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Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains. Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis. Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing. Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future. [ABSTRACT FROM AUTHOR]

Introduction: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. Purpose: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. Methods: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18–30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. Results: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*). Conclusion: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) has emerged as a valuable tool for managing complex wounds within the foot and ankle field. This review article discusses the expanding applications of NPWT in this specialized field. Specifically, it discusses the efficacy of NPWT for various wound types, including diabetic foot wounds, traumatic wounds, surgical wounds, and wounds involving exposed bone or soft tissue defects. NPWT demonstrates versatile utility for foot and ankle wound management by promoting healing, potentially reducing the need for secondary surgery, improving diabetic and neuropathic ulcer healing times and outcomes, and optimizing the healing of high-risk incisions. In addition, this review explores the underlying mechanisms through which NPWT might enhance wound healing. By synthesizing current evidence, this review provides a comprehensive overview of the role of NPWT in foot and ankle surgery and offers valuable insights to clinicians navigating the complexities of wound care in this challenging anatomical area. [ABSTRACT FROM AUTHOR]

Context: Ankle sprains are common during sport participation and associated with long-term deficits in self-report of function. However, little is known of short-term changes in self-report of function following injury. The authors aimed to assess statistical and clinically meaningful changes in self-report of function, as measured by the Foot and Ankle Ability Measure (FAAM), during the first 2 weeks after an ankle sprain injury. Design: A retrospective analysis of electronic medical records. Methods: Eighty-eight patients, who were diagnosed with an ankle sprain injury by an athletic trainer, received usual care from an athletic trainer, and completed the FAAM during treatment at weeks 1 and 2 postinjury. The authors calculated the percentage of patients who reported clinically meaningful changes and used Wilcoxon signed-rank tests to compare differences in FAAM scores between time points. Results: Between weeks 1 and 2, significant differences were noted for the FAAM Activities of Daily Living (FAAM-ADL) (P <.001) and FAAM Sport (FAAM-Sport) (P <.001). At the patient level, 86.5% (64/74) and 85.2% (69/81) of patients reported changes that exceeded the minimal clinically important difference value for the FAAM-ADL and FAAM-Sport, respectively, between weeks 1 and 2. At week 2, 31.8% (28/88) and 47.7% (42/88) of patients reported a score below 90% on the FAAM-ADL and below 80% on the FAAM-Sport subscale, respectively. Also, 36.4% (32/88) and 25.0% (22/88) of patients reported a score of 100% on the FAAM-ADL and FAAM-Sport subscales, respectively, at week 2. Conclusions: Patients report statistically significant and meaningful improvements in self-report of function during the first 2 weeks following ankle sprain injury. However, almost half of patients still report deficits in sport function at 2 weeks postinjury. Patient-reported outcome measures such as the FAAM, can help capture the patient's perception of function and inform patient care decisions. Research efforts should explore individual response patterns to treatment. [ABSTRACT FROM AUTHOR]

Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur. The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred. Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle. There were no significant differences in ankle dorsiflexion (DF) (p = 0.62), plantarflexion (PF) (p = 0.23), ground reaction force (GRF), or velocity (p = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (p = 0.046). There were no significant differences in dynamic pain measurements. Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Ankle orthoses are one of the interventions used to prevent first and repeated lateral ankle sprains. We conducted this systematic review of the literature to investigate the effect of ankle orthoses on postural control in individuals with acute, chronic, or functional ankle sprains. Methods: Three electronic databases (Scopus, PubMed,... [ABSTRACT FROM AUTHOR]

Clinical Scenario: A common rehabilitation goal after an acute lateral ankle sprain is the management of swelling. Traditionally, ice, elevation, and compression are used to manage swelling to create an optimal healing environment. It has been proposed that alternative interventions, such as kinesiology therapeutic (KT) tape, could be used to reduce swelling following acute ankle injury. Clinical Question: Is the application of KT tape an effective modality to address swelling after acute lateral ankle sprains? Summary of Key Findings: A systematic search was completed to identify articles that examined the impact of KT tape on swelling after an acute ankle sprain. A total of 206 articles were retrieved. Three articles were identified that compared KT tape with other interventions in the management of swelling due to acute ankle sprain. All 3 included studies had high critical appraisal scores using the Physiotherapy Evidence Database scale. Clinical Bottom Line: The current evidence suggests that KT tape may have comparable effects on swelling to elastic bandages when both were used in combination with nonsteroidal antiinflammatory drugs. However, when compared with a sham intervention or when used in combination with acupuncture, the use of KT tape had no effects on swelling. Together, these findings indicate that KT tape has limited to no clinical utility to reduce swelling following an acute lateral ankle sprain. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy, the clinical bottom line is based on grade B evidence. [ABSTRACT FROM AUTHOR]

The aim was to provide an update on anatomy and function of the medial ankle ligaments, diagnosis of their injuries and treatment of medial ankle instability. Literature search on PubMed. Injuries to the deltoid ligament are not uncommon in relation to malleolar fractures and ankle sprains. Chronic instability may lead to ankle osteoarthritis. However, there is no consensus on diagnostic criteria (clinically, by imaging and by arthroscopy), on indications for non-operative and operative treatment, and on standards for repair and reconstruction of the ligament complex. There is no current evidence to support acute repair of deltoid ligament injury. Reports on the effect of isolated deltoid ligament reconstruction are very sparse. There is a need for a focused effort to establish evidence for all aspects of deltoid ligament injury. [ABSTRACT FROM AUTHOR]

