Is subtle cavus foot a risk factor for chronic ankle instability? Comparison of prevalence of subtle cavus foot between chronic ankle instability and control group on the standing lateral radiograph

Background: Individuals with chronic ankle instability (CAI) have demonstrated strength deficits compared to healthy controls; however, the influence of ankle position on force measures and surface electromyography (sEMG) activation of the peroneus longus and brevis has not been investigated. The purpose of this study was to compare sEMG amplitudes of the peroneus longus and brevis and eversion force measures in 2 testing positions, neutral and plantarflexion, in groups with and without CAI. Methods: Twenty-eight adults (19 females, 9 males) with CAI and 28 healthy controls (19 females, 9 males) participated. Hand-held dynamometer force measures were assessed during isometric eversion contractions in 2 testing positions (neutral, plantarflexion) while surface sEMG amplitudes of the peroneal muscles were recorded. Force measures were normalized to body mass, and sEMG amplitudes were normalized to a resting period. Results: The group with CAI demonstrated less force when compared to the control group ( P < .001) in both the neutral and plantarflexion positions: neutral position, CAI: 1.64 Nm/kg and control: 2.10 Nm/kg) and plantarflexion position, CAI: 1.40 Nm/kg and control: 1.73 Nm/kg). There were no differences in sEMG amplitudes between the groups or muscles ( P > .05). Force measures correlated with both muscles’ sEMG amplitudes in the healthy group (neutral peroneus longus: r = 0.42, P = .03; plantarflexion peroneus longus: r = 0.56, P = .002; neutral peroneus brevis: r = 0.38, P = .05; plantarflexion peroneus longus: r = 0.40, P = .04), but not in the group with CAI ( P > .05). Conclusions: The group with CAI generated less force when compared to the control group during both testing positions. There was no selective activation of the peroneal muscles with testing in both positions, and force output and sEMG activity was only related in the healthy group. Clinical relevance: Clinicians should assess eversion strength and implement strength training exercises in different sagittal plane positions and evaluate for other pathologies that may contribute to reduced eversion strength in patients with CAI. Level of Evidence: Level III, cross-sectional

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Analysis of Ankle Laxity, Self-reported Function, and Perceived Instability in Chronic Ankle Instability, Coper, and Control Groups

Exercise Science ◽

10.15857/ksep.2021.30.1.43 ◽

2021 ◽

Vol 30 (1) ◽

pp. 43-51

Author(s):

Hongsuk Lee ◽

Hyunsoo Kim ◽

Ty Hopkins ◽

S. Jun Son

Keyword(s):

Ankle Instability ◽

Pearson Correlation ◽

Frontal Plane ◽

Static Stability ◽

Chronic Ankle Instability ◽

Control Group ◽

Control Groups ◽

Ankle Arthrometer ◽

Ankle Function ◽

And Control

PURPOSE:This study aimed to identify differences in ankle laxity in chronic ankle instability (CAI), coper, and control groups, and a correlation between ankle laxity, self-reported function, and perceived instability.METHODS: Sixty-six participants (22 CAI patients, 22 copers, and 22 controls) selected by recommendations of the International Ankle Consortium volunteered for this study. Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sports, and Ankle Instability Instrument (AII) were used to assess participants’ self-reported function and perceived instability. The FAAMADL and FAAM-Sports are reported as a percentage. Higher scores indicate better function. The AII is reported as “yes” responses while more “yes” responses indicate higher instability. Three trials of anterior/posterior (A/P) displacement and inversion/eversion (I/E) displacement were assessed by an instrumented ankle arthrometer. Greater displacement indicates higher laxity. The ankle positioned in sagittal- and frontal-plane neutral while A/P and I/E displacement were assessed with 125 N and 4 N-m, respectively. The means of three trials were used for data analysis. One-way ANOVA and Tukey post-hoc comparisons (α=0.05) were performed to identify differences in ankle laxity between groups. Pearson correlation analysis was performed to identify a relationship between ankle laxity, self-reported function, and perceived instability.RESULTS: CAI patients show greater A/P displacement compared to control group (p<.03), and greater I/E displacement compared to coper and control groups (p<.03). Several positive and negative correlations were found between ankle laxity, self-reported function, and perceived instability (p<.00).CONCLUSIONS: As self-reported function and perceived instability are correlated with greater laxity (I/E displacement), improving static stability (ankle laxity) may play an important role in improving perceived ankle function and instability in CAI.

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Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

Foot & Ankle International ◽

10.1177/1071100721997070 ◽

2021 ◽

pp. 107110072199707

Author(s):

Yasunari Ikuta ◽

Tomoyuki Nakasa ◽

Junichi Sumii ◽

Akinori Nekomoto ◽

Nobuo Adachi

Keyword(s):

Ankle Instability ◽

Ct Images ◽

Chronic Ankle Instability ◽

Control Group ◽

Deltoid Ligament ◽

Anterior Talofibular Ligament ◽

Mri Findings ◽

Calcaneofibular Ligament ◽

Level Of Evidence ◽

Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

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Prelanding movement strategies among chronic ankle instability, coper, and control subjects

Sports Biomechanics ◽

10.1080/14763141.2021.1927163 ◽

2021 ◽

pp. 1-17

Author(s):

Seunguk Han ◽

Seong Jun Son ◽

Hyunsoo Kim ◽

Hyunwook Lee ◽

Matthew Seeley ◽

...

