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This month’s update is by the core editorial team based out of the EMERGING research group from Manchester. We used a multimodal search strategy, drawing on free open access medical education resources and literature searches.1 We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as follows: ### Topic: Fractures ### Rating: Head turner ‘Broken-bone’ research almost feels antiquated in the pandemic era; however, here is an emergency medicine study reminding us of the good old days! The title is a giveaway, but briefly this is multicentre (20 UK trauma units), superiority, randomised controlled trial recruiting patients with ankle fractures that clinicians would opt to place in a 3-week cast2. The standard arm comprised a below-knee cast plus ankle exercises (once cast removed); the intervention arm comprised a removable brace plus verbal/written encouragement to undertake ankle exercises as soon/often as pain allowed. Following an intention-to-treat analysis, the primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 16 weeks. Planned secondary outcomes were complications, resource-use, quality-of-life measures and functional scores. Six hundred sixty-nine randomised patients were included. The headline result was no statistically significant difference in the OMAS at 16 weeks (mean difference 1.8, 95% CI −2.0 to 5.6). While the study was not powered for the secondary outcomes, among the subgroup who ultimately had operative management, more patients in the brace group had wound infection/breakdown. No difference was found in the resource usage. On the face of it, this study suggests that brace versus cast …

Background: In recent years, a three-dimensional ankle exercise has been proposed as a practice for strengthening the intrinsic foot muscles, however this topic still requires further research. This study aimed to compare the activities of the intrinsic muscles in healthy participants during 3D foot&ndash, ankle exercises, namely, short foot (SF), and toe spread out (TSO). Methods: Prior to the experiment, 16 healthy adults were trained on how to perform SF, TSO, and 3D foot&ndash, ankle exercises for an hour. Once all participants passed the foot&ndash, ankle exercise performance test, we randomly measured the activity of the intrinsic foot muscles using electromyography while the patients were performing foot&ndash, ankle exercises. Results: The abductor hallucis (AbH), extensor hallucis longus (EHL), and flexor hallucis brevis (FHB) activities showed significant differences among the exercises for intrinsic foot muscle strengthening (p &lt, 0.01). Additionally, the AbH/AdH (adductor hallucis) ratio showed significant differences among the exercises for strengthening the intrinsic foot muscles (p &lt, 0.01). Conclusions: Our results showed that the 3D extension exercise is as effective as the therapeutic exercise in terms of the AbH and FHB activities, and the AbH/AdH ratio. On the contrary, the 3D flexion exercise showed superiority in terms of the EHL activity.

The purpose of this study was to assess the effects of Ankle exercise on balance ability of stroke patients. Participants' balance ability were measured prior to the training and they conducted ankle exercise. As for ankle exercises, ankle stretching training and ankle muscle strengthening training ...

Objective: The aim of this study was to compare the effectiveness of ankle exercises on balance vs. ankle exercises with visual feedback on balance in stroke subjects. Subjects and Methods: In this study, 30 stroke patients were randomly and equally assigned. They performed ankle exercises for 1 h, five times per week for three weeks. The patients balance ability was measured using Berg Balance Scale (BBS), Timed Up and Go test (TUG) before and after the exercises to compare the effect of ankle exercises. The Stroke Specific Quality of Life (SSQOL) was also used before and after the exercises. Results: In this study the between group mean difference of BBS was 4 ± 3.82, the between group mean difference of TUG was 3.2 ± 0.72 and between group mean difference of SSQOL was 7.8 ± 2.22. The Baseline comparability was analysed using independent t-test and level of significance is p

Background: The largest percentage of injuries in basketball affect the lower limbs, specially the ankle joint, and this is the major cause of missed days of training during a season. Moreover, ankle injuries can increase the risk factor of recurrent injuries. Objectives: To determine whether a training program, based on specific ankle exercises for basketball, causes a change in the dynamic stability of a healthy group of basketball players, using the Star Excursion Balance Test (SEBT). Also, to determine the ideal number of repetitions to obtain a reliable measure of the test. Materials and methods: Experimental study. Seventeen uninjured basketball players participated (8 experimental [EG], 9 control [CG]) (EG = 15.12 yrs ± 0.83 yrs; CG = 14.67 yrs ± 1.0 yrs).The EG performed the training program during the warm-up, and the CG completed the regular warm-up. The SEBT was performed before and after the 6-week training program. In statistical analysis MANOVA 2 * 2 was used per group and time. Results: Only the measurements for the Posterior-Lateral direction were significant, namely in 2 groups (CG: Mdif = 15.5, P = .002 [95% CI: 6.83-24.17 cm]; EG: Mdif = 12.063, P = .014 [95% CI: 2.87-21.26 cm]). There were no differences in the SEBT between groups after the training protocol. Conclusions: One attempt seems to be sufficient for the completion of the test. The completion of a specific training program for healthy basketball players does not demonstrate improvements in the balance.