Ankle sprains are one of the most common musculoskeletal injuries. A sprain is defined as the stretching or tearing of ligaments; in the ankle these are the lateral ligamentous complex, deltoid ligament and distal tibiofibular syndesmosis ligaments. The mechanism of injury dictates which ligaments get injured, with the most common being inversion injuries causing anterior talofibular ligamentous sprain. Initial management of an ankle sprain consists of protection, rest, ice, compression and elevation. After the first 72 hours, the treatment depends on the severity of the sprain, with physiotherapy forming the mainstay of treatment in the majority of cases. In addition to strengthening exercises proprioceptive re-training helps with rehabilitation. The goal of treatment is to prevent chronic instability from occurring. Aside from syndesmotic injuries, surgical treatment is rarely required in the acute setting. Delayed ligamentous reconstruction may be required if chronic instability occurs, and is described as being an anatomic or non-anatomical reconstruction. This article reviews the anatomy, pathophysiology, clinical assessment and management of patients with ankle sprains. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that temporary lower-limb immobilisation increases the risk of venous thromboembolism • To recognise the need to assess venous thromboembolism risk in adults with lower-limb immobilisation • To better understand which patients with lower-limb immobilisation should be offered thromboprophylaxis Temporary lower-limb immobilisation following injury is a risk factor for the development of venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism. However, patients are not always risk-assessed for VTE in clinical practice and there is a lack of consensus among healthcare professionals on whether thromboprophylaxis should be offered and to whom. This article uses the fictional case study of a patient with an ankle fracture to explore the literature and guidance on VTE risk assessment and thromboprophylaxis in adults presenting to emergency settings with lower-limb trauma requiring immobilisation. It appears that it is important to consistently risk-assess patients and offer thromboprophylaxis to those deemed at moderate or high risk of VTE, since thromboprophylaxis is safe, efficacious and cost-effective in these patient groups. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical presentation and initial management of patients with deltoid ligament ankle sprains. Design: Retrospective. Setting: Practice-based research network. Participants: Athletic trainers (n = 133) from 52 clinics in 19 states. Independent Variable: Deltoid sprains (October 2009–April 2020). Main Outcome Measurements: Clinical findings (e.g., sport, mechanism of injury, severity, range of motion, tests) and initial management. Results: Deltoid sprains (n = 105) were diagnosed within 3.2 ± 4.1 days of injury, mostly in male secondary school athletes (n = 62/105, 59.0%). Common sports were football (n = 29/94, 30.9%) and basketball (n = 28/94, 29.8%). Common mechanism of injuries were twisting (n = 35/94, 37.2%) and contact (n = 28/94, 29.8%). Sprains were mostly mild (n = 59/94, 62.7%) with mild or no edema (n = 85/96, 85.5%) and effusion (n = 90/96, 93.4%). Active (n = 49/96, 51.0%) and passive range of motion (n = 54/96, 56.3%) were mostly normal, and a median of four (interquartile range = 2–5) tests were used, mostly anterior drawer (n = 74/105, 70.5%) and talar tilt-eversion (n = 74/105, 70.5%). Management involved removal from participation (n = 48/94, 51.1%), treatment by athletic trainers (n = 22/40, 55.0%), and referral to physicians (n = 16/40, 40.0%). Conclusions: Deltoid sprains mostly occurred in males playing football or basketball and were caused by twisting with minimal effusion, edema, and range of motion loss. Given the infrequency of deltoid sprains and difficulty diagnosing them, thorough clinical evaluation is necessary for treatment decisions. [ABSTRACT FROM AUTHOR]

Accessory or anomalous muscles around the ankle are not uncommon and are usually asymptomatic. They are traditionally encountered during imaging undertaken for evaluation of ankle pain. We reported the first case of a new accessory muscle in the anteromedial part of the ankle with associated partial thickness tear in an 18-year-old football player presenting as symptomatic pathology. In this article, we described the role of cross-sectional imaging in its diagnosis including successful management of the condition with ultrasound-guided platelet-rich plasma therapy and review-associated literature. [ABSTRACT FROM AUTHOR]

One of the health issues that many people encounter on a daily basis is bone fracture, which can happen for a number of reasons, such as arthritis, sprains, or external trauma. The patient experiences instability as a result of these issues. Internal fixation is a type of surgery used to support and mend a damaged bone Treatment options include ankle joint fixation, a surgical procedure employing pins, plates, rods, or screws. This study uses gait analysis methods to assess lower limb biomechanics. Gait analysis is vital for understanding walking patterns and intervention effectiveness. The impact of different shoe designs on ankle mechanics, using the finite element method and ANSYS, is investigated the results of the EMG and the GRF were discussed. This research deepens our understanding of lower limb biomechanics and ankle joint health. By evaluating stress effects and designing custom shoes, it enhances ankle injury treatment and management strategies. The patient, a 70-year-old woman with an internal fixation on her ankle joint, underwent a CT scan of her ankle. The patient underwent a number of experiments to evaluate her stability. EMG was used to determine the muscle stress for a brief period of time, and ground reaction force was then used to determine the pressure of walking. Both EMG and GRF have two walking speeds of 1.5 and 2 km/h while wearing four different types of shoes. The behavior of the EMG demonstrates that the stress on the muscle increases as walking speed increases, and the results varies depending on the shoe. The patient is afraid to apply pressure to the injured foot, so the healthy foot has better pressure over the entire, foot. The pressure reaches about 35 N/m2. The EMG of the rocker shoe with more damping has less muscle stress, using archfit and rocker gives the best distribution of GRF. Using a rocker gives the best distribution of pressure. [ABSTRACT FROM AUTHOR]

Context: Mulligan's Mobilization with Movement (MWM) is a common intervention used to address dorsifiexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature. Objective: The aim of this study was to examine the effect of serial MWM application on DFROM . Design: Repeatedmeasures cohort. Setting: A Midwestern University and the surrounding community . Participants: A total of 18 adults (13 females; age = 29 [12.87] y ; DFROM = 30.26° [4.60°]) with decrease dorsifiexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6 months, and no history of foot/ankle surgery. Intervention: Participants completed a single data collection session consisting of 10 individual sets of MWMs. Main Outcome Measures: DFROM was taken at baseline and immediately after each intervention set (post 1,post 2,... post 10) DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point. Results: Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P <.001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P> .417). Conclusions: MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages. [ABSTRACT FROM AUTHOR]

Background: Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility. Aim: To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions. Methods: Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5-0-5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system. Results: In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5-0-5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests. Conclusion: In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Treatment measures for ankle sprains include care recommendations, symptomatic therapy, joint immobilization using bandages and plasters, and reconstructive surgery. Objective The purpose of this study is to compare the therapeutic effect of bandages and plastering in the treatment of ankle sprain. Methods This study was a randomized clinical trial that was conducted on 78 patients who were referred to the Poursina Hospital emergency room with ankle sprains. Patients who needed treatment after being diagnosed with ankle sprain were included in the study. The patients who met the inclusion criteria were divided into two groups A (plaster) and B (bandage) by a simple random method, and 3, 6, and 12 weeks after the start of the treatment, they were examined for the level of pain. Results The results showed that the amount of pain based on the visual analogue scale (VAS) after three and six weeks in the bandage group was lower than in the plaster group and this difference was statistically significant (P<0.001). Ankle-hindfoot scale (AHS) after 3, 6, and 12 weeks had the same average in the two studied groups. The duration of activity restriction in the plaster group was significantly lower than in the bandage group. The treatment results were evaluated in terms of complete recovery, time to return to work and activity, and pain level. Conclusion Plastering treatment reduces the days of activity limitation and patients return to work and daily activities faster. However, plastering has limitations, such as more cost and limiting the movements of the limbs. For a logical conclusion, there is a need for more studies considering all aspects of applying bandage and plastering methods in ankle sprain. [ABSTRACT FROM AUTHOR]

