Ankle Strength Deficits in a Cohort of College Athletes With Chronic Ankle Instability

Context: Lateral ankle sprains commonly occur in an athletic population and can lead to chronic ankle instability. Objective: To compare ankle strength measurements in athletes who have mechanical laxity and report functional instability after a history of unilateral ankle sprains. Design: Retrospective cohort. Setting: Athletic Training Research Lab. Participants: A total of 165 National Collegiate Athletic Association Division I athletes, 97 males and 68 females, with history of unilateral ankle sprains participated. Main Outcome Measures: Functional ankle instability was determined by Cumberland Ankle Instability Tool scores and mechanical ankle instability by the participant having both anterior and inversion/eversion laxity. Peak torque strength measures, concentric and eccentric, in 2 velocities were measured. Results: Of the 165 participants, 24 subjects had both anterior and inversion/eversion laxity and 74 self-reported functional ankle instability on their injured ankle. The mechanical ankle instability group presented with significantly lower plantar flexion concentric strength at 30°/s (139.7 [43.7] N·m) (P = .01) and eversion concentric strength at 120°/s (14.8 [5.3] N·m) (P = .03) than the contralateral, uninjured ankle (166.3 [56.8] N·m, 17.4 [6.2] N·m, respectively). Conclusion: College athletes who present with mechanical laxity on a previously injured ankle exhibit plantar flexion and eversion strength deficits between ankles.

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Eccentric Plantar-Flexor Torque Deficits in Participants With Functional Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-43.1.51 ◽

2008 ◽

Vol 43 (1) ◽

pp. 51-54 ◽

Cited By ~ 56

Author(s):

Jason Fox ◽

Carrie L. Docherty ◽

John Schrader ◽

Trent Applegate

Keyword(s):

Athletic Training ◽

Ankle Instability ◽

Plantar Flexion ◽

Control Group ◽

Prior History ◽

Ankle Sprains ◽

Plantar Flexors ◽

Functional Ankle Instability ◽

Significant Difference ◽

History Of

Abstract Context: Inversion ankle sprains can lead to a chronic condition called functional ankle instability (FAI). Limited research has been reported regarding isokinetic measures for the plantar flexors and dorsiflexors of the ankle. Objective: To examine the isokinetic eccentric torque measures of the ankle musculature in participants with stable ankles and participants with functionally unstable ankles during inversion, eversion, plantar flexion, and dorsiflexion. Design: Case-control study. Setting: Athletic training research laboratory. Patients or Other Participants: Twenty participants with a history of “giving way” were included in the FAI group. Inclusion criteria for the FAI group included a history of at least 1 ankle sprain and repeated episodes of giving way. Twenty participants with no prior history of ankle injury were included in the control group. Intervention(s): Isokinetic eccentric torque was assessed in each participant. Main Outcome Measure(s): Isokinetic eccentric testing was conducted for inversion-eversion and plantar-flexion–dorsiflexion movements. Peak torque values were standardized to each participant's body weight. The average of the 3 trials for each direction was used for statistical analysis. Results: A significant side-by-group interaction was noted for eccentric plantar flexion torque (P < .01). Follow-up t tests revealed a significant difference between the FAI limb in the FAI group and the matched limb in the control group. Additionally, a significant difference was seen between the sides of the control group (P = .03). No significant interactions were identified for eccentric inversion, eversion, or dorsiflexion torques (P > .05). Conclusions: A deficit in plantar flexion torque was identified in the functionally unstable ankles. No deficits were identified for inversion, eversion, or dorsiflexion torque. Therefore, eccentric plantar flexion strength may be an important contributing factor to functional ankle instability.

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The Role of Ankle Strength in Functional Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.6.1.21 ◽

1997 ◽

Vol 6 (1) ◽

pp. 21-29 ◽

Cited By ~ 34

Author(s):

Cynthia M. McKnight ◽

Charles W. Armstrong

Keyword(s):

Range Of Motion ◽

Ankle Instability ◽

Plantar Flexion ◽

Normative Values ◽

Functional Ankle Instability ◽

Full Activity ◽

History Of ◽

Ankle Strength

The purpose of this study was to determine if there were any differences in ankle range of motion, strength, or work between persons with normal ankles (Normal,n= 14), those with functional ankle instability (FAI,n= 15), and those with a history of FAI who have been through formal proprioceptive rehabilitation (Rehab,n= 14). A second puipose was to determine normative values for ankle strength and work measurements using the Biodex® isokinetic system. There were no significant differences between groups for ankle range of motion or for any strength or work measurements. The overall strength/work averages were 11.75/3.42 for plantar flexion, 339/1.48 for dorsiflexion, 3.30/2.40 for inversion, and 2.62/1.79 for eversion. Dorsiflexion torque overall was 31.43% of plantar flexion, and the evertors produced 75.42% of the torque produced by the invertors. It is recommended that clinicians continue to rehabilitate ankles with strength and proprioceptive exercises but do not rely on ankle strength/work testing as the only criteria for determining an athlete's readiness to return to full activity.