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

Control Subjects ◽

Movement Strategies ◽

And Control

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Bilateral Proprioceptive Evaluation in Individuals With Unilateral Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-52.2.08 ◽

2017 ◽

Vol 52 (4) ◽

pp. 360-367 ◽

Cited By ~ 11

Author(s):

Andreia S. P. Sousa ◽

João Leite ◽

Bianca Costa ◽

Rubim Santos

Keyword(s):

Outcome Measure ◽

Ankle Instability ◽

Position Sense ◽

Chronic Ankle Instability ◽

Joint Position Sense ◽

Control Group ◽

Injured Limb ◽

History Of ◽

Ankle Proprioception ◽

Force Sense

Context: Despite extensive research on chronic ankle instability, the findings regarding proprioception have been conflicting and focused only on the injured limb. Also, the different components of proprioception have been evaluated in isolation. Objective: To evaluate bilateral ankle proprioception in individuals with unilateral ankle instability. Design: Cohort study. Setting: Research laboratory center in a university. Patients or Other Participants: Twenty-four individuals with a history of unilateral ankle sprain and chronic ankle instability (mechanical ankle instability group, n = 10; functional ankle instability [FAI] group, n = 14) and 20 controls. Main Outcome Measure(s): Ankle active and passive joint position sense, kinesthesia, and force sense. Results: We observed a significant interaction between the effects of limb and group for kinesthesia (F = 3.27, P = .049). Increased error values were observed in the injured limb of the FAI group compared with the control group (P = .031, Cohen d = 0.47). Differences were also evident for force sense (F = 9.31, P < .001): the FAI group demonstrated increased error versus the control group (injured limb: P < .001, Cohen d = 1.28; uninjured limb: P = .009, Cohen d = 0.89) and the mechanical ankle instability group (uninjured limb: P = .023, Cohen d = 0.76). Conclusions: Individuals with unilateral FAI had increased error ipsilaterally (injured limb) for inversion movement detection (kinesthesia) and evertor force sense and increased error contralaterally (uninjured limb) for evertor force sense.

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Perceptions of caregivers on immunization in Ntungamo district, Uganda

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214559 ◽

2021 ◽

Vol 8 (12) ◽

pp. 5729

Author(s):

Byamukama Topher ◽

Keraka M. Margaret ◽

Gitonga Eliphas

Keyword(s):

Risk Factor ◽

Intervention Group ◽

Cost Effective ◽

Systematic Sampling ◽

Control Group ◽

Post Intervention ◽

Mortality And Morbidity ◽

Significant Difference ◽

Quasi Experimental ◽

And Control

Background: Immunization is one of the most cost-effective public health interventions to reduce child mortality and morbidity associated with infectious diseases. The objective of this study was to determine the perceptions of caregivers on immunization in Ntungamo district.Methods: Quasi-experimental study was used with health centres assigned to intervention and control groups. Purposive sampling was used to select the two counties where the study was done. Proportional sampling was done to get study samples from each health facility, while systematic sampling was done to get study participants. A total of 787 children from twelve health facilities provided the study sample. A post intervention evaluation was conducted to determine the effect of these interventions. Association of variables was tested using Mann Whitney U-test and Chi-square.Results: On benefits, most caregivers in the intervention group (85.3%) and in the control group (54.3%) regarded immunization as very highly and moderately beneficial to their children respectively. On risks, most caregivers in the intervention group (85.5%) and control group (43.1%) regarded the risk factor associated with immunization as very low and moderate respectively. From hypothesis testing, there was a significant difference on the perceived benefits and risks of immunization between the intervention and control group.Conclusions: Most caregivers in the intervention and control group regarded immunization as very highly beneficial and moderately to their children respectively. Most of the caregivers in the intervention and control group regarded the risk factor associated with immunization as very low and moderate respectively.

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Strength-Training Protocols to Improve Deficits in Participants With Chronic Ankle Instability: A Randomized Controlled Trial

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.71 ◽

2015 ◽

Vol 50 (1) ◽

pp. 36-44 ◽

Cited By ~ 44

Author(s):

Emily A. Hall ◽

Carrie L. Docherty ◽

Janet Simon ◽

Jackie J. Kingma ◽

Joanne C. Klossner

Keyword(s):

Strength Training ◽

Visual Analog Scale ◽

Ankle Instability ◽

Controlled Trial ◽

Chronic Ankle Instability ◽

Control Group ◽

Analog Scale ◽

Protocol Group ◽

Proprioceptive Neuromuscular Facilitation ◽

Hop Test

Context: Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. Objective: To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. Design: Randomized controlled trial. Setting: Athletic training research laboratory. Patients or Other Participants: A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band–protocol group (n = 13 [33%] age = 19.7 ± 2.2 years, height = 172.9 ± 12.8 cm, weight = 69.1 ± 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 [33%], age = 18.9 ± 1.3 years, height = 172.5 ± 5.9 cm, weight = 72.7 ± 14.6 kg), or a control group (n = 13 [33%], age = 20.5 ± 2.1 years, height = 175.2 ± 8.1 cm, weight = 70.2 ± 11.1 kg). Intervention(s): Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions. Main Outcome Measure(s): Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. Results: The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (P < .05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (P < .05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (P > .05). Conclusions: Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.