Chronic lesions of the syndesmosis are uncommon and result from insufficient primary treatment. These specific treatment results are limited due to the fact of low case numbers. The interpretation of the available clinical results is therefore to be drawn with care. The majority involved patients with anatomic reconstruction, arthroscopic debridement and screw fixation. Alternative techniques include suture button fixation or arthrodesis. This article summarizes the relevant clinical experiences in treating chronic syndesmosis instability to provide necessary knowledge for practical care. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the burden of knee, hip, and lumbar spine disorders occurring in the year after an ankle sprain and the influence therapeutic exercise (TE) has on this burden. Methods: A total of 33,361 individuals diagnosed with ankle sprain in the Military Health System between 2010 and 2011 were followed for 1 yr. The prevalence of knee, hip, and lumbar care-seeking injuries sustained after sprain was identified. Relationships between demographic groups, ankle sprain type, and use of TE with rate of proximal injuries were evaluated using Cox proportional hazard models to determine hazard rate effect modification by attribute. The observed effect of TE for ankle sprain on rate of injury to proximal joints was evaluated using Kaplan–Meier survival analyses. Results: Of the total cohort, 20.5% (n = 6848) of patients sustained a proximal injury. Specifically, 10.1% of the cohort sustained a knee (n = 3356), 2.9% a hip (n = 973), and 10.3% a lumbar injury (n = 3452). Less than half of the cohort received TE after initial sprain. Patients that did were less likely to have subsequent knee (HR = 0.87, 95% confidence interval [CI] = 0.80–0.94), hip (HR = 0.68, 95% CI = 0.58–0.79), or lumbar (HR = 0.82, 95% CI = 0.76–0.89) injuries. Conclusions: One in five individuals that sought care for an ankle sprain experienced a proximal joint injury in the following year. TE for the management of the initial ankle sprain reduced the likelihood of proximal injury diagnosis and should be considered in treatment plans for return to work and sport protocols after ankle sprains. [ABSTRACT FROM AUTHOR]

With the popularization of biomechanical simulation technology, aiming at the rehabilitation of ankle joint injury, we imported simplified model of proposed 2-UPS/RR (two identical unconstraint kinematic branches with a universal–prismatic–spherical (UPS) structure and two rotating pair (R)) ankle rehabilitation robot into AnyBody Modeling System. Therefore, a human–machine model was established using the HILL-type muscle model and muscle recruitment criteria. This paper investigated the effects of rehabilitation trajectories on biomechanical response during rehabilitation. Additionally, three main lower limb muscles (soleus, peroneal brevis, and extensor digitorum longus) were examined under different rehabilitation trajectories (plantar dorsiflexion, varus or valgus, and compound movement) in the present study. Based on the biomechanical response of lower limbs, the results showed that different muscles had different sensitivities to the change of rehabilitation trajectories. The correlation coefficient between joint force and plantar dorsiflexion angle reached 0.99 (P < 0.01), indicating that the change of joint force was mainly dominated by plantar dorsiflexion/plantar flexion, but also affected by varus or valgus. Safe rehabilitation training can be achieved by controlling the designed 2-UPS/RR rehabilitation robot. The behavior of muscle force and joint force under different rehabilitation trajectories can meet the needs of rehabilitation and treatment of joint diseases, and provide more reasonable suggestions for early rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: To quantify the reduction in wound size and change in wound quality following low-cost topical oxygen therapy (TOT) in patients with acute traumatic musculoskeletal wounds of the foot and ankle. Method: This prospective interventional study included patients with acute traumatic musculoskeletal wounds of the foot and ankle of <3 weeks' duration after they had undergone debridement and required subsequent wound coverage. A sterile C-Arm cover was used to cover the wound and 100% oxygen was administered at 1 atm, at a rate of 10l/min for 90 minutes on each of four consecutive days, through a suction catheter connected to an oxygen cylinder. The cycle was repeated after a three-day break. Wound surface area (by plotting on graph paper) and wound quality (by modified wound infection checklist score and swabs for culture and Gram staining) were assessed before and after TOT application. Results: The study cohort included 20 patients ≥18 years of age. There was a statistically significant (p<0.001) reduction in mean wound surface area from 79.3cm2 at baseline to 69.6cm2 after two cycles of TOT. The mean modified wound infection checklist score was 13.6 and 0.8, respectively, before and after two cycles of TOT, suggesting statistically significant improvement (p=0.02) in wound quality. All patients showed no growth in their wound culture after TOT. Conclusion: TOT appears to be a promising and cost-effective alternative in the management of traumatic wounds. However, future studies with larger sample sizes and control groups for comparison are needed to establish the benefit of TOT in acute traumatic musculoskeletal wounds. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evaluation and management of ankle injuries is routine in traditional clinical settings. However, minimal evidence exists regarding the management of acute musculoskeletal injuries in austere high-altitude wilderness environments. CASE PRESENTATION: The patient was a 36-year-old male who sustained a right lateral ankle sprain climbing down from an elevation of 16 000 ft on Denali, the tallest mountain in North America. The baseline Lower Extremity Functional Scale (LEFS) score was 9/80 and the baseline numeric pain-rating scale (NPRS) score was 9/10. Management included manual therapy, therapeutic exercise, and sport-specific mountaineering interventions. After 3 days, his LEFS score improved to 55/80 and NPRS improved to 4/10. Before subsequent descending of 7000 ft to the base camp, ongoing management including boot fitting and gait training with crampons was provided to safely descend challenging terrain. OUTCOME AND FOLLOW-UP: The patient was able to descend to the base camp under his own control, saving substantial people power after significantly improving his functional level with physical therapist management. During a virtual follow-up visit 2 weeks after the expedition, his LEFS score was 72/80 and his NPRS score was 2/10. All improvements were maintained at 3-month follow-up. DISCUSSION: A physical therapist in an austere wilderness setting was able to effectively manage an ankle injury in a challenging environment with limited resources. Due to the patient's successful outcome, he was able to avoid the cost of a helicopter rescue and save precious national park resources. [ABSTRACT FROM AUTHOR]

Introduction: Basketball players must perform jumps with both feet off the ground in the game, and they frequently land off balance and sustain ankle injuries. Despite the fact that the ankle supports the entire body's weight and has a wide range of motion, it is a frequently injured joint. Objective: In order to prevent recurrent ankle sprains and secondary consequences, the objective of this study is to identify the prevalence, risk factors and preferred treatment for ankle sprains among Maldivian basketball players. Methodology: A questionnaire was provided to the basketball players in the greater Male' region in the Maldives which helped obtain the necessary information to perform the study. Prevalence was analysed by frequency and the significance of risk factors was analysed using the Chi-Square Test on SPSS version 26. Results: In total, 92.7% of the 193 basketball players had an ankle sprain. Age, frequency of playing per week, player's position, and injury mechanism were identified as significant risk factors. Majority of the participants (62.6%) preferred the RICE (Rest, Ice, Compression, Elevation) approach for treating ankle sprains, followed by visits to physiotherapy clinics (14.5%) and hospitals (22.9%). Participants with prior educational experience in injury prevention made up 27.4% of the group. Conclusions: The results revealed a high prevalence of ankle sprains among basketball players from the Maldives Male' region, with age, weekly playing frequency, injury mechanism, and player position serving as important risk factors. This study provides an opportunity to start a conversation amongst athletes, coaches, and medical professionals because the majority of the participants lacked prior knowledge about injury prevention. Future intervention studies can be carried out to lessen the frequency and seriousness of ankle sprains in Maldivian basketball players. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively review and report the outcomes of ankle syndesmotic injury management in elite athletes. Data sources: Three databases were searched for articles reporting the rate of return to sport following treatment of ankle syndesmotic injuries in elite athletes (collegiate or professional level). Ten articles and 440 athletes were included. Articles reporting the rate of return to sport following high ankle sprain injury in elite athletes. Data collected included demographics, type of treatment received, and return to sport (RTS) information. A random effects model was used. Main results: The estimated overall rate of RTS was 99% (95% CI, 95.5-99.9). The mean time to RTS was 38 ± 18 (range, 14-137) days. Of the 440 athletes, 269 (269/440%, 61%) were treated nonoperatively (nonoperative group); the rate of RTS was 99.6%, and the athletes returned at a mean time of 29 ± 14 (range, 13-45) days. A total of 171 athletes (171 of 440%, 39%) underwent surgical treatment (operative group). All (171 of 171%, 100%) athletes returned at a mean time of 50.3 ± 13 (range, 41-137) days. Almost all athletes who underwent surgery had suture button fixation (164 of 171 athletes, 96%), and the mean time to RTS was 7 weeks with 9.1% complication rate. Conclusions: Elite athletes with ankle syndesmosis injury return to sport at an extremely high rates, following operative or nonoperative treatment. Return to the preinjury level of competition should be expected at 4 weeks and 7 weeks in high-level athletes who undergo nonoperative and operative management, respectively. Suture button fixation was used by the majority of studies reporting surgical management of ankle syndesmosis injuries in athletes. [ABSTRACT FROM AUTHOR]

