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Context: Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI. Methods: Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants' involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions. Results: A significant group × time interaction existed for psychosocial outcomes (P =.008), but not for balance (P =.159), strength (P =.492), or ankle function and disability (P =.128). Time main effects existed for balance (P =.003), strength (P <.001), function and disability (P <.001), and psychosocial outcomes (P =.006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS. Conclusions: Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians. [ABSTRACT FROM AUTHOR]

Context: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. Objective: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. Evidence Acquisition: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. Evidence Synthesis: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, −0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, −0.94; very low certainty evidence). Conclusions: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI. [ABSTRACT FROM AUTHOR]

Objectives: The static and dynamic correlations of postural stability to its three potential contributors, namely, proprioception, tactile sensation, and strength remain unclear among people with chronic ankle instability (CAI). This study aimed to compare static and dynamic postural stability, along with proprioception, tactile sensation, and strength between people with and without CAI and explore their correlations. Methods: Sixty-seven participants with CAI and 67 participants without CAI were enrolled in this study. Ankle proprioception, plantar tactile sensation, and lower limb strength were measured by a proprioception test device, a set of monofilaments, and a strength testing system, respectively. Static and dynamic postural stability were measured during standing and jump landing on a force plate and indicated by the root mean square of center of pressure and time to stability. Results: Compared to people without CAI, people with CAI had poorer postural stability, proprioception, tactile sensation, and strength. Both groups demonstrated correlation between proprioception and static postural stability, but only people without CAI showed correlation between proprioception and dynamic postural stability. Both groups demonstrated a correlation between tactile sensation and static postural stability, but not with dynamic stability. Both groups demonstrated a correlation between strength and both static and dynamic postural stability. Conclusions: People with CAI had deficits in static and dynamic postural stability, proprioception, tactile sensation, and strength. Among people with CAI, proprioception, tactile sensation, and strength can help maintain static postural stability; strength can help maintain dynamic postural stability, whereas proprioception may not provide sufficient information for dynamic postural stability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with chronic ankle instability are prone to inversion ankle sprains during landing. Moderately increasing the foot toe-out angle during landing may reduce the occurrence of inversion ankle sprains, but no studies have directly demonstrated this effect. OBJECTIVE: To explore the effect of increased toe-out angle during landing on the peak inversion angle, peak angular velocity, and the time to peak inversion among individuals with and without chronic ankle instability. METHODS: A total of 60 participants were recruited for this study, including 30 individuals with chronic ankle instability and 30 without chronic ankle instability. The study utilized a simulated sprain apparatus for drop-landing tests, featuring a platform that could tilt forward by 24° and inward by 15°, thus simulating the foot position during an ankle inversion sprain. Participants were required to perform drop-landing tests under two landing conditions: natural landing and toe-out landing, with the latter involving a greater foot toe-out angle, over 150% more than the former. Kinematic data of participants were recorded using a 12-camera three-dimensional motion capture system. Data analysis was conducted using two-way repeated measures analysis of variance and Spearman correlation analysis. RESULTS AND CONCLUSION: (1) Significant main effects of condition were found for peak inversion angle during drop-landing (P < 0.001, η² p=0.270), peak inversion velocity (P=0.015, η² p=0.098), and peak inversion time (P < 0.001, η² p=0.260); a significant main effect of group was found for peak inversion velocity (P=0.029, η² p=0.080). (2) There were significant negative correlations between the foot toe-out angle at landing and the peak ankle inversion angle (P=0.021, r=-0.310; P=0.042, r=-0.278) as well as the peak inversion time (P=0.018, r=-0.312; P=0.021, r=-0.309) in both chronic ankle instability and non-chronic ankle instability groups. Moreover, a significant negative correlation was also found between the foot toe-out angle and peak inversion velocity in the chronic ankle instability group (P=0.021, r=-0.312). (3) It is indicated that increasing the foot toe-out angle at landing can reduce the peak inversion angle, peak inversion velocity, and the peak inversion time during landing in patients with chronic ankle instability and non-chronic ankle instability, thereby decreasing the risk of ankle inversion sprains. [ABSTRACT FROM AUTHOR]

People with chronic ankle instability (CAI) have insufficient ankle dorsiflexion range of motion (DFROM) and decreases proprioception and muscle strength. Foam roller with and without vibration as a warm-up intervention may have benefits for healthy populations, but the effect on applied to injured individuals is still lacking, especially in CAI. Therefore, we aimed to compare the acute effects of three warm-up interventions, including vibration foam rolling (VR), foam rolling (FR), and static stretching (SS) in adults with CAI. This study was a randomized, counterbalanced crossover trial. Eligible sixteen adults with CAI received all three interventions (VR, FR, and SS) in unilateral CAI leg in a randomized order. Each intervention included 6 sets, 30 s each, targeting the ankle dorsiflexors and plantarflexors, with a 30-s rest time in between. Ankle dorsiflexion range of motion (DFROM), muscle strength, and ankle proprioception were measured before and immediately after each intervention. VR significantly improved ankle DFROM and muscle strength by over 30% compared to the pre-intervention, whereas FR improved DFROM by 23.68%, and SS did not improve DFROM. Additionally, VR was more significantly effective than SS in improving ankle DFROM and maximal strength. The ankle joint repositioning error angle did not have significantly different. Our results suggest that VR and FR interventions may be incorporated into warm-ups for adults with CAI to improve ankle DFROM. Furthermore, VR offers additional benefits in increasing muscle strength, especially compared to SS. • First study compares effects of VR, FR, SS in chronic ankle instability (CAI). • VR and FR improve ankle dorsiflexion ROM and strength in CAI population. • Static stretching lacks ankle dorsiflexion ROM enhancement in CAI. • VR is more effective than SS for dorsiflexion ROM and muscle strength in CAI. • Ankle proprioception unaffected by VR, FR, SS in CAI. [ABSTRACT FROM AUTHOR]

