A Novel Dynamic Ankle-Supinating Device

2010 ◽  
Vol 26 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Gregory M. Gutierrez ◽  
Thomas Kaminski
Keyword(s):  
Ankle Instability ◽  
Control Strategies ◽  
Neuromuscular Control ◽  
Biomechanical Analysis ◽  
Ankle Sprains ◽  
Compensatory Mechanisms ◽  
Lateral Ankle ◽  
History Of ◽  
Underlying Causes ◽  
Insight Into

Lateral ankle sprains (LAS) are among the most common joint injuries, and although most are resolved with conservative treatment, others develop chronic ankle instability (AI). Considerable attention has been directed toward understanding the underlying causes of this pathology; however, little is known concerning the neuromuscular mechanisms behind AI. A biomechanical analysis of the landing phase of a drop jump onto a device that simulates the mechanism of a LAS may give insight into the dynamic restraint mechanisms of the ankle by individuals with AI. Furthermore, work evaluating subjects who have a history of at least one lateral ankle sprain, yet did not develop AI, may help elucidate compensatory mechanisms following a LAS event. Identifying proper neuromuscular control strategies is crucial in reducing the incidence of AI.

scholarly journals Evaluating and Differentiating Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 617-627 ◽  
Author(s):  
Phillip A. Gribble
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
High Rate ◽  
Diagnostic Tools ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
The Status ◽  
History Of ◽  
Ankle Complex

Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.

Use of Cadaveric Graft in Reconstruction of Peroneus Brevis Rupture and Lateral Ankle Instability

2019 ◽  
Vol 109 (1) ◽  
pp. 70-74
Author(s):  
Cory P. Clement ◽  
Ronald Guberman ◽  
Edward Lee ◽  
Lady P. DeJesus
Keyword(s):  
Ankle Instability ◽  
Ankle Sprains ◽  
Peroneus Longus Tendon ◽  
Lateral Ankle ◽  
Peroneus Longus ◽  
Lateral Ankle Instability ◽  
History Of ◽  
Peroneus Brevis ◽  
End To End

This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral tears. She had a history of multiple ankle sprains and had previously undergone a failed peroneus brevis tendon retubularization procedure. The use of cadaver graft is well documented in the literature for tendon repairs but not well documented in end-to-end repair of the peroneal tendons. A review of the literature revealed only one 2013 study reporting on the benefits and clinical outcomes of cadaver allograft use in peroneal reconstruction.

scholarly journals Lateral Ankle Sprain and Chronic Ankle Instability

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984693 ◽  
Author(s):  
Aida K. Sarcon ◽  
Nasser Heyrani ◽  
Eric Giza ◽  
Christopher Kreulen
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Invasive Procedures ◽  
Clinical Tests ◽  
Level Of Evidence ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
History Of

A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle “giving way” with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle’s biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications. Level of Evidence: Level V, expert opinion.

Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability

2019 ◽  
Vol 41 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Muhammet Baybars Ataoğlu ◽  
Mehmet Ali Tokgöz ◽  
Anıl Köktürk ◽  
Yılmaz Ergişi ◽  
Mustafa Yasin Hatipoğlu ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Pearson Correlation ◽  
Clear Understanding ◽  
Ankle Sprains ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Talocrural Joint ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Tibiofibular Joint

Background: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. Methods: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length ( a), posterior facet length ( b), angle between the anterior and posterior facets ( c), fibular notch depth ( d), tibia thickness ( e), and fibula thickness ( f) was measured. Results: It was found that instability was more frequent when the length of a ( P < .001) and e ( P < .001) were shorter. In addition, when value of a/ b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller ( P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a- e and instability ( r = −0.348, P < .001, and r = −0.328, P = .001; respectively). Conclusion: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet ( a) and thinner tibia ( e) were strongly correlated with lateral ankle instability. Level of Evidence: Level III, retrospective case control study.

scholarly journals Surgical Management of Lateral Ankle Instability in Athletes

2019 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Luis D. Camacho ◽  
Zachary T. Roward ◽  
Yu Deng ◽  
L. Daniel Latt
Keyword(s):  
Surgical Management ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Ankle Sprains ◽  
Functional Rehabilitation ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Initial Surgery ◽  
Lateral Ankle Ligaments

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

Effects of Inversion Perturbation After Step-Down on the Latency of the Peroneus Longus and Peroneus Brevis

2011 ◽  
Vol 27 (4) ◽  
pp. 283-290 ◽  
Author(s):  
Adam C. Knight ◽  
Wendi H. Weimar
Keyword(s):  
Ankle Sprain ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneus Longus ◽  
Significant Difference ◽  
History Of ◽  
Step Down ◽  
Peroneus Brevis ◽  
High Ankle Sprain

The purpose of this investigation was to determine the effect of different types of ankle sprains on the response latency of the peroneus longus and peroneus brevis to an inversion perturbation, as well as the time to complete the perturbation (time to maximum inversion). To create a forced inversion moment of the ankle, an outer sole with fulcrum was used to cause 25 degrees of inversion at the ankle upon landing from a 27 cm step-down task. Forty participants completed the study: 15 participants had no history of any ankle sprain, 15 participants had a history of a lateral ankle sprain, and 10 participants had a history of a high ankle sprain. There was not a significant difference between the injury groups for the latency measurements or the time to maximum inversion. These findings indicate that a previous lateral ankle sprain or high ankle sprain does not affect the latency of the peroneal muscles or the time to complete the inversion range of motion.

scholarly journals Gait Kinematics After Taping in Participants With Chronic Ankle Instability