The lateral ankle sprain is one of the most common injuries, especially in competitive sports and recreational activities, and often leads to residual symptoms, such as pain, subjective instability, loss of function, repetitive injury and risk of developing chronic ankle instability. One of the most effective methods of improving the dynamic stabilization and the complex function of the ankle is proprioceptive training. The aim of this report is to present a physiotherapeutic program for functional recovery, with an emphasis on proprioception and balance training, and to evaluate its effectiveness on static and dynamic postural control in patients with lateral ankle sprain. Material and methods: Nine patients (mean age 25,6 years) with grade II lateral ankle sprain, treated non-operatively participated in the study. The specialized physiotherapeutic program included exercises and techniques for reactivation of the fibular muscles, and balance and proprioceptive training, performed on unstable surfaces. The progression was made by moving from non-weight-bearing to weight-bearing position, and by decreasing the base of support from bilateral to unilateral stance on the affected lower limb. Patients were challenged by incorporating trunk perturbations, head, upper and lower extremity movements, as well as functional activities, performed on unstable surfaces. The functional outcome and static and dynamic postural balance control were assessed using static (One-leg stance) and dynamic (Y balance test) balance tests. Results: The baseline One leg stance and Y balance test measures of our patients showed in general diminished static balance and impaired dynamic postural control. The results of the last follow up after 8 weeks of proprioceptive training showed a statistically significant improvement in all the investigated indicators, but a presence of a certain deficit was found in the assessment of both static and dynamic stabilization. In order to achieve optimal functional results, the implementation of specialized proprioceptive training should continue until the functional deficit is completely overcome. Conclusion: Early inclusion of a specialized individualized physiotherapy and training of the proprioception and dynamic stabilization could successfully reduce the deficit in neuromuscular control and static and dynamic balance. The proprioceptive training should start as early as possible, should be individualized according to functional limitations and arthrokinematic changes of the whole kinetic chain of the injured lower limb and patients’ capabilities, and designed to provide successful return to previous functional level of activity and participation in recreational and sports activities. [ABSTRACT FROM AUTHOR]

Various syndesmotic fixation methods in ankle injury are recommended; however, a lack of biomechanical information persists regarding the stiffness of the fixation methods. The current study thus aimed to assess biomechanical cadaveric validation and perform a finite element analysis of syndesmotic fixation comparing endobutton vs. screw after syndesmotic injury with an ankle fracture. Five pairs of ankles of fresh cadavers were used for the validity test for Anterior Inferior Tibiofibular Ligament (AITFL), Posterior Inferior Tibiofibular Ligament (PITFL), and Interosseous ligament biomechanics properties. Four finite element models (FEM) were created: an intact model, a fracture model with/without syndesmotic injury, an endobutton fixation model, and a syndesmotic screw fixation model. Each FEM was tested vis-à-vis external rotation force, anteroposterior translation force, and compression force until model failure. The primary outcomes were stiffness and force until failure. The respective anteroposterior translation force for the stiffness of the intact model, the screw fixation model, and the endobutton fixation was 8.14, 9.15, and 8.17 N/mm. The respective external rotation force for the stiffness of intact, screw fixation, and endobutton model was 0.927,0.949, and 0.940 Nm/degree. The respective stress under compression force in the intact, screw fixation, and endobutton model was 39.94,25.59, and 37.30 MPa. Both screw and endobutton fixation models provided more translation, compression, and rotation stability than normal syndesmosis, but the screw model provided greater translation and compression force stability than the endobutton model. There was no difference in rotational stability between the two models. We thus recommend the same rehabilitation protocol for both fixation methods; however, vigorous translation and compression should be avoided when using endobutton fixation. [ABSTRACT FROM AUTHOR]

Background: A lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population. It is uncertain what percentage of these patients develop persisting symptoms including pain, recurrent sprains and subjective instability. This systematic review was conducted to assess the presence and duration of persistent symptoms after a first LAS.Methods: A systematic review of the Medline, Web of Sciences, Embase, CINAHL and Pedro databases was performed to identify peer-reviewed articles concerning the occurrence and duration of remaining symptoms after a first LAS. Inclusion criteria focused on selection of patients without previous ankle injuries and study quality. One of the following outcomes had to be described: subjective instability, resprains, remaining symptoms.Results: In total, 15 studies were included. The occurrence of patients with subjective instability decreased from 37.9% (95%CI [6.0-69.7]) at 3 months to 16.1% (95%CI [7.8-24.3]) at 6 months and 8.1% (95%CI [3.3-13.3]) at 12 months. The occurrence of patients with a recurrent LAS was 15.8% (95%CI [6.3-25.3]) at 12 months. The occurrence of patients with residual pain decreased from 48.6% (95%CI [23.6-73.5]) at 3 months, to 21.5% (95%CI [2.8-40.2]) at 6 months and 6.7% (95%CI [3.2-10.1]) at 12 months.Conclusion: This study offers new insights in the presence of remaining symptoms after a first LAS and the development of chronic ankle instability. Twelve months following an initial LAS, a significant number of patients may still have symptoms. The incidence of subjective instability, and pain, continues to decrease until 12 months post-injury. This new information may suggest that a longer period of non-operative treatment may be warranted before recommending surgical intervention in patients with a first LAS. [ABSTRACT FROM AUTHOR]

