Foot and Ankle Ability Measure Scores in Patients with Chronic Ankle Instability Following Joint Mobilization

2013 ◽  
Vol 18 (2) ◽  
pp. 4-7 ◽  
Author(s):  
Megan N. Houston ◽  
Patrick O. McKeon ◽  
Matthew C. Hoch
Keyword(s):  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Functional Impairments ◽  
Talocrural Joint ◽  
Physically Active ◽  
Joint Mobilization ◽  
Heavy Work ◽  
Ability Measure

Context:Following joint mobilizations, individuals with chronic ankle instability (CAI) have reported increased self-reported function as measured by the Foot and Ankle Ability Measure (FAAM).Objective:To examine the effect of a 2-week talocrural joint mobilization intervention on individual items of the FAAM in physically active adults with CAI.Participants:Twelve adults with CAI.Intervention:Self-reported function was documented with the FAAM-ADL and FAAM-Sport at preintervention and at 1-week postintervention. The joint mobilization intervention consisted of six treatments over 2 weeks. During each treatment, subjects received 4 minutes of talocrural traction and 8 minutes of Maitland Grade-III anterior-to-posterior talocrural joint mobilization.Main Outcome Measures:Participants completed the 21-item FAAM-ADL and 8-item FAAM-Sport.Results:Signifcant changes were detected between preintervention and 1-week follow-up measures for “Walking on even ground” (p= 0.06), “Going down stairs” (p= 0.07), “Walking on uneven ground” (p= 0.03), “Light to moderate work” (p= 0.06), “Heavy work” (p= 0.03), “Recreational activity” (p= 0.07), “Landing” (p= 0.03), “Low impact activities” (p= 0.07), and “Cutting” (p= 0.02). No signifcant changes were identifed in the other 20 items (p> 0.10).Conclusion:The fndings suggest talocrural joint mobilization may address specifc mechanical and functional impairments associated with the aforementioned tasks during physical activity.

Effect of a 2-Week Joint-Mobilization Intervention on Single-Limb Balance and Ankle Arthrokinematics in Those With Chronic Ankle Instability

2014 ◽  
Vol 23 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Matthew C. Hoch ◽  
David R. Mullineaux ◽  
Richard D. Andreatta ◽  
Robert A. English ◽  
Jennifer M. Medina-McKeon ◽  
...  
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Talocrural Joint ◽  
Joint Mobilization ◽  
Multiple Treatment ◽  
Eyes Open

Context:A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.Objective:To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.Design:Repeated measures.Setting:Research laboratory.Participants:12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).Intervention:Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.Main Outcome Measures:Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.Results:No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).Conclusions:The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Cameron J. Powden ◽  
Kathleen K. Hogan ◽  
Erik A. Wikstrom ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Chronic Ankle Instability ◽  
Physical Contact ◽  
Future Research ◽  
Talocrural Joint ◽  
Sham Condition

Context:Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).Objective:Examine the immediate effects of talocrural joint traction in those with CAI.Design:Blinded, crossover.Setting:Laboratory.Participants:Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering “yes” to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.Intervention:Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.Main Outcome Measures:The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.Results:No significant treatment effects were identified for any variables.Conclusion:A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

The Immediate Effects of an Anterior-To-Posterior Talar Mobilization on Neural Excitability, Dorsiflexion Range of Motion, and Dynamic Balance in Patients With Chronic Ankle Instability

2014 ◽  
Vol 23 (4) ◽  
pp. 351-359 ◽  
Author(s):  
Matthew Harkey ◽  
Michelle McLeod ◽  
Ashley Van Scoit ◽  
Masafumi Terada ◽  
Michael Tevald ◽  
...  
Keyword(s):  
Postural Control ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Corticospinal Excitability ◽  
Spinal Reflex ◽  
Control Group ◽  
Joint Mobilization ◽  
Grade Iii

Context:Altered neuromuscular function and decreased dorsiflexion range of motion (DFROM) have been observed in patients with chronic ankle instability (CAI). Joint mobilizations are indicated for restoring DFROM and dynamic postural control, yet it remains unknown if a mobilization can alter neuromuscular excitability in muscles surrounding the ankle.Objective:To determine the immediate effects of a Maitland grade III anterior-to-posterior joint mobilization on spinal-reflex and corticospinal excitability in the fibularis longus (FL) and soleus (SOL), DFROM, and dynamic postural control.Design:Single-blinded randomized control trial.Setting:Research laboratory.Patients:30 patients with CAI randomized into a mobilization (n = 15) or control (n = 15) group.Intervention:Maitland grade III anterior-to-posterior joint mobilization.Main Outcome Measures:Spinal-reflex excitability was measured with the Hoffmann reflex, while corticospinal excitability was evaluated with transcranial magnetic stimulation. DFROM was measured seated with the knee extended, and dynamic postural control was quantified with the Star Excursion Balance Test. Separate 2 × 2 repeated-measures ANOVAs were performed for each outcome measure. Dependent t tests were used to evaluate individual differences within groups in the presence of significance.Results:Spinal-reflex and corticospinal excitability of the SOL and FL were not altered in the mobilization or control group (P > .05). DFROM increased immediately after the mobilization (P = .05) but not in the control group, while dynamic postural control was unchanged in both groups (P > .05).Conclusion:A single joint-mobilization treatment was efficacious at restoring DFROM in participants with CAI; however, excitability of spinal reflex and corticospinal pathways at the ankle and dynamic postural control were unaffected.

