JCF) after receiving a single session of vibration-based gait retraining? Ten individuals with CAI underwent a single session of vibration-based gait retraining. Kinematic and kinetic data were collected during walking on an instrumental treadmill with force plates embedded in it. Following a baseline gait assessment without feedback, participants walked at a self-selected speed for 10 minutes while receiving feedback. Data was collected during an early (1 st and 2 nd minute) and late adaptation phase (9 th and 10 th minute) and, compared to baseline values. Impact and propulsive vGRF variables (i.e. peak, time to peak, and loading rate) were obtained. Musculoskeletal modeling was used to calculate ankle JCF variables (peak, impulse, and loading rate) during stance phase. Propulsive vGRF and ankle JCF outcomes were significantly reduced during the early and late adaptation phases (p ≤ 0.039). These results indicate that vibration-based gait retraining can immediately reduce propulsive vGRF and ankle JCF and may represent a modality that could help restore appropriate ankle joint loading patterns in those with CAI.

Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

BackgroundTo prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI.MethodsA systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach.ResultsSixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture.ConclusionsThis review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

The effects of visual feedback disruption on postural control with chronic ankle instability

ObjectivesThe purpose of this study was to identify the effects of reduced visual feedback via stroboscopic glasses on dynamic postural control among chronic ankle instability (CAI), lateral ankle sprain (LAS) coper and uninjured control participants. DesignControlled trial in a laboratory setting. MethodsTwenty CAI patients, 20 copers, and 20 controls participated in this study. Each participant performed a single-leg hop stabilization test with eyes open (EO) and stroboscopic vision (SV). Two-way ANOVAs (group × condition) were used to examine the differences between group (CAI, coper, and control) and condition (EO and SV). ResultsThere was a significant group by condition interaction for DPSI scores. CAI patients displayed increased DPSI scores with SV compared to EO (p < 0.01), and CAI patients had increased DPSI scores only with SV when compared with controls. All participants displayed decreased dynamic postural control under the SV condition compared to the EO condition (p < 0.01) regardless of ankle group. ConclusionsCAI patients rely more on visual feedback during dynamic postural control than copers and controls. However, they may not be as able to compensate for the disrupted visual feedback during a dynamic task. Regardless of ankle injury history, stroboscopic glasses could be cost-effective visual disruption devices during a dynamic balance task.

Altered Lower Extremity Kinematics During Jump Landing-cutting Following Inversion Perturbation In Chronic Ankle Instability Patients

Altered Lower Extremity Kinematics During Jump Landing-cutting Following Inversion Perturbation In Chronic Ankle Instability Patients

Altered Muscle Activation Patterns During Jump Landing-Cutting Following Inversion Perturbation In Chronic Ankle Instability Patients

Altered Muscle Activation Patterns During Jump Landing-Cutting Following Inversion Perturbation In Chronic Ankle Instability Patients