Background & Aims: Following a serious injury, microtrauma and as a result of microscopic damage in joint surfaces, pain disorders in the skeletal and muscular system develop over time. Pain in the musculoskeletal system, in addition to injury, causes secretion and fatigue in the pastoral structure, which leads to disruption of the neuromuscular system. Although the foot is the last part of the lower limb chain and resists the incoming forces, it is expected to cause movement pathology, pathokinesiology and increased stress and thus injury due to improper distribution of forces. It reaches the tissues and muscles of the leg, and as a result, the risk of joint pain increases. In futsal, which is one of the vulnerable sports, most of the injuries of the lower limbs are assigned to the wrist and knee, According to the report of the National Association of American Sports Science Colleges, ankle injuries compared to other body joints in disciplines such as; It has basketball, volleyball, futsal, etc. Ankle pain can be caused by aspirin, instability, arthritis, gout, tendonitis, fracture, nerve compression and infection in this joint. In this popular field, due to the fact that players have to withdraw from this sport due to pain and injury in their basic ages, and as a result, talents are not lost, attention was paid to movement sciences and rehabilitation. Familiarity with biomechanical principles in injury or disease is a very important part of air and treatment activity. If we can provide a targeted ability in ankle pain and evaluate and perform the tasks they do in static and dynamic conditions, it will allow athletes and even non-athletes to return to sports faster and more confidently. And they do everyday, was a witness The first step in this field is to know the rehabilitation method that optimally minimizes the frequency of pain and re-injury. As a result, biomechanical principles and evaluations become reliable in treatment and help to increase better performance. Research shows that mechanical proprioception movements with ultrasound supplements improve and increase neuromuscular function and balance of the plantar pressure center, as well as a significant reduction in pain, in the same direction, from existing changes and the degree of impact on foot posture or position. in which the patient is located, by using biomechanical evaluations in the initial or final stages of the rehabilitation period, it helps the treatment to increase the effectiveness of the methods used with higher validity and to use better methods with higher effectiveness. take. Take, Therapeutic strategies to prevent and increase the return to daily and sports activities include: external supporters, manual therapy, and deep sensory exercises, which generally divide rehabilitation into two types, mechanical and physical. Studies have shown that deep sensory exercises and orthoses and tapings reduce the amount of damage by 50%. In addition, the postural changes or the condition in which the patient or the injured person is located, recovery during the rehabilitation phase helps the specialists to take appropriate actions to have a better effect. In the meantime, examining the amount of electrical muscle activity and the pressures on the person in the biomechanical analysis of the person will give valuable information about treatment and rehabilitation strategies. According to the available documents, foot and ankle problems even cause pain in the upper limb areas such as the back due to its effects on the posture and the way the forces interact in walking over time. Considering the increasing trend of basic ages in futsal, in order to avoid re-injury or to prevent it, it is necessary to take preventive measures. In this approach, the use of proprioception exercises and the use of ultrasound waves on the injured area of the ankle have a significant effect on the walking process, the sense of the position of the ankle joint, and the function of the muscles around the joint. Failure to use proprioception exercises reduces performance and ankle sprains, which is the result of instability followed by chronic ankle pain. is looking for To get a better result, the use of ultrasound therapy modality by applying a length of heat in the ankle along with deep sensory exercises will be useful in controlling and improving the function of the device and foot posture. In rehabilitation planning, understanding the mechanism of applied forces will help professionals to provide the appropriate protocol to increase the function of the device and joints. Because a period of rehabilitation before and after the changes in the posture or the condition in which the patient or athlete is located, can have a great help in the therapeutic methods of care and treatment of its effectiveness in the treatment protocol. it shows. In most cases, in the field of rehabilitation, the therapist is unwilling and according to the conditions of the teams and the pressure of the coaches and sports managers upon the player's return, he trains and competes with the speed of action of the fields. But this athlete's return is mostly temporary and causes joint injuries and choices in the future. Therefore, in the evaluations and screenings at the beginning and end of the season, as in the field of football, in this field as well, the amount of injuries can be minimized by taking into account clinical evaluation tests. In this study, our aim was to investigate the effects of deep sensory training with ultrasound therapy on the chronic ankle pain of young players along with the evaluation of the center of pressure and the changes in the activities of the 2 specialized muscles, tibialis anterior and peroneus longus during walking, in response to changes in their activity can help people with ankle injuries. Methods: The statistical sample of this study included 24 people (12 people in the experimental group and 12 people in the control group). Pain intensity in both groups was assessed through the standard Visual analogue scale form, which is characterized by a pain scale of 1 to 10, and the selection criterion was a score of 7 (high pain intensity). Also, for analysis and evaluation of electrical muscle function by electromyography system of anterior tibialis and peroneus longus muscles, subjects of both groups were recorded using UK Biometrics system in stance phase in 14-meter path of both groups (pre-test). The experimental group then received a deep sensory training protocol with 3 MHz ultrasound for three weeks. The control group performed its normal activities during this period. After the treatment period, both groups re-tested and checked the pain and recorded the electrical activity of the muscles as a pre-test (post-test). For statistical analysis, correlated T-test was used for intra-group comparison and independent for inter-group comparison (p<0.05). Results: The results showed a significant difference only in the activity of Peroneus longus muscle in comparison with pre- and post-test of the experimental group. Also, a significant difference in the amount of pain in the experimental group before and after rehabilitation interventions was observed in the comparison within the group. Conclusion: Based on the results of this study, it can be mentioned that the use of deep sensory exercises with ultrasound waves as an effective method in the rehabilitation of the musculoskeletal system in chronic pain can be used by physiotherapists and other sports rehabilitation specialists. Because its effectiveness was effective in reducing the amount of pain and normal function of selected muscles in static and dynamic positions (walking). [ABSTRACT FROM AUTHOR]

What are the effects of the Mulligan Concept™ posterior fibular mobilization with movement (MWM) on clinical outcomes in patients who sustain an acute lateral ankle sprain (LAS)? The evidence reviewed was level C–Recommendation based on "consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention or screening." In the studies examined, patients who received Mulligan Concept™ posterior fibular mobilizations in combination with other treatments significantly improved (Minimal Clinically Important Difference met) on the Numeric Rating Scale (NRS) and Disablement of Physically Active (DPA) scale. All patients in the studies were discharged within 2-18 days. However, due to the low level of evidence and the use of traditional conservative treatments in conjunction with mobilization, it is difficult to ascertain whether the Mulligan LAS treatment aided recovery more than traditional methods of treating acute LAS. Therefore, Mulligan Concept™ posterior fibular MWM may be useful clinically in conjunction with traditional conservative treatments for reduction of pain, disability and discharge time for patients with acute LAS, but future research must be conducted to determine if MWMs offer any benefits above and beyond traditional methods of treatment. [ABSTRACT FROM AUTHOR]

Distance runners represent a unique patient population. The cyclic activity associated with distance running leads to a high incidence of injury. Gait patterns, the extrinsic and intrinsic muscles of the foot and ankle, foot strike pattern, shoe wear considerations, alignment, and orthotics are also all important considerations that must be considered by the treating provider. The purpose of this work is to review relevant functional anatomy, recent studies on gait patterns in running, orthotics, and theory on how the body moves through space during running in order to better equip the clinician to treat long distance runners. [ABSTRACT FROM AUTHOR]