[Purpose] The purpose of this study was to examine the effects of ankle exercises on balance ability when using shoe height insoles. [Subjects and Methods] Thirty adults in their 20s, who were students, were randomly divided into an experimental group and a control group (n=15/group). Individuals in the experimental group wore height-adjustable silicon insoles measuring 3, 5, and 7 cm three times per week for four weeks. The ankle exercise program consisted of stretching exercises, resistance training, and a balance exercise. [Results] There was a significant improvement in the balance ability of the experimental group for all height insoles (3, 5, and 7 cm) following the exercise program, as compared with before the exercise program. There was no significant improvement in the balance ability of the control group for all height insoles following the exercise program as compared with before the exercise program. The experimental group exhibited a significant improvement in balance ability following the exercise program for all the height insoles as compared with the control group. [Conclusion] According to the results of this study, active ankle exercises are helpful in preventing ankle joint damage, as they improve balance ability.

Materials and methods The development followed the Delphi method: (a) Production of the 1st version of the booklet: selection of information about self-assessment and foot care; creation of a male and female characters to dialogue with patients; selection of 7 simple and efficient exercises to increase foot strength and mobility; description of the exercises by pictures; and development of a table to control the progression of each exercise. A progression of approximately 6 levels of difficulty is available for each exercise that also differs in number of series and repetitions, body positions and materials used. After performing each exercise, patients have to classify their effort (easy, difficult, very difficult) and based on that, a progression will be made or not; (b) Professionals specialists' assessment: a jury was composed by 8 experts in dealing with diabetes. They assessed in the booklet the adequacy of the language, quantity and quality of the information and pictures provided, effectiveness of the selected exercises, motivation of daily practicing as a lifestyle, and contribution to be used as a tool to facilitate the communication between patients and health care providers.

We reviewed 47 patients following operatively treated ankle fracture-dislocation, at an average of 15 months after injury, to assess the outcome of two different postoperative regimens. Of the 47 patients, 27 received early active and passive ankle exercises, and 20 patients received immediate plaster splintage. Patients were assessed clinically by an independent surgeon and subjective, objective and radiological criteria recorded. No significant difference was apparent between the two groups on any of the criteria, although the early movement group contained more patients who were completely pain free, had a normal gait and no radiological signs of arthrosis (P < 0.05). This was achieved at the expense of a longer stay in hospital (average 10.2 days versus 7.4 days for plaster splintage) and more ankle swelling.

Fifty-one patients with dislocated lateral malleolar fractures took part in this prospective randomized study. Active ankle movements with weight bearing in an orthosis were compared with active ankle movements without weight bearing using a dorsal splint. By using cerclage, staples, and pins (Cedell 1967), an exact reconstruction of the ankle mortise was achieved in 44/51 ankles. Radiographic and stereophotogrammetric analyses at 3 months showed no redislocation and only small movements in the ankle mortise. Better loaded dorsal flexion capacity at 3 months was found in the orthosis group. This study was designed as the second part of a consecutive study. In the first part, early or late weight bearing without ankle exercises was compared (Ahl et al. 1986). The results from the two consecutive parts indicate that active ankle movements in combination with weight bearing facilitate and improve the rehabilitation following operation for an ankle fracture.

Background Undertaking randomised controlled trials can be challenging. Many trials fail to recruit, there may be issues around consent, patient preferences and treatment comparisons. The patient preference and Zelen designs have attempted to address the issues around recruitment and patient preference. However the cohort multiple randomised controlled trial has been suggested as an alternative design. The REFORM study uses this design to evaluate the clinical and cost effectiveness of a multifaceted podiatry intervention consisting of an orthotic, foot and ankle exercises and footwear advice for the prevention of falls in the over 65.