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Placental Vascular Obstructive Lesions: Risk Factor for Developing Necrotizing Enterocolitis

Pathology Research International ◽

10.4061/2010/838917 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Laure Dix ◽

Matthias Roth-Kleiner ◽

Maria-Chiara Osterheld

Keyword(s):

Risk Factor ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Strong Association ◽

Age Groups ◽

Control Group ◽

Age Group ◽

Significant Difference ◽

And Control

Necrotizing enterocolitis (NEC) is a severe neonatal disease affecting particularly preterm infants. Its exact pathogenesis still remains unknown. In this study, we have compared the prevalence of vascular obstructive lesions in placentae of premature newborns which developed NEC and of a control group. We further compared separately the findings of placentae of infants of less than 30 weeks of gestation, the age group in which NEC occurs most frequently. We found signs of fetal vascular obstructive lesions in 65% of the placentae of preterm patients developing NEC, compared to only 17% of the placentae of preterm patients in the control group. In the age groups below 30 weeks of gestation, 58.5% of placentae of later NEC patients presented such lesions compared to 24.5% in the control group. The significant difference between NEC and control group suggests a strong association between fetal vascular obstructive lesions and NEC. Therefore, we propose that fetal vascular obstructive lesions might be considered as a risk factor for the development of NEC in premature infants.

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Evaluation of Joint Position Recognition Measurement Variables Associated With Chronic Ankle Instability: A Meta-Analysis

Journal of Athletic Training ◽

10.4085/1062-6050-47.4.15 ◽

2012 ◽

Vol 47 (4) ◽

pp. 444-456 ◽

Cited By ~ 29

Author(s):

Jennifer M. Medina McKeon ◽

Patrick O. McKeon

Keyword(s):

Ankle Instability ◽

Meta Analysis ◽

Plantar Flexion ◽

Absolute Error ◽

Chronic Ankle Instability ◽

Effect Sizes ◽

Control Group ◽

Neutral Position ◽

Joint Position ◽

Standard Deviations

Objective To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI). Data Sources We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals. Study Selection Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes. Data Extraction Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study. Data Synthesis Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5°/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.

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Chronic Ankle Instability Impairs Submaximal Force Steadiness and Accuracy

Journal of Athletic Training ◽

10.4085/15-20 ◽

2020 ◽

Author(s):

Hyunwook Lee ◽

S. Jun Son ◽

Hyunsoo Kim ◽

Seunguk Han ◽

Matthew Seeley ◽

...

Keyword(s):

Visual Information ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Feedback Mechanism ◽

Controlled Study ◽

Control Group ◽

Force Output ◽

Force Steadiness ◽

Lower Accuracy ◽

Accuracy Measure

Abstract Context: Patients with chronic ankle instability (CAI) have demonstrated sensorimotor impairments. Submaximal force steadiness and accuracy measure sensory, motor, and visual function via a feedback mechanism, which helps researchers and clinicians to comprehend sensorimotor deficits associated with CAI. Objective: To determine if participants with chronic ankle instability experience deficits in hip and ankle submaximal force steadiness and accuracy compared to healthy controls. Design: A case-controlled study Setting: Research Laboratory Patients and Other Participants: Twenty-one CAI patients and 21 uninjured controls participated in this study. Intervention(s): n/a. Main Outcome Measure(s): Maximal voluntary isometric contraction (MVIC), force steadiness and accuracy (10% and 30% of their MVIC) of ankle evertors, invertors, and hip abductors. The central 10-sec (20–87% of the total time) of the 3 trials were analyzed. An independent t-test was used to assess MVIC. Two-way, 2 × 3, ANOVAs were used to assess force steadiness and accuracy. Results: Relative to controls, the CAI group demonstrated lower accuracy in invertors (p =.0006). Across all motions, the CAI group showed less steadiness (p = .0005) and lower accuracy (p = .0074) than the controls in 10% MVIC. In terms of MVIC, the CAI group showed less force output in hip abduction compared with the control group (p < .0001). Conclusions: CAI patients showed an inability to control ongoing fine force (10% and 30% of their MVIC) through a feedback mechanism during an active test. These findings suggest deficits in sensorimotor control that lead CAI patients to be more susceptible to injury positions since they have difficulty integrating the peripheral information and correcting their movement in relation to visual information.

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