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries. [ABSTRACT FROM AUTHOR]

Background: Isolated pediatric lateral ankle injuries, including ankle sprain (AS) and nondisplaced Salter-Harris type 1 (SH-1) distal fibular fracture, are common orthopaedic sports-related injuries. Variability in treatment is suspected among pediatric orthopaedic surgeons. Complications from medical treatment or lack thereof have not been reported in this population. Purpose: The purpose of this study was to investigate treatment variability and associated complications after pediatric AS and SH-1 via a survey of members of the Pediatric Orthopaedic Society of North American (POSNA). Study Design: Cross-sectional study. Level of evidence, 5. Methods: A voluntary, anonymous survey was distributed to POSNA membership (approximately 1400 members) via email. Survey questions, specific to both grade 1 or 2 AS and nondisplaced or minimally displaced SH-1 injuries in skeletally immature patients, focused on initial evaluation, immobilization, return to sports, and complications. We analyzed variability both in treatment between AS and SH-1 injury and in respondent characteristics. For statistical analysis, chi-square or Fisher exact test was used for categorical variables, and analysis of variance was used for continuous variables. Results: The survey response rate was 16.4% (229/1400). Of the respondents, 27.7% used examination only to distinguish between AS and SH-1, whereas 18.7% performed serial radiography to aid with diagnosis. A controlled ankle motion boot or walking boot was the most common immobilization technique for both AS (46.3%) and SH-1 (55.6%); the second most common technique was bracing in AS (33.5%) and casting in SH-1 (34.7%). Approximately one-third of all respondents recommended either outpatient or home physical therapy for AS, whereas only 11.4% recommended physical therapy for SH-1 (P <.01). Results showed that 81.2% of respondents reported no complications for SH-1 treatment and 87.8% reported no complications for AS treatment. Cast complications were reported by 9.6% for SH-1 and 5.2% for AS. Rare SH-1 complications included distal fibular growth arrest, infection, nonunion, late fracture displacement, and recurrent fracture. Conclusion: Significant variability was found in primary treatment of pediatric AS and SH-1 injuries. Rare complications from injury, treatment, and neglected treatment after SH-1 and AS were reported. [ABSTRACT FROM AUTHOR]

Context: While the incidence and reinjury rates of lateral ankle sprain (LAS) continue to persist at high rates across many sporting activities, further exploration of assessment and treatment beyond the traditional ligamentous and strength/proprioceptive model is warranted. Further, assessing and treating both arthrokinematic and osteokinematic changes associated with LAS can provide insight into a more diverse approach to treating ankle pathology. Objective: To examine the clinical use of the Mulligan Concept mobilization with movement (MWM) while treating patients diagnosed with an acute grade I or II LAS through authentic patient care. Design: An a priori case series. Setting: Intercollegiate athletic training clinic. Patients: Intercollegiate patients diagnosed with an acute grade I or II LAS. Intervention: The Mulligan Concept distal fibular anterior to posterior MWM. Main Outcome Measures: Pain-Intensity Numeric Rating Scale (NRS) with Non-Weight Bearing (NRS-NWB) and Weight Bearing (NRS-WB), Disablement of the Physically Active Scale (DPA-scale), Foot and Ankle Ability Measure (FAAM) with Activity of Daily living (FAMM-ADL) and Sport (FAAM-Sport), Client Specific Impairment Measure (CSIM), Y-Balance Composite (YBC), and Weight Bearing Measure for Dorsiflexion (WBDF). Results: Patients who are diagnosed with an acute grade I or II LAS and are treated with the Mulligan Concept report immediate and long-lasting minimal clinically important differences in patient outcome measures. Conclusion: Clinicians who examine and use the Mulligan Concept MWM to treat acute LAS can expect immediate positive results that are progressively retained over time specific to patient-centered outcome measures as well as functional clinician-based measures. Based on the immediate and positive results, clinicians should examine associated osteokinematic and arthrokinematic changes beyond that of the traditional ligamentous model. [ABSTRACT FROM AUTHOR]

Case Series Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping. Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed. All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3–8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1–8 weeks). A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings. Therapy, 4 [ABSTRACT FROM AUTHOR]

The article provides information on various research, cases, and proposals of interest to physical and massage therapists in 2022. Topics discussed include an American College of Rheumatology study of the clinical effect of end-range Maitland mobilization in the management of knee osteoarthritis, research on adductor muscle injuries among Union of European Football Associations (UEFA) soccer athletes, and a proposal for the classification of the coracobrachialis longus.

Objective: In a pragmatic and randomized clinical trial, patients with lateral ankle sprains were assessed, under blinded conditions, for their responsiveness and improvements during Mulligan mobilization-with-movement (MWM) therapy. Methods: Overall, 51 participants with subacute lateral ankle sprains (Grade I–II) were recruited. Following an MWM screening procedure, responders were randomized to either an intervention group (MWM) or a sham group. The MWM group received inferior tibiofibular, talocrural, or cubometatarsal MWM. The treatment or sham was administered upon three sessions, each 4 days apart. Changes from baseline were measured and compared between the sessions for dorsiflexion range of motion, pain, stiffness perception, and the Y-balance test. Results: In total, 43 participants were considered responders to MWM. Using a two-way repeated-measure ANOVA, a statistical and clinically meaningful improvement in dorsiflexion range of motion was revealed in the MWM group (p = 0.004, 1rst = +1.762 cm; 3rd = +2.714 cm), whereas no improvement following the first session occurred in the sham group (p = 0.454, 1rsttrial = +1.091 cm; 3rdtrial = +1.409 cm). Pain and stiffness significantly improved, yet below the clinically meaningful level. The MWM group demonstrated a significant improvement after three sessions for the Y-balance test (p = 0.001, +8.857 cm). Conclusion: More than 80% of participants with subacute lateral ankle sprains responded well to the MWM approach. Three sessions of pragmatically determined MWM provided a significant and clinically meaningful benefit in dorsiflexion range of motion and Y-balance test performance compared to a sham treatment. [ABSTRACT FROM AUTHOR]

This article discusses the management of lower limb soft tissue injuries in athletes, in particular high ankle sprains and anterior cruciate ligament (ACL) tears, that commonly present to the ED, to provide insight from my perspective with regards to common difficulties and current best practice. A similar approach can be applied to many other soft tissue injuries seen in ED.