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Chronic ankle instability (CAI) is prevalent among individuals who sustain a lateral ankle sprain (LAS) injury. The persistence of the characteristic long-standing clinical symptoms of CAI may be attributable to the lack of adoption by physiotherapists of evidence-informed clinical guidelines. To investigate the extent to which French-speaking physiotherapists implement the International Ankle Consortium rehabilitation-oriented assessment (ROAST) framework when providing clinical care for individuals with an acute LAS injury. Cross-sectional study. Online survey informed by a Delphi process of foot-ankle experts. A total of 426 French-speaking physiotherapists completed the online survey. The survey was disseminated to French-speaking physiotherapists in France; Switzerland; Quebec, Canada; Luxembourg; and Belgium. It comprised closed and open-ended questions organized in 5 sections: (1) participant demographics, (2) participant self-assessment of expertise, (3) clinical diagnostic assessment of the ankle (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions were analyzed using best-practice thematic-analysis guidelines. Only 6.3% (n = 27) of the respondents could name all Ottawa Ankle Rules criteria. Only 25.6% (n = 109) of the respondents cited or described criterion standard tests from the literature to assess the integrity of the lateral ankle ligaments. Less than 25% (n = 71) of the respondents reported using clinical evaluation outcome metrics (ROAST) recommended by the International Ankle Consortium to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional than the mechanical insufficiencies associated with CAI. A minority of French-speaking physiotherapist survey respondents use the International Ankle Consortium ROAST to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Our goal was to determine whether state Medicaid expansion and patient insurance statuses affected access to care for ankle sprain patients. Methods: Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, and Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, and Texas) states were chosen. Twelve practices from each state (N = 96) were randomly selected from the American Orthopaedic Foot and Ankle Society (AOFAS) directory and called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain using either Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance. Results: An appointment was obtained at 65.6% clinics when calling with BCBS and at 45.8% with Medicaid (P =.006). There was a significant difference in successful scheduling based on insurance status in Medicaid unexpanded states (P =.007). In all states except Iowa, there were more appointments scheduled using BCBS than with Medicaid. The 3 main reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and whether the patient was referred (17.6%). The waiting period for an appointment did not differ by Medicaid expansion or insurance statuses. Conclusion: For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. Level of Evidence: Level II prospective cohort study [ABSTRACT FROM AUTHOR]

[Display omitted] Traditional kinesiology tape (KT) is an elastic fabric tape that clinicians and sports trainers widely use for managing ankle sprains. However, inadequate mechanical properties, adhesive strength, water resistance, and micro-damage generation could affect the longevity of the tape on the skin during physical activity and sweating. Therefore, autonomous room-temperature self-healing elastomers with robust mechanical properties and adequate adhesion to the skin are highly desirable to replace traditional KT. Ionic aggregates were introduced into the polymer matrix via electrostatic attraction between polymer colloid and polyelectrolyte to achieve such elastic tape. These ionic aggregates act as physical crosslink points to enhance mechanical properties and dissociate at room temperature to provide self-healing functions. The obtained elastic tape possesses a tensile strength of 3.7 MPa, elongation of 940 %, toughness of 16.6 MJ∙m−3, and self-healing efficiency of 90 % for 2 h at room temperature. It also exhibits adequate reversible adhesion on the skin via van der Waals force and electrostatic interaction in both dry and wet conditions. The new elastic tapes have great potential in biomedical engineering for preventing and rehabilitating ankle sprain. [ABSTRACT FROM AUTHOR]