scholarly journals Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function

2017 ◽  
Vol 52 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Erik A. Wikstrom ◽  
Patrick O. McKeon
Keyword(s):  
Ankle Instability ◽  
Weight Bearing ◽  
Treatment Success ◽  
Chronic Ankle Instability ◽  
Response Analysis ◽  
Controlled Clinical Trial ◽  
Foot And Ankle ◽  
Minimally Clinically Important Difference ◽  
Medicine Research ◽  
Ability Measure

Context:  Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)–associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. Objective:  To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. Design:  Secondary analysis of a randomized controlled clinical trial. Setting:  Sports medicine research laboratories. Patients or Other Participants:  Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. Intervention(s):  Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. Main Outcome Measure(s):  Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure–Sport (FAAM–S). Results:  Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM–S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM–S improvements from AJM. Patients &lt;22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM–S improvement after PM. Also, those who made ≥2 single-limb–stance errors had a 98% probability of a meaningful FAAM–S improvement from PM. Patients with ≤53.1% on the FAAM–S had an 83% probability of a meaningful FAAM–S improvement after CS. Conclusions:  Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and &lt;5 previous sprains. Age, weight-bearing–dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.

Altered Plantar-Receptor Stimulation Impairs Postural Control in Those With Chronic Ankle Instability

2012 ◽  
Vol 21 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Patrick O. McKeon ◽  
Alex J. Stein ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Physically Active ◽  
Plantar Surface ◽  
Eyes Closed ◽  
Eyes Open ◽  
Sensorimotor Mechanisms ◽  
Control Sham

Context:Postural control as assessed via time-to-boundary (TTB) measures has been shown to be impaired in those with chronic ankle instability (CAI). Foot orthotics have been shown to improve postural control, although it is not clear if this is via mechanical or sensorimotor mechanisms.Objective:To assess the effect of textured shoe inserts that provide no mechanical support on postural control as assessed by TTB measures in subjects with CAI.Design:A crossover design to examine the effects of a textured insole on postural control in individuals with unilateral CAI. The independent variables were vision (eyes open, eyes closed) and texture (textured insole, sham insole, control).Setting:Laboratory.Participants:20 physically active individuals, 12 men, 8 women, age 18–45 y (21.5 ± 5.51) with self-reported CAI.Intervention:Each subject balanced in shod single-limb stance with eyes open and eyes closed under 3 conditions (control, sham, and textured insole). The order of testing under the 3 shoe conditions and 2 vision conditions was counterbalanced.Main Outcome Measures:The mean of TTB minima and the standard deviation of TTB minima in the mediolateral (ML) and anteroposterior directions.Results:There were significant reductions in TTB ML magnitude and variability found in the textured condition compared with the control and sham conditions. In the textured condition, subjects failed significantly more trials than any other condition.Conclusions:Stimulating the plantar surface of the foot, via a textured insole, has an effect in the broad spectrum of postural-control maintenance in individuals with CAI.

scholarly journals Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092737 ◽  
Author(s):  
Christopher J. Holland ◽  
Jonathan D. Hughes ◽  
Mark B.A. De Ste Croix
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Mixed Model ◽  
Female Athletes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Treatment Groups ◽  
Joint Mobilization ◽  
All Treatment

Background: Chronic ankle instability (CAI) is linked to mechanical and functional insufficiencies. Joint mobilization is purported to be effective at treating these deficits. Purpose: To examine the effect of different treatment durations of a grade IV anterior-to-posterior ankle joint mobilization on weightbearing dorsiflexion range of motion (WB-DFROM), posterior talar glide (PG), and dynamic postural control in individuals with CAI. Study Design: Controlled laboratory study. Methods: A total of 48 female athletes (mean age, 22.8 ± 4.8 years) with unilateral CAI participated in this study. Participants were randomly assigned to 1 of 3 treatment conditions: 30 seconds, 60 seconds, and 120 seconds. Treatment was provided to the injured limb on 3 separate occasions 48 hours apart and consisted of a Maitland grade IV anterior-to-posterior talar joint mobilization based on the participant’s initial group assignment. WB-DFROM; PG; and the anterior (ANT), posteromedial (PM), and posterolateral (PL) reach directions of the Star Excursion Balance Test were measured bilaterally before and after each treatment. The uninjured limb acted as a control. Data were analyzed using 2-way mixed-model analyses of variance, and effect sizes were calculated through use of Hedges g. Results: Significant differences were detected after all treatment sessions for all outcome measures ( P ≤ .001) and between treatment groups after sessions 1, 2, and 3 for all outcome measures ( P ≤ .001). Effect sizes were very large or huge for all treatment groups for WB-DFROM, PG, and ANT reach direction. Substantial variation was found in effect sizes for PM and PL measures. Conclusion: Accessory mobilization is an effective treatment to induce acute changes in ankle motion and dynamic postural control in patients with CAI, with longer treatment durations conferring greater improvements. Clinical Relevance: This study adds clarity to the use of joint mobilization treatments and will add to the current clinical practice strategy for patients with CAI.