We analysed the effects of an experimental novel protocol of intensive hydrotherapy with hydrogen-rich water (HRW) on injury recovery in athletic men who suffered an acute ankle sprain (AAS) and compared it with a RICE protocol (rest, ice, compression, elevation). Professional athletes (age 23.7 ± 4.0 years; weight 78.6 ± 5.7 kg, height 182.5 ± 4.3 cm; professional experience 5.9 ± 3.9 years) who incurred AAS during a sport-related activity were randomly assigned immediately after the injury to either hydrogen group (n = 9) or a conventional RICE treatment group (n = 9). Hydrogen group received six 30-min ankle baths with HRW throughout the first 24 h post-injury, with hydrotherapy administered every 4 hours during the intervention period. RICE group stood off the injured leg, with ice packs administered for 20 min every 3 hours, with the injured ankle compressed with an elastic bandage for 24 hours and elevated at all possible times above the level of the heart. HRW was equivalent to RICE protocol to reduce ankle swelling (2.1 ± 0.9% vs. 1.6 ± 0.8%; P = 0.26), range of motion (2.4 ± 1.3 cm vs. 2.7 ± 0.8 cm; P = 0.60), and single-leg balance with eyes opened (18.4 ± 8.2 sec vs. 10.7 ± 8.0 sec; P = 0.06) and closed (5.6 ± 8.4 sec vs. 3.9 ± 4.2 sec; P = 0.59). This non-inferiority pilot trial supports the use of HRW as an effective choice in AAS management. However, more studies are needed to corroborate these findings in other soft tissue injuries. [ABSTRACT FROM AUTHOR]

Objective: To explore the mechanism of the action of Huoxue Huayu Lishui prescription on acute ankle joint injury. Methods: Forty-eight SPF rats were randomly divided into blank group, model group, Shujin Huoluo capsule group, low, medium and high dose groups for promoting blood circulation and removing blood stasis. The blank group was not modeled, and the other groups were modeled. Each group of 8 animals, the Shujin Huoluo capsule group was given 0.2g/ml mixed liquid by gavage, and the low, medium and high blood circulation and blood stasis Lishui prescription group was given 1.03g/ml, 2.06g/ml, 4.12g/ml decoction For the stomach, the normal group was given 1.5ml/100g, once a day for 1 week. The expression of NF-κB P65 and transforming growth factor kinase 1 (TAK1) protein in the soft tissue around the ankle joint of rats was detected by sports protein immunoblotting method, and the mRNA expression of NF-κB P65 and TAK1 was detected by PCR technology. Results: One day after modeling, the expressions of P65 and TAK1 mRNA and protein in the model group, the positive drug group, and low, medium and high doses of Huoxue Huayu Lishui Recipe were significantly different from those of the blank control group (P<0.05). After taking the medicine for 7 days, compared with the model group, the expressions of P65 and TAK1 mRNA and protein in the Shujin Huoluo capsule group and the low, medium and high dose Huoxue Huayu Lishui Recipe group were all decreased (P<0.05). After 7 days of taking the medicine, compared with the Shujin Huoxue Capsule group, there was no difference in P65 protein in the low-dose Huoxue Huayu Lishui Recipe group. The expression of P65 protein in the middle and high groups and the Shujin Huoxue Capsule group were all decreased (P<0.05). Compared with the Shujin Huoxue Capsule group, the expressions of TAK1 protein, P65 and TAK1 mRNA in the low, medium, and high groups and the Shujin Huoxue Capsule group were all decreased (P<0.05). The results suggest that Huoxue Huayu Lishui Recipe can inhibit the expression of NF-κB P65 and TAK1 protein in ankle joint injury. Conclusion: Huoxue Huayu Lishui prescription may regulate the expression of NF-κB P65 and TAK1 in ankle joint injury of NF-κB rats, so as to improve the clinical symptoms of local swelling and pain in the ankle joint. [ABSTRACT FROM AUTHOR]

Background. About 1/3 of tibial plateau fractures are associated with proximal fibula fractures, but most proximal fibula fractures are often ignored. The aim of this study was to precisely explain the classification and treatment strategies of six injury types of the fibular column associated with tibial plateau fractures. Methods. Patients with ipsilateral proximal fibula and tibial plateau fractures treated in our hospital were retrospectively reviewed from Aug 2007 to Mar 2020. Two experienced surgeons and two radiologists divided fibular column injury into 6 injury types according to the AO classification and four-column nine-segment classification. The treatment scheme (surgically treated or conservatively treated) was also recorded. Results. In total, 355 proximal fibula fractures were included. Type 2 fibular head fracture was the most common type of injury in 122, and the segregate of superior tibiofibular syndesmosis was the rarest type in 3. In avulsion injury proximal of fibular pattern, the proportion of patients who need surgical intervention is the highest. Conclusions. Six injury types in the four-column nine-segment classification covered all types of bony and soft tissue injuries of the fibular column and concisely explained the injury mechanism. The classification is helpful for the precise judgement and decision-making of the concomitant fibular column injuries in tibial plateau fractures. [ABSTRACT FROM AUTHOR]

Ankle sprains are common occurrences in athletic and general populations. High volumes of ankle sprains elevate the clinical burden on athletic trainers (ATs). The National Athletic Trainers' Association (NATA) published a position statement regarding the treatment and management of ankle sprains, but certain factors might affect an AT's ability to effectively implement the recommendations. To evaluate ATs' current understanding, perceptions, and difficulties regarding the treatment, management, and long-term effects of ankle sprains. Cross-sectional study. Online survey instrument. A total of 796 ATs (years certified = 12.1 ± 9.2) across all athletic training job settings. Participants completed a 38-question survey that addressed their demographic characteristics, as well as their perceptions and knowledge of the epidemiology, treatment, and management of ankle sprains. The survey was also used to document participants' patient education practices and attitudes toward the NATA position statement regarding ankle sprains, along with the challenges of and pressures against implementation. Descriptive statistics, correlations, and analyses of variance were used to analyze the data and evaluate group differences and relationships. Of the participants, 83% demonstrated a moderate understanding of fundamental ankle sprain epidemiology. Group differences regarding patient education were seen by education levels, years certified, and job setting. Overall, 38.1% of ATs were either unsure or unaware of the NATA position statement, but those who were aware rated its usefulness at 3.89 on a scale of 1 to 5, with 1 being not useful at all; 3, neutral; and 5, very useful. On average, 1.9 ± 0.88 challenges to implementing effective treatment practices were documented, and 2.0 ± 0.95 pressures to return athletes to play after ankle sprain were reported. Nearly 40% of the ATs were either unaware or unsure of the current recommendations regarding how patients with ankle sprains are treated, which could affect how care is delivered. [ABSTRACT FROM AUTHOR]

• Experimental research involving patients with ankle sprain is largely unregistered. • Most conclusions of treatment effectiveness are based solely on statistical significance. • Just 9% of statistically significant findings compare favorably to key measures of minimum clinical importance. • There is a high risk of false-positive discovery in a core field of musculoskeletal research. Lateral ankle sprain is the most common musculoskeletal injury. Although clinical research in this field is growing, there is a broader concern that clinical trial outcomes are often false and fail to translate into patient benefits. We audited 30 years of experimental research related to lateral ankle sprain management (n = 74 randomized controlled trials) to determine if reports of treatment effectiveness could be validated beyond statistical certainty. A total of 77% of trials reported positive treatment effects, but there was a high risk of false discovery. Most trials were unregistered and relied solely on statistical significance, or lack of statistical significance, rather than on interpreting key measures of minimum clinical importance (e.g., minimal detectable change, minimal clinically important difference). Future clinical trials must adopt higher standards of reporting and data interpretation. This includes consideration of the ethical responsibility to preregister their research and interpretation of clinical outcomes beyond statistical significance. [Display omitted] [ABSTRACT FROM AUTHOR]