Chronic Ankle Instability (CAI) is a condition characterized by giving-way episodes, instability and recurrent ankle sprains. Poor sleep can increase the risk of musculoskeletal injury and sleep is known to be an important aspect of injury recovery. However, the effect sleep has on those with CAI as well as its risk for recurrent episodes of giving-way remains unclear. The purpose of this study was to examine the relationship between sleep behaviour and giving-way episodes associated with CAI. Twenty-five participants with CAI (11 M/14 F, age = 22.9 ± 2.7 years, height = 171.9 ± 8.9 cm, mass = 76.7 ± 15.9 kg) were included in this study. All participants completed baseline patient-reported outcome measures and wore a fitness tracker that measured sleep for 1 month. Seven participants had a giving-way (GW, no-giving way = NWG) episode. Those with a giving-way episode spent significantly less time asleep (GW = 325.3 ± 63.2 min, NGW = 413.9 ± 49.5 min, p < 0.001, d = 1.659), less time in bed (GW = 384.9 ± 79.0 min, NGW = 473.1 ± 55.0 min, p = 0.002, d = 1.419), less minutes in REM (GW = 59.9 ± 19.9 min, NGW = 93.5 ± 25.4 min, p = 0.002, d = 1.400) and less minutes in light sleep (GW = 197.6 ± 51.5 min, NGW = 250.2 ± 34.4 min, p = 0.003, d = 1.328) compared to those without. In conclusion, this study shows that individuals with CAI who suffered a giving-way episode had poorer sleep behaviour the night before an episode. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acute lateral ankle sprain (ALAS) affects balance, often assessed by changes in traditional center of pressure (COP) parameters. Spatiotemporal measures of COP and time-to-boundary (TTB) analysis may offer improved sensitivity in detecting postural deviations associated with ALAS. However, the neurophysiological mechanism underlying these changes remains unknown. This study aimed to explore the effects of ALAS on spinal reflex excitability in the fibularis longus (FL) during single-leg balance and TTB parameters following ALAS. Methods: Fourteen participants with and without ALAS were recruited within 14 days from the onset of the injury. We assessed FL spinal reflex excitability and postural control during a single-leg stance. The primary outcomes included the H/M ratio, H-latency, and TTB parameters. For H-reflex testing, the peripheral electrical stimulation was delivered at the sciatic nerve before bifurcating into the tibial and common fibular nerve while participants maintained a single-leg balance position with the involved side of the limb. The TTB parameters of the medial–lateral (ML) and anterior–posterior (AP) directions of the mean, SD, and minimum were assessed, which indicate postural correction and strategies. Results: Patients with ALAS had a significantly lower AP-TTB minimum compared with healthy uninjured controls, with a moderate effect size (p = 0.039; d = −0.83). However, there was no significant difference in the H/M ratio (ALAS: 0.29 ± 0.16 vs. CON: 0.24 ± 0.10; p = 0.258) and H-reflex latency (ALAS: 34.6 ± 1.92 vs. CON: 33.8 ± 1.75 ms; p = 0.277); Conclusions: These results indicate that reflex control at the spinal level may have a minimal role in response to balance deficits following ALAS. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Family doctors are the primary care providers for ankle sprains, which are a prevalent condition that they treat with great care. Family physicians' differing management styles and levels of knowledge about established recommendations may have a substantial influence on patient outcomes. Aims: The current study aimed to assess the level of awareness among family physicians regarding established guidelines for ankle sprain management. Materials and Methods: A cross-sectional study was conducted targeting all available and accessible primary care physicians within the Department of Family Medicine at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia during the period from 2023 to May 2024. Data were collected using an online questionnaire that was initiated by the study researchers after comprehensive review of similar articles in the literature. Results: A total of 88 primary care physicians were included. Physicians' ages ranged from 25 to 60 years with a mean age of 33.4 ± 7.4 years old. A total of 47 (53.4%) were males, 29 (33%) were residents, 28 (31.8%) were consultants, 16 (18.2%) were senior Registrar, and 9 (10.2%) were GPs. A total of 41 (46.6%) of the study physicians had an overall good knowledge level about ankle sprain while most of them (53.4%) had poor knowledge level. A total of 55 (62.5%) of the study physicians utilize the Ottawa Ankle Rules to guide the need for X-ray imaging in ankle sprains, and 52 (59.1%) routinely provide information on preventive measures to patients diagnosed with an ankle sprain. Conclusion: The study found that primary care physicians have average knowledge about ankle sprains, diagnosis, classification, and treatment, with lower knowledge of follow-up plans. They need training and educational programs. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether individuals with chronic ankle instability (CAI) can activate the fibularis longus compartments with high-density surface electromyography (HD-sEMG) biofeedback to the same extent as those without CAI, and to analyze the effect of ankle position on compartment activation in individuals with CAI using HD-sEMG feedback. Methods: There were 16 volunteers per group (CAI and No-CAI). The sEMG amplitude at each compartment (anterior and posterior) and the barycenter of the spatial sEMG amplitude distribution of the fibularis longus were recorded during eversion in neutral and plantar flexion positions at 30% and 70% of maximum voluntary contraction force, both with and without visual feedback on the spatial sEMG amplitude distribution. Results: sEMG amplitude of the posterior compartment of the fibularis longus in the CAI group trained with HD-sEMG feedback during eversion at 70% maximum voluntary contraction (in plantar flexion) was significantly higher than without HD-sEMG feedback (95% CI = 3.75–34.50% root mean square) and was similar to the activation of the No-CAI group (95% CI = −14.34% to 34.20% root mean square). Furthermore, individuals with CAI who underwent training with HD-sEMG feedback in plantar flexion exhibited a posterior displacement of the barycenter (95% CI = 0.56–2.84 mm). Conclusions: Utilizing HD-sEMG feedback during eversion in plantar flexion position increases activation of the fibularis longus posterior compartment in individuals with CAI to the same extent as healthy people. HD-sEMG–based topographic maps can serve as effective feedback training to restore motor control of the ankle. Long-term efficacy for improving motor function requires investigation through longitudinal studies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the relative efficacy of various physical therapy interventions for chronic ankle instability (CAI). DESIGN: A network meta-analysis of randomized controlled trials. LITERATURE SEARCH: PubMed, Cochrane Library, Embase, Scopus, and CINAHL bibliographic databases were searched up to December 2023. STUDY SELECTION CRITERIA: Randomized controlled trials examining nonsurgical treatments for CAI. DATA SYNTHESIS: We used frequentist network meta-analysis to assess 8 outcomes across 44 trials, including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scale or Sport scale, Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) in 3 directions (anterior [A], posteromedial [PM], and posterolateral [PL]), dorsiflexion range of motion, and pain. Surface under the cumulative ranking curve (SUCRA) values identified the most effective interventions. RESULTS: Based on SUCRA rankings, a regimen combining balance and strengthening exercises, augmented with either manual therapy or dry needling, was identified as the most effective in enhancing function (SUCRA: FAAM ADL = 95.2% [manual]/83.9% [dry needling]; FAAM Sport = 87.9% [manual]/80.1% [dry needling]), improving dynamic balance (SUCRA [manual]: SEBT-A = 92.1%; SEBT-PM = 98.0%; SEBT-PL = 90.8%), and significantly relieving pain (SUCRA: 99.9%). A multimodal exercise approach combined with manual therapy showed superior efficacy in increasing dorsiflexion (SUCRA: 61.6%). Tai chi emerged as the most promising intervention for improving stability (SUCRA: 99.9%). CONCLUSION: Interventions that emphasized strengthening and balance exercises were the most effective strategy for achieving best function and pain relief for patients with CAI. Multimodal exercises and tai chi might improve ankle range of motion and instability, respectively. [ABSTRACT FROM AUTHOR]

Chronic lateral ankle instability is a common diagnosis in foot and ankle clinics. Internal Brace (IB) augmentation is a surgical procedure that utilizes fibertape augmentation of the lateral ankle ligaments. Studies have shown the superiority of fibertape augmentation over traditional lateral ankle stabilization procedures such as the Brostrom or Brostrom-Gould. The IB procedure has been described elsewhere and the fixation involves placing bone anchors with attached suture tape at each end of the Brostrom repair augmenting the fixation. Various studies exist that support the mechanical advantage of the Brostrom with IB over non augmented repair. This technique allows for earlier weight bearing and range of motion which translates into earlier return to activity and sport. While there are guidelines for rehabilitation after Brostrom procedures, there are currently no guidelines regarding rehabilitation after the IB. The purpose of this clinical commentary is to describe an early mobility and rehabilitation protocol after IB augmentation for the ankle. The post operative protocol provides treatment goals, weight bearing status recommendations, and rehabilitation intervention suggestions after IB augmentation. Level of Clinical Evidence: V [ABSTRACT FROM AUTHOR]