2014 ◽  
Vol 49 (3) ◽  
pp. 322-330 ◽  
Author(s):  
Lisa Chinn ◽  
Jay Dicharry ◽  
Joseph M. Hart ◽  
Susan Saliba ◽  
Robert Wilder ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Gait Cycle ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Knee Kinematics ◽  
Chronic Ankle Instability ◽  
Mean Difference ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
Gait Kinematics

Context: Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics. Objective: To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability. Design: Controlled laboratory study. Setting: Motion analysis laboratory. Patients or Participants: A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain. Intervention(s): Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized. Main Outcome Measure(s): Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap. Results: During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found. Conclusions: In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in foot positioning and the mechanical properties of the tape may explain the protective aspect of taping in preventing lateral ankle sprains.

scholarly journals Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain

2011 ◽  
Vol 46 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Lindsey W. Klykken ◽  
Brian G. Pietrosimone ◽  
Kyung-Min Kim ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Motor Neuron ◽  
Ankle Sprain ◽  
Tibialis Anterior ◽  
Ankle Instability ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Leg Muscles ◽  
Motor Neuron Pool ◽  
Neuron Pool

Context: Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. Objective: To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Design: Case-control study. Setting: Laboratory. Patients or Other Participants: Ten individuals with acute ankle sprains (6 females, 4 males; age = 19.2 ± 3.8 years, height = 169.4 ± 8.5 cm, mass = 66.3 ±11.6 kg) and 10 healthy individuals (6 females, 4 males; age = 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass = 66.3 ± 10.2 kg) participated. Intervention(s): The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. Main Outcome Measure(s): The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (Hmax) and maximal muscle response (Mmax) and was then normalized using the Hmax:Mmax ratio. Results: The soleus MNPE in the ankle-sprain group was higher in the injured limb (Hmax:Mmax = 0.63; 95% confidence interval [CI], 0.46, 0.80) than in the uninjured limb (Hmax:Mmax = 0.47; 95% CI, 0.08, 0.93) (t6 = 3.62, P = .01). In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (Hmax:Mmax = 0.06; 95% CI, 0.01, 0.10) than in the uninjured ankle (Hmax:Mmax = 0.22; 95% CI, 0.09, 0.35), but this finding was not different (t9 = −2.01, P = .07). No differences were detected between injured (0.22; 95% CI, 0.14, 0.29) and uninjured (0.25; 95% CI, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t9 = −0.739, P = .48). We found no side-to-side differences in any muscle among the healthy group. Conclusions: Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles.

scholarly journals Systematic Review of Postural Control and Lateral Ankle Instability, Part I: Can Deficits Be Detected With Instrumented Testing?

2008 ◽  
Vol 43 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Patrick O. McKeon ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Increased Risk ◽  
Clinical Questions

Abstract Objective: To answer the following clinical questions: (1) Is poor postural control associated with increased risk of a lateral ankle sprain? (2) Is postural control adversely affected after acute lateral ankle sprain? (3) Is postural control adversely affected in those with chronic ankle instability? Data Sources: PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway. Study Selection: Only studies assessing postural control measures in participants on a stable force plate performing the modified Romberg test were included. To be included, a study had to address at least 1 of the 3 clinical questions stated above and provide adequate results for calculation of effect sizes or odds ratios where applicable. Data Extraction: We calculated odds ratios with 95% confidence intervals for studies assessing postural control as a risk factor for lateral ankle sprains. Effect sizes were estimated with the Cohen d and associated 95% confidence intervals for comparisons of postural control performance between healthy and injured groups, or healthy and injured limbs, respectively. Data Synthesis: Poor postural control is most likely associated with an increased risk of sustaining an acute ankle sprain. Postural control is impaired after acute lateral ankle sprain, with deficits identified in both the injured and uninjured sides compared with controls. Although chronic ankle instability has been purported to be associated with altered postural control, these impairments have not been detected consistently with the use of traditional instrumented measures. Conclusions: Instrumented postural control testing on stable force plates is better at identifying deficits that are associated with an increased risk of ankle sprain and that occur after acute ankle sprains than at detecting deficits related to chronic ankle instability.

Neuromuscular Control Training Does Not Improve Gait Biomechanics in Those With Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
Vol 25 (4) ◽  
pp. 165-169
Author(s):  
Kimmery Migel ◽  
Erik Wikstrom
Keyword(s):  
Ankle Instability ◽  
Balance Training ◽  
Neuromuscular Control ◽  
Chronic Ankle Instability ◽  
Program Completion ◽  
Ankle Sprains ◽  
Bottom Line ◽  
Gait Biomechanics ◽  
Rehabilitation Programs ◽  
Evidence Grade

Introduction/Clinical Scenario: Ankle sprains are highly common within the population and can lead to chronic ankle instability (CAI). Individuals with CAI have both functional and mechanical impairments, which are thought to contribute to maladaptive gait biomechanics. Neuromuscular control and balance training are frequently incorporated into rehabilitation programs, however the effect of balance training on gait biomechanics remains unknown. Focused Clinical Question: Does balance or neuromuscular training improve gait biomechanics in individuals with CAI? Summary of Key Findings: Three studies assessed 4–6 weeks of progressive neuromuscular control training and found no improvements in gait biomechanics. One study found a worsening of eversion position at midstance upon program completion. However, when training was augmented with destabilizing shoes, improvements in dorsiflexion were noted. Clinical Bottom Line: Cumulative findings suggest that neuromuscular control training does not improve gait biomechanics in those with CAI. However, augmentation of programs may be beneficial. Strength of Recommendation: There is high-quality evidence(Grade B) that balance training does not alter gait biomechanics in patients with CAI.

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