scholarly journals Validity of the Foot and Ankle Ability Measure in Athletes With Chronic Ankle Instability

2008 ◽  
Vol 43 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Christopher R. Carcia ◽  
RobRoy L. Martin ◽  
Joshua M. Drouin
Keyword(s):  
Athletic Training ◽  
National Collegiate Athletic Association ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Functional Deficits ◽  
Outcome Instrument ◽  
Global Ratings ◽  
Specific Outcome ◽  
Ability Measure

Abstract Context: The Foot and Ankle Ability Measure (FAAM) is a region-specific, non–disease-specific outcome instrument that possesses many of the clinimetric qualities recommended for an outcome instrument. Evidence of validity to support the use of the FAAM is available in individuals with a wide array of ankle and foot disorders. However, additional evidence to support the use of the FAAM for those with chronic ankle instability (CAI) is needed. Objective: To provide evidence of construct validity for the FAAM based on hypothesis testing in athletes with CAI. Design: Between-groups comparison. Setting: Athletic training room. Patients or Other Participants: Thirty National Collegiate Athletic Association Division II athletes (16 men, 14 women) from one university. Main Outcome Measure(s): The FAAM including activities of daily living (ADL) and sports subscales and the global and categorical ratings of function. Results: For both the ADL and sports subscales, FAAM scores were greater in healthy participants (100 ± 0.0 and 99 ± 3.5, respectively) than in subjects with CAI (88 ± 7.7 and 76 ± 12.7, respectively; P &lt; .001). Similarly, for both ADL and sports subscales, FAAM scores were greater in athletes who indicated that their ankles were normal (98 ± 6.3 and 96 ± 6.9, respectively) than in those who classified their ankles as either nearly normal or abnormal (87 ± 6.6 and 71 ± 11.1, respectively; P &lt; .001). We found relationships between FAAM scores and self-reported global ratings of function for both ADL and sports subscales. Relationships were stronger when all athletes, rather than just those with CAI, were included in the analyses. Conclusions: The FAAM may be used to detect self-reported functional deficits related to CAI.

scholarly journals Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures

2018 ◽  
Vol 53 (6) ◽  
pp. 578-583 ◽  
Author(s):  
Emily A. Hall ◽  
Andrea K. Chomistek ◽  
Jackie J. Kingma ◽  
Carrie L. Docherty
Keyword(s):  
Strength Training ◽  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Physically Active ◽  
Fear Avoidance Beliefs ◽  
Patient Reported ◽  
Ability Measure ◽  
Training Protocol

Context:  Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding the effectiveness of clinical interventions. Objective:  To determine the improvement of patient-reported outcomes after balance- and strength-training and control protocols among participants with CAI. Design:  Randomized controlled clinical trial. Setting:  Athletic training research laboratory. Patients or Other Participants:  Thirty-nine volunteers with CAI who scored 11 or greater on the Identification of Functional Ankle Instability questionnaire were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). Intervention(s):  Each group met for 20 minutes, 3 times each week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. Main Outcome Measure(s):  Global patient-reported outcomes, regional ankle function, and perceived instability were measured using the Disablement in the Physically Active Scale, the Fear-Avoidance Beliefs Questionnaire, the Foot and Ankle Ability Measure, and a visual analog scale for perceived instability. Participants completed the questionnaires at pretest and 6 weeks posttest. A multivariate repeated-measures analysis of variance with follow-up univariate analysis was conducted. The α level was set a priori at .05. Results:  No time-by-group interaction was found (P = .78, η2 = 0.09). However, we observed a main effect for time (P = .001, η2 = 0.49). Follow-up univariate analyses revealed differences between the pretest and posttest for the Disablement in the Physically Active Scale (P = .02, η2 = 0.15), Fear-Avoidance Beliefs Questionnaire (P = .001, η2 = 0.27), Foot and Ankle Ability Measure–Activities of Daily Living subscale (P = .003, η2 = 0.22), Foot and Ankle Ability Measure–Sport subscale (P = .001, η2 = 0.36), and visual analog scale (P = .008, η2 = 0.18). Conclusions:  Statistically, after the 6-week intervention, all groups improved in global and regional health-related quality of life. Clinicians should compare patient-reported outcomes with clinical measures to have a better understanding of progression during rehabilitation.

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