Background: Chronic syndesmotic instability (CSI) can be associated with severe long-term pain and disability. This study aimed to investigate the risk factors associated with the development of CSI in patients who underwent conservative treatment after the first episode of acute ankle sprain (AAS) that did not result in a satisfactory outcome. Methods: We retrospectively analyzed the clinical data of patients who underwent ankle arthroscopy for suspected CSI between January 2020 and September 2023. The patients were divided into the instability and stability groups based on the syndesmotic space width measured under arthroscopy, with 3 mm as the critical value. Demographic, arthroscopic, and imaging information such as the anterior talofibular ligament (ATFL), calcaneofibular ligament, posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), deltoid ligament (DL), interosseous membrane, height of the syndesmotic fluid, injuries of the talus, calcaneus, tibia, and fibula, effusion of the tibiotalar and talocalcaneal joints, fibular morphology, and fibular incisura features, were recorded. Univariate and multivariate analyses were performed successively to identify the risk factors. Results: Of the 356 patients, 102 developed CSI after the first episode of AAS. In the multivariate analysis, development of CSI was associated with 5 clinical factors: DL injury (odds ratio [OR] 7.453, 95% CI 3.007-18.471; P <.001), positive bandage-binding test (OR 7.196, 95% CI 2.942-17.599; P <.001), grade 2 to 3 injury of the PITFL (OR 2.727, 95% CI 1.044-7.124; P =.041), positive squeeze test (OR 2.455, 95% CI 1.045-5.770; P =.039), and body mass index (BMI) (OR 1.306, 95% CI 1.121-1.522; P <.001). Conclusion: Five key factors were associated with CSI development in patients who underwent conservative treatment after the first episode of AAS that did not result in a satisfactory outcome: DL injury, positive bandage-binding test, grade 2 to 3 injury of the PITFL, positive squeeze test, and BMI. [ABSTRACT FROM AUTHOR]

Background: Sport-related ankle sprains (SASs) are prevalent in adolescents (ages 10-19), increasing the risk of developing posttraumatic osteoarthritis (PTOA). Although early ankle osteoarthritis (OA) is not well defined, OA eventually includes alterations in bone mineral density (BMD), structural changes, and soft tissue pathology. This study examined the impact of SAS sustained in adolescent sport on bone and soft tissue structural outcomes 3-15 years postinjury. Methods: Participants (n = 10) with prior unilateral SAS in adolescent sport (HxAI) were compared to age- and sex-matched controls. To assess injury-related pathologies and BMD, 1.5-tesla (T) extremity magnetic resonance imaging (MRI) and computed tomography scans were used. Semiquantitative scores for injury patterns and OA features from MRI scans were summed and compared between groups. The talus, calcaneus, navicular, and 5% distal tibia were segmented, and BMD was measured for each bone. Results: All HxAI participants exhibited MRI injury pathology (median 2; IQR 1-6), whereas only 1 of 10 controls showed pathology (median 0; IQR 0-0), χ2(1, n = 20) = 16.36, P <.001. Both the injured and uninjured ankles in HxAI displayed injury pattern pathology. Additionally, 3 of 10 injured ankles and 2 of 10 uninjured ankles in the HxAI group (median 0; IQR 0-3), but none of the controls (median 0; IQR 0-0), exhibited OA features. In the HxAI group, talus BMD was lower in the injured ankle (502.4 ± 67.9 g/cm3) compared with the uninjured ankle (515.6 ± 70.1 g/cm3) (F = 13.33, P =.002), with no significant BMD differences at the calcaneus, navicular, or 5% distal tibia. No differences were observed between the ankles of the control group. Conclusion: The presence of injury pattern pathology, structural changes, and reduced talus BMD suggest that degenerative changes may occur in individuals as early as 3-15 years following ankle injury. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research was to examine effect of aquatic exercise training in young females with chronic instability of the ankle. Method: The research comprised of 100 female individuals aged 20-30 years that fulfilled the inclusion and exclusion criteria. Participants were separated into two categories with equal participants, control group (n=50) and experimental group (n=50) by using SPSS software. Experimental group underwent hydrotherapy program while control group underwent land-based exercise program with frequency of twice a week for about 6 weeks. The scores were statistically analysed by using paired and unpaired t-test. Findings: The findings showed that the two groups improved significantly in ROM. Group B improved significantly in ankle dorsiflexion, plantarflexion, inversion, and eversion (p < 0.0001), while the Group A showed p values of 0.0271, 0.3758, 0.4466, and 0.0452, respectively. The experimental group exhibited more improvement in MMT than the control group. The experimental group had significant strength in dorsiflexors, plantarflexors, invertors, and evertors (p < 0.0001), while the control group had significant strength dorsiflexors, invertors, and evertors (p = 0.0015, 0.0055, and 0.0020) and plantarflexors (p = 0.0207), respectively. The experimental group improved SEBT significantly (p < 0.0001) in all directions, while the control group exhibited significant results (p< 0.0001,0.0068,0.0062,0.0031,0.0090, 0.0423,0.0167). Conclusion: It concluded that the aquatic training program had shown a significant positive response in improving ROM, muscle strength and balance among young females experiencing chronic instability of the ankle. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unilateral chronic ankle instability has adverse effects on the affected limb, and evidence has shown that the nonaffected side may be similarly involved, but direct evidence is currently lacking. OBJECTIVE: To investigate the effects of unilateral chronic ankle instability on bilateral postural stability, proprioception, plantar tactile sensation, and muscle strength. METHODS: A total of 122 participants were recruited in this study, including 67 individuals with unilateral chronic ankle instability and 55 individuals without chronic ankle instability. Postural stability, proprioception, plantar tactile sensation and muscle strength were tested bilaterally in individuals with unilateral chronic ankle instability, as well as in those without chronic ankle instability. One-way analysis of variance or Kruskal-Wallis test was used for intergroup comparisons. RESULTS AND CONCLUSION: (1) Compared with individuals without chronic ankle instability, individuals with chronic ankle instability had longer time to stability in the anterior-posterior direction bilaterally (P=0.001-0.012), and longer time to stability in the medial-lateral direction on the affected side (P=0.012- 0.025); had higher proprioception thresholds of plantarflexion, dorsiflexion, inversion, and eversion of the bilateral ankles (P=0.000-0.035); showed lower tactile sensation sensitivities of the bilateral great toe, first metatarsal head, fifth metatarsal head, arch, and heel (P=0.000-0.008); and had weaker muscle strength for inversion and eversion of the bilateral ankles (P=0.000-0.019). (2) Individuals with unilateral chronic ankle instability have bilateral deficits in postural stability, proprioception, plantar tactile sensation, and muscle strength. Therefore, the rehabilitation needs of both limbs should be fully considered when treating chronic ankle instability. [ABSTRACT FROM AUTHOR]