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Evaluating and Differentiating Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-484-17 ◽

2019 ◽

Vol 54 (6) ◽

pp. 617-627 ◽

Cited By ~ 5

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.

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Gait Biomechanics Following Taping and Bracing in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0030 ◽

2020 ◽

Vol 29 (3) ◽

pp. 373-376

Author(s):

Kimmery Migel ◽

Erik Wikstrom

Keyword(s):

Range Of Motion ◽

Ankle Instability ◽

External Rotation ◽

Plantar Flexion ◽

Chronic Ankle Instability ◽

Ankle Sprains ◽

Case Control Studies ◽

Bottom Line ◽

Gait Biomechanics ◽

Evidence Grade

Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.

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Effects of a 4-Week Biomechanical Ankle Platform System Protocol on Balance in High School Athletes With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2015-0045 ◽

2017 ◽

Vol 26 (1) ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Mary Spencer Cain ◽

Stacy Watt Garceau ◽

Shelley W. Linens

Keyword(s):

High School ◽

Athletic Training ◽

Outcome Measures ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Ankle Sprains ◽

High School Athletes ◽

Balance Test ◽

Significant Group ◽

Platform System

Context:Chronic ankle instability (CAI) describes the residual symptoms present after repetitive ankle sprains. Current rehabilitation programs in the high school population focus on a multistation approach or general lower-extremity injury-prevention program. Specific rehabilitation techniques for CAI have not been established.Objective:To determine the effectiveness of a 4-wk biomechanical ankle platform system (BAPS) board protocol on the balance of high school athletes with CAI.Design:Randomized control trial.Setting:Athletic training facility.Patients:Twenty-two high school athletes with “giving way” and a history of ankle sprains (ie, CAI) were randomized into a rehabilitation (REH) (166.23 ± 0.93 cm, 67.0 ± 9.47 kg, 16.45 ± 0.93 y) or control (CON) (173.86 ± 8.88 cm, 84.51 ± 21.28 kg, 16.55 ± 1.29 y) group.Interventions:After baseline measures, the REH group completed a progressive BAPS rehabilitation program (3 times/wk for 4 wk), whereas the CON group had no intervention. Each session consisted of 5 trials of clockwise/counterclockwise rotations changing direction every 10 s during each 40-s trial. After 4 wk, baseline measurements were repeated.Main Outcome Measures:Dependent measures included longest time (time-in-balance test), average number of errors (foot lift test), average reach distance (cm) normalized to leg length for each reach direction (Star Excursion Balance Test [SEBT]), and fastest time (side hop test [SHT]).Results:Significant group-by-time interactions were found for TIB (F1,20 = 9.89, P = .005), FLT (F1,20 = 41.18, P < .001), SEBT-anteromedial (F1,20 = 5.34, P = .032), SEBT-medial (F1,20 = 7.51, P = .013), SEBT-posteromedial (F1,20 = 12.84, P = .002), and SHT (F1,20 = 7.50, P = .013). Post hoc testing showed that the REH group improved performance on all measures at posttest, whereas the CON group did not.Conclusion:A 4-wk BAPS rehabilitation protocol improved balance in high school athletes suffering from CAI. These results can allow clinicians to rehabilitate in a focused manner by using 1 rehabilitation tool that allows benefits to be accomplished in a shorter time.

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The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00480-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Chiao-I Lin ◽

Sanne Houtenbos ◽

Yu-Hsien Lu ◽

Frank Mayer ◽

Pia-Maria Wippert

Keyword(s):

Ankle Sprain ◽

Sports Injuries ◽

Ankle Instability ◽

Sports Injury ◽

Chronic Ankle Instability ◽

Risk Of Bias ◽

Ankle Sprains ◽

Exclusion Criteria ◽

Wide Range ◽

History Of

Abstract Background Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations. Methods An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method. Results After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias. Conclusions The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.