Clinical Scenario: Ankle sprains account for roughly 10% of sport-related injuries in the active population. The majority of these injuries occur from excessive ankle inversion, leading to lateral ligamentous injury. In addition to pain and swelling, limitations in ankle range of motion (ROM) and self-reported function are common findings. These limitations are thought to be due in part to loss of mobility in the talocrural joint. Accordingly, some investigators have reported using high-velocity, low-amplitude thrust-manipulation techniques directed at the talocrural joint to address deficits in dorsiflexion (DF) ROM and function. This review was conducted to ascertain the impact of talocrural joint-thrust manipulation (TJM) on DF ROM, selfreported function, and pain in patients with a history of ankle sprain. Focused Clinical Question: In patients with a history of inversion ankle sprain, does TJM improve outcomes in DF ROM. self-reported function, and/or pain? [ABSTRACT FROM AUTHOR]

Objective Distal fibular mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques. Methods In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3/wk within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation, edema draining massage, and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure and Patient Global Impression of Improvement Scale were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength. Results MWM and MWMtape were equally effective and participants demonstrated greater function on the Foot and Ankle Ability Measure at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for Patient Global Impression of Improvement Scale or any of the secondary outcomes. Conclusion There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibular MWM is most effective to achieve activities of daily living and sport function when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit. Impact Distal fibular mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long-term activities of daily living and sport function. In the short term, anteroposterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibular mobilization with movement. [ABSTRACT FROM AUTHOR]

Athletic preinjury function is typically determined via subjective recall; however, obtaining preinjury function before injury occurs should be attempted in order to establish an individual baseline for postinjury comparison. The purpose of this study was to obtain preinjury baseline values for the Foot and Ankle Disability Index (FADI) and Foot and Ankle Disability Index sport version (FADISP), single-leg hop for distance, and Star Excursion Balance Test anterior reach and determine if athletes returned to those values following ankle injury. Out of 41 qualifying injuries, FADI/FADISP scores were significantly reduced at initial injury compared with baseline and all other time points (p <.001) but recovered by discharge. Single-leg hop and Star Excursion Balance Test recovered to baseline values by the discharge time point (p ≥.98). Subjective and objective preinjury function can be reestablished by discharge from supervised treatment following low-grade ankle injury and maintained for at least 6 months following the cessation of treatment. However, testing metrics should be reviewed on an individual athlete basis, because group data may mask individual patient needs. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effects of unilateral and bilateral ankle stabilization surgery with or without additional concurrent procedures for other pathologies on return to activity in patients who were allowed unrestricted weight bearing postoperatively. Methods: Ninety-three athletes underwent 120 ankle stabilization surgeries including 27 that underwent bilateral simultaneous surgery using the all-inside arthroscopy-modified lasso-loop technique and were divided into two groups: arthroscopic ligament repair alone without concurrent procedures (group A) and with simultaneous procedures for other pathologies (group B). Group A was further subdivided into unilateral (group A1) and simultaneous bilateral ankle surgery (group A2), and group B into ankle stabilization surgery with simultaneous procedures not requiring weight bearing postoperatively (Group B1) and with concurrent procedures allowing weight bearing (Group B2). Return to activity postoperatively was assessed by recording the time to walk without any support, jog, and return to full athletic activities. Clinical outcomes were assessed preoperatively and 12 months postoperatively using a subjective clinical score. Results: The average time between surgery and unsupported walk, jog, and return to full athletic activities was 1.6 ± 2.5, 16.9 ± 3.7, and 42.4 ± 19.3 days in group A, 17.2 ± 19.6, 34.5 ± 20.8, and 60.9 ± 22.8 days in group B, 1.7 ± 2.9, 16.1 ± 2.4, and 41.6 ± 18.2 days in group A1, 1.3 ± 0.6, 18.9 ± 5.5, and 44.6 ± 22.5 days in group A2, 25.3 ± 20.2, 43.3 ± 21.1, and 70.7 ± 23.1 days in group B1, and 4.8 ± 11.7, 20.7 ± 11.7, and 45.0 ± 13.7 days in group B2, respectively. These results indicate that the patients in group B2 showed a statistically significant faster time to return to activity than did those restricted from weight bearing. Differences in ankle stabilization alone between patients in groups A1 and A2 as well as groups B2 and A were not statistically significant. Clinical outcomes were similar for patients in groups B2 and A1 versus group A2. Conclusion: Time to return to activity and clinical outcomes after ankle stabilization surgery using the modified lasso-loop technique were negatively affected if simultaneous bilateral surgery or simultaneous concurrent procedures were added or if weight bearing was unrestricted. However, a delay in return to athletic activity was observed when ankle stabilization surgery was performed using the modified lasso-loop technique with concurrent procedures that require non-weight bearing postoperatively. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies regarding chronic syndesmosis injury remain unclear. Purpose: An international group of experts representing the fields of sports injuries in the foot and ankle area were invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injuries. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). Study Design: Consensus statement. Methods: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 15 clinical questions and statements were related to the clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies for chronic syndesmosis injury and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: Of the 15 questions and statements, 5 reached unanimous support and 10 achieved strong consensus. Conclusion: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with diagnosis, classification, and nonoperative treatment strategies for chronic syndesmosis injury. [ABSTRACT FROM AUTHOR]

This study compared the modification of musculoarticular stiffness (MAS) and clinical outcomes after mobilization with movement (MWM) on the inferior tibiofibular joint and a placebo MWM. Moreover, injured and non-injured ankle MAS were compared after MWM therapy. A single-blinded randomized trial was conducted on 75 participants (mean age: 22.3 ± 2.17 years) with chronic self-reported asymmetric perception of ankle dorsiflexion stiffness. Participants were allocated to one of three groups: inferior tibiofibular MWM (ITFMWM), placebo and non-injured. Sinusoidal oscillation methods were used for experimental quantification of the MAS and clinical outcomes were assessed using the weight-bearing lunge test (WBLT), pain and stiffness perception. Three assessments were made: one pre-treatment (T0), one after the manual technique (T1) and one after taping (T2). Two-way ANOVA showed no significant differences between the groups and no interaction effect for the outcome measures. However, a significant difference for the time effect (T0-T1-T2) was found in the three groups for WBLT dorsiflexion range of motion (p < 0.001, Cohen's d = 0.21) and stiffness perception (p < 0.001, Cohen's d = 0.54) but the minimal clinically important differences were not reached for either value. The results could not support that a single session of ITFMWM modifies MAS or the clinical outcomes compared to placebo treatment. Furthermore, injured MAS does not differ from non-injured MAS in chronic ankle dorsiflexion stiffness. Further studies should assess subjects' responsiveness concerning the Mulligan concept and focus on a medium- to long-term follow-up. [ABSTRACT FROM AUTHOR]