Introduction: Lateral Ankle sprain is a common sports injury with a high incidence rate after muscle fatigue. Health specialists are searching for the best conservative approach to reduce the complications of this injury and decrease the incidence rate after fatigue. This systematic review and meta-analysis aimed to assess the effectiveness of external ankle support on balance in patients with ankle instability following muscle fatigue. Methods: We conducted a systematic search of PubMed, Scopus, and Web of Science up to April 29, 2024, to find articles involving populations with ankle instability, interventions using external ankle support (taping or ankle orthoses), and outcomes related to balance assessed during muscle fatigue. The Risk of Bias 2 tool was used for risk of bias assessment. Data on patients, interventions, fatigue protocols, and outcomes were extracted and analysed. A meta-analysis was performed using Review Manager 5.3 software, calculating standardized mean differences with 95% confidence intervals (CI) for each outcome. Results: Nine crossover studies involving 230 subjects were included. The narrative synthesis shows that external ankle supports improve the single leg hop test [Mean difference=7.84, P=0.01], center of pressure range and velocity, and ankle inversion. The meta-analysis results indicate that compared to the control group, external ankle supports after muscle fatigue significantly change Y balance clinical test-posterolateral [MD=1.22, 95% CI (0.16, 2.28), p=0.03], Y balance clinical test-posteromedial [Mean difference=2.60, 95% CI (0.42, 4.79), p=0.03], center of pressure time to stabilization-mediolateral [Mean difference=-0.68, 95% CI (-1.29, -0.07), p=0.04], center of pressure time to stabilization-vertical [Mean difference=-0.62, 95% CI (-0.94, -0.30), p=0.01], and vertical ground reaction force [Mean difference=0.58, 95% CI (0.21, 0.96), p=0.02]. Discussion: External ankle supports are an effective conservative intervention for improving specific aspects of balance in patients with ankle instability, particularly following muscle fatigue. Significant improvements were observed in the Y Balance Test, center of pressure measures, vertical ground reaction force, and single-leg hop performance. Healthcare professionals are encouraged to incorporate external ankle supports into rehabilitation programs for individuals with ankle instability. These supports can enhance balance, improve functional outcomes, and help mitigate the negative effects of muscle fatigue on postural stability.

Abstract Background Chronic ankle instability is associated with long-term neuromuscular deficits involving poor postural control and peroneal muscular impairment. Symptoms of chronic ankle instability hinder engagement in physical activity and undermine the patient’s quality of life. Despite the existence of various treatment modalities, none has conclusively provided evidence of clinical effectiveness in counteracting neuromuscular deficits, such as arthrogenic muscle inhibition of the peroneal longus (PL). Pulse electromagnetic field therapy employed as an adjunct biophysical therapy can potentially improve stability by mitigating peroneal muscle weakness and by activating the peroneal muscle. We postulate that by combining standard care (muscle strengthening, balance training, and range of motion exercise) with pulse electromagnetic field therapy, postural control stability and peroneal muscle weakness will significantly improve. Methods This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 48 adults with chronic ankle instability will be recruited and randomly allocated into either the intervention or control groups. The intervention group (n = 24) will receive active pulse electromagnetic field therapy and standard exercise training, while the control group (n = 24) will receive sham pulse electromagnetic field therapy and standard exercise training for 8 weeks. Primary and secondary outcomes will be evaluated at baseline, week 4, 8 as well as at 3-, 6-, and 12-month follow-up visits. Discussion Chronic ankle instability is a common debilitating condition without a curative conservative treatment. Investigating different treatment modalities will be essential for improving rehabilitation outcomes in this clinical population. This study will investigate the effectiveness of pulsed electromagnetic field therapy on the functional and clinical outcomes in the chronic ankle instability population. This trial may demonstrate this non-invasive biophysical therapy to be an effective measure to help patients with CAI. Trial registration ClinicalTrials.gov NCT05500885. Registered on August 13, 2022.

Objectives: The focus of patients’ attention during the physiotherapy program has been reported to affect the rehabilitation goals. The study aimed to investigate the effectiveness of an external focus of attention (EFA) on static balance and functional ability in individuals with chronic ankle instability (CAI). Methods: Fourteen subjects with CAI, aged from 19 to 25 years, were randomly assigned to two groups: external and internal focus of attention (IFA) group. The outcome measures of the study were static balance and functional ability. A pre-intervention evaluation was performed. Following instructions to an external or an IFA, subjects practiced on a balance board 3 times per week for 4 weeks. At the end of each week, they performed evaluation tests, including a time balance test, foot lift test, side hop test, figure-8 test, and star excursion balance test (SEBT). Parametric (mixed analysis of variance) and non-parametric analysis (the Mann–Whitney and Friedman tests) were performed between measurements and groups. Results: The intervention program showed a statistically significant improvement in static balance and functional ability in both groups. The results indicated the main effect of time (F(2.488, 29.855)=43.880, P

Abstract Background Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains. Materials and methods This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26. Results The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P

The 11+ is a structured warm-up program designed to prevent injuries in soccer players, but has proven efficacy in many populations, settings and sports. It consists of 15 exercises that target the most common injury sites, such as the knee, ankle, and groin. However, the implementation and adherence of the 11+ remain suboptimal, and recent compelling data indicates underlying mechanisms of injury risk related to neural control of movement may not be adequately targeted. Updates to the 11+ considering practical implications of neurocognitive and ecological motor learning may be warranted for coaches and practitioners. We review the evidence on how an updated 11+ may influence the cognitive and perceptual processes involved in motor control and learning, such as attention, anticipation, decision making, and feedback. How the 11+ can be adapted to the ecological constraints and affordances of the football (soccer) environment is also discussed, including the task, the individual, and the context. By considering these factors, the 11+ can be more effective, engaging, and enjoyable for the players, and thus improve its adoption and compliance. The 11+ has the capability to not only a physical warm-up, but also a neurocognitive and ecological preparation for the game. Therefore, the purpose of this manuscript is to describe the conceptual design of a new ecological neurocognitively enriched 11+, that builds on the strong foundation of the original intervention with considerations for the newly discovered potential neural control of movement risk factors. [ABSTRACT FROM AUTHOR]