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Clinical Examination Results in Individuals With Functional Ankle Instability and Ankle-Sprain Copers

Journal of Athletic Training ◽

10.4085/1062-6050-48.3.15 ◽

2013 ◽

Vol 48 (5) ◽

pp. 581-589 ◽

Cited By ~ 22

Author(s):

Cynthia J. Wright ◽

Brent L. Arnold ◽

Scott E. Ross ◽

Jessica Ketchum ◽

Jeffrey Ericksen ◽

...

Keyword(s):

Activities Of Daily Living ◽

Clinical Examination ◽

Ankle Sprain ◽

Daily Living ◽

Ankle Instability ◽

Ankle Sprains ◽

Foot And Ankle ◽

Functional Ankle Instability ◽

History Of ◽

Ability Measure

Context: Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. Objective: To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Intervention(s): Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Main Outcome Measure(s): Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Results: Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). Conclusions: Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

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Ligament Laxity Following Inversion Injury with and without Chronic Ankle Instability

Foot & Ankle International ◽

10.3113/fai.2008.0305 ◽

2008 ◽

Vol 29 (3) ◽

pp. 305-311 ◽

Cited By ~ 55

Author(s):

Tricia J. Hubbard

Keyword(s):

Repeated Measures ◽

Mixed Model ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Ankle Sprains ◽

Significant Group ◽

Lateral Ankle ◽

Anterior Displacement ◽

Ligament Laxity ◽

And Inversion

Background: Not all patients develop chronic ankle instability (CAI) after one or more lateral ankle sprains; some seem to heal or adjust to the ankle laxity after injury. Why do some patients develop CAI and others are able to cope and return to normal function? The purpose of this study was to examine ligament laxity between subjects with and without CAI. Materials and Methods: Sixteen subjects with unilateral CAI and 16 subjects without participated in the study. Ligament laxity was measured with an instrumented ankle arthrometer. The arthrometer measured ankle joint motion for anterior/posterior displacement (mm) during loading at 125 N and inversion/eversion rotation (degrees of ROM) during loading at 4000 N/mm. For each dependent variable a 2 × 2 mixed model ANOVA was run with the between factor being group (CAI, No CAI) and the within factor with repeated measures being side (involved, uninvolved). Results: A significant group by side interaction for anterior displacement (F1,30 = 370.085, p < 0.001), and inversion rotation (F1,30 = 7.455, p = 0.010) was found. There was significantly more anterior displacement and inversion rotation for the involved ankles of the CAI group than the involved ankles of the stable group and the uninvolved ankles of the CAI group. Conclusion: Based on the results of this study it appears that the increased anterior displacement and inversion rotation compared to patients without instability may be why subjects develop CAI. Although the patients without instability have a history of more than one lateral ankle sprain, they did not demonstrate increased laxity, which may be the reason why they do not complain of the functional impairment demonstrated in subjects with CAI.

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Lateral Ankle Sprain and Chronic Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011419846938 ◽

2019 ◽

Vol 4 (2) ◽

pp. 247301141984693 ◽

Cited By ~ 1

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.

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The Effect of Fibular Reposition Taping on Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0166 ◽

2019 ◽

Vol 28 (2) ◽

pp. 205-210

Author(s):

Bradley C. Jackson ◽

Robert T. Medina ◽

Stephanie H. Clines ◽

Julie M. Cavallario ◽

Matthew C. Hoch

Keyword(s):

Postural Control ◽

Range Of Motion ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Ankle Sprains ◽

Clinical Scenario ◽

Clinical Question ◽

Bottom Line ◽

Significant Difference ◽

History Of

Clinical Scenario: History of acute ankle sprains can result in chronic ankle instability (CAI). Arthrokinematic changes resulting from CAI may restrict range of motion and contribute to postural control deficits. Mulligan or fibular reposition taping (FRT) has been suggested as a means to realign fibular positional faults and may be an effective way to improve postural control and balance in patients with CAI. Clinical Question: Is there evidence to suggest that FRT will improve postural control for patients with CAI in the affected limb compared with no taping? Summary of Key Findings: Three of the 4 included studies found no significant difference in postural control in patients receiving FRT compared with sham or no tape. Clinical Bottom Line: There is moderate evidence refuting the use of FRT to improve postural control in patients with CAI. Strength of Recommendation: There is grade B evidence to support that FRT does not improve postural control in people with CAI.

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