Purpose: Chronic ankle instability (CAI) causes maladaptive neuroplastic changes in the central nervous system, which may lead to high injury potential under dual-task conditions. This study aims to explore the effects of dual-task paradigm on the injury potential during landing among individuals with CAI. Methods: Twenty participants with CAI (4 female and 16 male, 12 were affected with their right limbs and 8 were affected with their left limbs, 20.4 ± 1.7 years, 176.9 ± 5.0 cm, and 72.0 ± 11.1 kg) and eighteen without CAI (6 female and 12 male, 20.2 ± 1.5 years, 173.5 ± 7.0 cm, and 70.3 ± 10.8 kg) were recruited. They drop-landed on a trap-door device, with their affected or matched limbs on a flippable platform, under single- (drop-landing only) and dual-task (drop-landing while subtracting of serial threes) conditions. A twelve-camera motion capture system was used to capture the kinematic data. Two-way ANOVA with mixed design (CAI vs non-CAI groups by single-vs dual-task conditions) was used to analyze the data. Results: Significant group-by-condition interactions were detected in the ankle inversion angle (P = 0.040, η 2 p = 0.012) and ankle inversion angular velocity (P = 0.038, η 2 p = 0.114). Both indicators decreased among individuals without CAI from single-to dual-task conditions, while remained unchanged among those with CAI; and they were higher among individuals with CAI under both single- and dual-task conditions, compared to those without CAI. Conclusion: Individuals with CAI have a reduced ability to limit ankle inversion compared to those without CAI. Under dual-task conditions, individuals without CAI limited their ankle inversion, while those with CAI did not. Drop-landing, especially under dual-task conditions, poses a high risk of excessive ankle inversion for individuals with CAI. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to provide a detailed description of the anatomy and radiology of the medial sleeve and present an approach in its management among elite athletes. Methods: Five cases of elite athletes who underwent treatment for a medial sleeve injury of which the diagnosis was confirmed through physical examination and additional magnetic resonance imaging scan are described in this study. Results: Two patients presented with isolated medial sleeve injuries, while the other three patients suffered from concomitant ankle injuries. Non‐operative treatment consisted of relative rest, soft cast immobilization and mobilization in a walking boot or kinesiotape which was successful in four of the cases with regard to the medial sleeve. One patient underwent surgery due to syndesmotic instability. Another patient presented with combined medial and lateral ankle instability which was treated surgically with an open medial and lateral ligament repair. All patients were able to return to their pre‐injury sports and at the time of the last follow‐up were still playing in their pre‐injury level of competition. Conclusion: Medial sleeve injuries of the ankle in elite athletes should be considered in the differential diagnosis for athletes presenting with medial ankle pain. Inherent knowledge regarding anatomy is essential when guiding the management of these injuries which can be treated successfully with a non‐operative approach consisting of relative rest, immobilization, kinesiotape and physical therapy. In case of persistent medial instability or rotational instability, surgical repair is a viable treatment option. Both modalities allow athletes to return to the pre‐injury level of competition. However, early diagnosis is crucial to minimize the delay of appropriate treatment and avoid potential residual symptoms. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Tissue flossing involves wrapping a rubber band around a muscle group for a few minutes while performing joint motion, enhancing ankle joint torque and range of motion. As limited ankle dorsiflexion range of motion and plantar flexion muscle weakness are risk factors for sports injury, assessing the therapeutic effects of tissue flossing is important. This study aimed to evaluate the immediate effects of calf tissue flossing on enhancing ankle joint torque and dorsiflexion range of motion. We conducted a randomized controlled crossover trial involving 19 healthy adult males who received two interventions (low and high-pressure tissue flossing bands) and a control condition (underwrap). Each intervention was applied for 2 minutes on the non-dominant calf, with 5--10 days between sessions. A pressure sensor placed on the posterior calf monitored the wrapping compression force. The intervention exercise comprised six voluntary isometric contractions of the ankle at three angles (20° plantar flexion, neutral 0°, and 10° dorsiflexion) for 3 seconds each using a dynamometer. The maximal isometric ankle plantar flexion torque and dorsiflexion range of motion were evaluated pre- and post-intervention. Significant interactions were observed in ankle plantar flexion torque at 10° dorsiflexion (p < 0.01) but not at 0° or 20° plantar flexion. The low- and high-pressure bands significantly enhanced ankle plantar flexion torque by 4.3 Nm (effect size [ES]: 0.14, p = 0.02) and 4.9 Nm (ES: 0.15, p < 0.05), respectively, and also enhanced the ankle dorsiflexion range of motion by 1.7° (ES: 0.43, p < 0.01) and 1.3° (ES: 0.35, p = 0.02), respectively, compared to the control. The low- and high-pressure band conditions had comparable effects on torque and range of motion. A few minutes of the calf tissue flossing intervention significantly enhanced ankle plantar flexion torque and dorsiflexion range of motion, although the effect sizes were trivial to small. [ABSTRACT FROM AUTHOR]

Prolotherapy is a non-surgical treatment that involves injecting an irritant solution into ligament and tendon attachments to induce a localized inflammatory response and promote the regeneration of connective tissue. This study reviewed the effects and mechanisms of prolotherapy in the foot and ankle region. Prolotherapy contributes to pain reduction and functional improvement in conditions such as Achilles tendinopathy, plantar fasciitis, ankle sprain, and osteochondral lesions of the talus. On the other hand, the limited number of studies and lack of standardized protocols remain challenges. Further research and the establishment of standardized protocols will be needed to maximize the efficacy of prolotherapy and expand its indications. [ABSTRACT FROM AUTHOR]

Objectives: The focus of patients' attention during the physiotherapy program has been reported to affect the rehabilitation goals. The study aimed to investigate the effectiveness of an external focus of attention (EFA) on static balance and functional ability in individuals with chronic ankle instability (CAI). Methods: Fourteen subjects with CAI,... [ABSTRACT FROM AUTHOR]

Background: Chronic ankle instability is associated with long-term neuromuscular deficits involving poor postural control and peroneal muscular impairment. Symptoms of chronic ankle instability hinder engagement in physical activity and undermine the patient's quality of life. Despite the existence of various treatment modalities, none has conclusively provided evidence of clinical effectiveness in counteracting neuromuscular deficits, such as arthrogenic muscle inhibition of the peroneal longus (PL). Pulse electromagnetic field therapy employed as an adjunct biophysical therapy can potentially improve stability by mitigating peroneal muscle weakness and by activating the peroneal muscle. We postulate that by combining standard care (muscle strengthening, balance training, and range of motion exercise) with pulse electromagnetic field therapy, postural control stability and peroneal muscle weakness will significantly improve. Methods: This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 48 adults with chronic ankle instability will be recruited and randomly allocated into either the intervention or control groups. The intervention group (n = 24) will receive active pulse electromagnetic field therapy and standard exercise training, while the control group (n = 24) will receive sham pulse electromagnetic field therapy and standard exercise training for 8 weeks. Primary and secondary outcomes will be evaluated at baseline, week 4, 8 as well as at 3-, 6-, and 12-month follow-up visits. Discussion: Chronic ankle instability is a common debilitating condition without a curative conservative treatment. Investigating different treatment modalities will be essential for improving rehabilitation outcomes in this clinical population. This study will investigate the effectiveness of pulsed electromagnetic field therapy on the functional and clinical outcomes in the chronic ankle instability population. This trial may demonstrate this non-invasive biophysical therapy to be an effective measure to help patients with CAI. Trial registration: ClinicalTrials.gov NCT05500885. Registered on August 13, 2022. [ABSTRACT FROM AUTHOR]

Background Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. Purpose The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Study Design Case series Methods Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Results Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. Conclusion POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level of Evidence Level IV, Case Series [ABSTRACT FROM AUTHOR]

Researchers have shown that patients with chronic ankle instability (CAI) have deficits in memory and attention allocation. This functional deficit affects lower extremity performance. Motor-cognitive dual-task training may improve lower limb dysfunction caused by central nervous system injury. Further study is needed to determine whether dual-task training is more favorable than single-task training for improving neuromuscular control in patients with CAI. To compare the effects of balance-cognition dual-task training and balance single-task training on lower limb function and electroencephalography changes during static postural control in patients with CAI. Randomized clinical trial (Chinese Clinical Trial Registry: ChiCTR2300073875). Rehabilitation training room. A total of 24 patients with CAI (age = 22.33 ± 2.43 years, height = 175.62 ± 7.7 cm, mass = 70.63 ± 14.59 kg) were block randomized into 2 groups. Protocols were performed 3 times per week for 6 weeks. The single-task group underwent 1-legged static balance training with eyes open and closed and hopping balance training. The dual-task group underwent balance and cognitive training (backward-counting task). Cortical activity, proprioception, muscle onset time (difference between the muscle activation time and touchdown time), and dynamic balance were assessed before and after the interventions. We performed multivariate analyses of variance to identify main effects and interactions across groups and time. A post hoc Bonferroni test was performed for pairwise comparisons when interactions were present. All participants successfully completed the 6-week interventions. Proprioception, peroneus longus (PL) muscle onset time, and dynamic postural control improved after the interventions in both groups (P <.05). Dual-task training was superior to single-task training in improving joint position sense in plantar flexion, shortening PL muscle onset time, and altering cortical activity (P <.05). A 6-week program of balance training or balance combined with cognitive training could improve the functional deficits associated with CAI. The dual-task training could also improve joint position sense in plantar flexion, PL muscle onset time, and cortical activity. [ABSTRACT FROM AUTHOR]

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Background and Aims: Gait initiation (GI) in individuals with chronic ankle instability (CAI) has shown differences in the center of pressure (COP) and muscular measures compared to healthy controls. Some studies reported that these alterations appeared when GI was with the affected leg, while others indicated that they occurred when GI was with the non‐affected leg. This systematic review aimed to understand kinetic and muscular differences between individuals with CAI, healthy controls, and the affected and non‐affected legs of individuals with CAI. Methods: PubMed, Science Direct, Web of Science, Google Scholar, and Scopus databases (1990–2023) were searched using the Population, Exposure, Comparator, and Outcome measure. The PRISMA guidelines were followed. The outcome measures were the peak and rate of COP displacement in the medial‐lateral and anterior‐posterior directions, and resultant plane during phases 1, 2, and 3 of COP trace during GI and the duration of each phase. The other measures included the onset time of the tibialis anterior and soleus muscle activity between individuals with CAI, healthy controls, and the affected and non‐affected legs of the individuals with CAI. The studies' quality assessment was conducted based on the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Five studies were included in the final evaluation. The results of included studies showed, individuals with CAI spent less time during phases 1 and 2, as well as a shorter peak of COP displacement in the lateral direction during phase 1 compared to healthy controls, regardless of whether the GI was with the affected or non‐affected leg. Conclusion: Individuals with CAI have probably adopted a strategy involving adjusting the peak of COP displacement to manage internal sway while in a single‐leg stance. Overall, there was no comprehensive conclusion about differences between the two legs in individuals with CAI. [ABSTRACT FROM AUTHOR]

This study aims to design a preventive program using Proprioceptive Neuromuscular Facilitation (PNF) to enhance the range of motion of the ankle joint and the strength of surrounding muscles, thereby preventing injuries in female volleyball players under 15 years of age. The program was implemented with a sample of 6 players over 6 weeks, with 3 training sessions per week, each lasting 60 minutes. An experimental design with a single group was used, employing pre-test, mid-program assessment, and post-test measurements to evaluate the program’s impact. The results indicated statistically significant differences between the three measurements, with improvements favoring the mid-program assessment and post-test. A significant improvement was observed in both the range of motion and muscle strength around the ankle joint, which contributed to a reduced likelihood of injuries and improved functional performance. These findings suggest that the program is an effective preventive strategy for improving ankle stability. It is recommended for continuous use throughout the sports season to reduce the incidence of ankle sprains in female volleyball players. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionComparisons of talar cartilage and the anterior talofibular ligament (ATFL) profiles in individuals with different levels of chronic ankle instability (CAI) provide insight into early adaptation of tissue morphology.This study compared morphologic response and recovery of the talar cartilage and ATFL before and after 30-min of self-paced treadmill running between individuals with CAI, coper (full recovery from a first-time ankle sprain), and healthy controls.Sixty young males (24.8 years, 176.9 cm, 75.7 kg) were allocated into the CAI, coper, and healthy control group by their number of ankle sprains and scores on the self-reported ankle instability questionnaires (Cumberland Ankle Instability Tool, and Foot and Ankle Ability Measure-Activities of Daily Living). Ultrasonographic images in the cross-sectional area (CSA; overall, lateral, and medial) and ATFL length (unstressed and stressed and position) before and after treadmill running were recorded and analyzed.There were no group by time interactions in the talar cartilage CSA (F14,399 <1.09, p > .36 for all tests) and ATFL length (F14,399< .69, p > .79 for all tests). Regardless of time, CAIs had the largest overall (F2,399 = 42.68, p < .001), lateral (F2,399 = 37.16, p < .001), and medial (F2,399 = 36.57, p < .001) CSA of talar cartilage and the longest stressed-ATFL length (F2,399 = 54.42, p < .001), followed by copers and healthy controls.Morphologic features of the talar cartilage and ATFL appear to depend on the level of ankle instability (e.g. a history of recurrent ankle sprain). [ABSTRACT FROM AUTHOR]

Background: Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains. Materials and methods: This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26. Results: The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P < 0.05). Patients treated with plaster casts reported the lowest pain levels, with a significant relationship between pain levels and the two treatment methods (P < 0.05). Range of motion results were similar for both treatment methods, while the cast treatment showed the highest incidence of skin complications. A significant relationship was observed between spring ankle braces and plaster casts regarding skin complications (P < 0.05). Conclusion: Treating ankle sprains with plaster casts leads to higher satisfaction and lower pain levels compared to using spring ankle braces. [ABSTRACT FROM AUTHOR]

Introduction: This study compares the efficacy of routine treatment plus short foot exercises (SFE) with routine treatment alone on dynamic balance and pain in subjects with sub-acute ankle sprain. Materials and Methods: A total of 32 patients (18-45 years old) with primary ankle sprain were randomly enrolled into the control group performing routine treatment alone or the SFE group performing routine treatment plus SFE. The dynamic balance was assessed using the star excursion balance test. Pain and ankle dorsiflexion range of motion were assessed using the numeric pain rating scale and a goniometer. The outcomes were evaluated at the baseline and after the end of treatment. The groups were compared using the one-way analysis of variance/analysis of covariance test. The effect sizes also were calculated to determine the efficacy of the SFE. Results: Dynamic balance in the SFE group had a significant increase in the anterior, lateral, medial, and anteromedial directions compared to the control group (P=0.001, P=0.002, P=0.014, P=0.0001). No significant differences were observed between the groups in other directions of the star excursion balance test (P>0.05). Additionally, pain intensity was lower significantly in the SFE group than in the control group (P=0.0001). In the SFE group ankle dorsiflexion range was significantly more than the control group (P=0.025). The effect sizes also showed a high efficacy favoring SFE. Conclusion: The combination of routine treatment and SFE can be an effective intervention for managing ankle sprain. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing. Design: This was a randomized, controlled, double-blind trial. Thirtysix individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week0 and week6. A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week6, with the outcome variables at week0 as covariates. Results: Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (−16.05, −78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week6. Conclusions: Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control. [ABSTRACT FROM AUTHOR]

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. [ABSTRACT FROM AUTHOR]

Introduction. Considering the high prevalence and very difficult treatment of talus osteochondral lesions and uncertainty regarding the exact cause of this type of lesion in the ankle, it is necessary to investigate the accompanying factors. Therefore, using MRI images, this retrograde study was designed to investigate the frequency of chronic ligament injuries in patients with talus osteochondral lesions. Methods. In a case-control study, 34 MRIs with evidence of osteochondral injury and 25 MRIs without OCD were collected by examining MRIs of the last three years. All MRIs were reviewed for ligament and syndesmosis, and the OCD type and characteristics, including the lesion diameter, anatomical location, type, and depth, were recorded. The study population characteristics were completed using the relevant checklist and pre-existing information. Data were analyzed using SPSS software version 24. Results. The mean age was 36.2 ± 12.9 and 41.5 ± 11.9 in the case and control groups (p = 0.118). There was no significant difference in gender between groups. ATFL, AITFL, and CFL ligaments with a frequency of 61.8%, 44.1%, and 32.4% in the case group and 44%, 24%, and 16% in controls were the most common concomitant detected ligament injuries. Also, the medial and middle regions were the most common OCD sites, with a rate of 88% and 76%, respectively. Conclusions. The present study indicated more ligament injuries in patients with OCD than in the control group. [ABSTRACT FROM AUTHOR]

Lateral ankle ligament reconstruction (LALR) is fundamental to avoid instability and the risk of osteoarthritis. After surgery, deficits in muscular strength and the proprioceptive system lead to functional changes. This study aimed to investigate if proprioceptive and isokinetic training can be incorporated to manage a professional soccer player after LALR. A 25-year-old professional soccer player, who injured his right ankle while playing, participated in the study. An MRI revealed partial rupture of the anterior talofibular ligament and associated fracture of the posterolateral distal fibular. Three months after the reconstruction surgery, the participant performed 20 sessions of isokinetic training along with 10 proprioceptive exercises. Outcomes were isokinetic inversion and eversion variables in concentric mode at 60, 120, and 240°/s (during the isokinetic phase – sustained velocity), postural sway (assessed in single-limb stance, using a force platform), and physical function (Foot and Ankle Ability Measure (FAAM) and the Lower Extremity Functional Scale (LEFS)). Post-treatment, the sustained velocity increased by ∼6% and decreased by 3% in the other isokinetic phases in inversion and eversion. At 60°/s, the Peak Torque/Body Mass for the evertor muscle was 30% higher post-treatment. Center of Pressure (CoP) data with eyes open showed a decrease for anteroposterior dispersions and displacement. The FAAM (sports sub-section) and LEFS increased by 15.6 and 9 points, respectively. Isokinetic and proprioceptive training improved postural control parameters, physical function, and inversion and eversion isokinetic variables in a professional soccer player after lateral ligament reconstruction. [ABSTRACT FROM AUTHOR]