scholarly journals The Role of the Calcaneofibular Ligament in Chronic Ankle Pain Following Severe Ankle Sprains

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Richard Alvarez ◽  
Randall Marx ◽  
Mark Mizel ◽  
Loren Latta ◽  
Paul Clifford
Keyword(s):  
Ankle Sprain ◽  
Plantar Flexion ◽  
Neutral Position ◽  
Peroneal Tendon ◽  
Ankle Sprains ◽  
Ankle Pain ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneal Tendons

Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was then dissected to observe the integrity and relationship of the lateral ankle structures. Results: Four of the eight specimens sustained CFL tears as viewed by MRI and confirmed through anatomic dissection. One of the four specimens with a CFL tear had a mid substance ligament rupture with the proximal half of the ligament positioned superficial to the peroneal tendon complex. This relationship was observed using the MRI. Conclusion: Creating severe lateral ankle sprain produced ruptures of the CFL with interposition of the peroneal tendon complex between the torn ends of the ligament was seen and identified. This phenomenon may prevent primary ligament healing of the CFL and may be a contributing factor in the chronic ankle pain of non-surgically treated lateral ankle sprains. Perhaps surgical intervention should be considered if clinical suspicion exists, such as with a Stener lesion of the hand.

scholarly journals Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

Sports ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 41
Author(s):  
Philippe Terrier ◽  
Sébastien Piotton ◽  
Ilona M. Punt ◽  
Jean-Luc Ziltener ◽  
Lara Allet
Keyword(s):  
Ankle Sprain ◽  
Strength Function ◽  
Selection Procedure ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Functional Scores ◽  
Logistic Regressions ◽  
Poor Outcomes ◽  
Clinical Measures

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

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 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 Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study

2016 ◽  
Vol 51 (3) ◽  
pp. 213-222 ◽  
Author(s):  
Fereshteh Pourkazemi ◽  
Claire Hiller ◽  
Jacqueline Raymond ◽  
Deborah Black ◽  
Elizabeth Nightingale ◽  
...  
Keyword(s):  
Discriminant Analysis ◽  
Ankle Sprain ◽  
Control Group ◽  
Stepwise Discriminant Analysis ◽  
Ankle Sprains ◽  
Balance Test ◽  
Cross Sectional ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Star Excursion Balance Test

The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding.Context: To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain.Objective: Cross-sectional study.Design: We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains.Patients or Other Participants: We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance.Main Outcome Measure(s): The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ( = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ( = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group.Results: Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.Conclusions:

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.

Reinjury after Acute Lateral Ankle Sprains in Elite Track and Field Athletes

2009 ◽  
Vol 37 (9) ◽  
pp. 1755-1761 ◽  
Author(s):  
Nikolaos Malliaropoulos ◽  
Maria Ntessalen ◽  
Emmanuel Papacostas ◽  
Umile Giuseppe Longo ◽  
Nicola Maffulli
Keyword(s):  
Ankle Sprain ◽  
Track And Field ◽  
Low Grade ◽  
Ankle Sprains ◽  
High Grade ◽  
Level Of Evidence ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Grade Ii ◽  
Persistent Disability

Background Lateral ankle sprains can lead to persistent disability in athletes. The authors studied the effect of a lateral ankle sprain on reinjury occurrence in the same region. Hypothesis There will be no difference in reinjury rate between low-grade (grades I and II) and high-grade (IIIA and IIIB) acute lateral ankle sprains. Study Design Cohort study (prognosis); Level of evidence, 1. Methods From 1996 to 2004, the authors managed 202 elite Greek track and field athletes for an acute lateral ankle sprain. Sprains were classified into 4 degrees (I, II, IIIA, and IIIB). The same rehabilitation protocol was prescribed for all the athletes. The rate of a lateral ankle reinjury was recorded in the 24 months following injury. Results At a follow-up of 24 months, 36 of 202 athletes (17.8%) experienced a second lateral ankle sprain. Of the 79 athletes with a grade I injury, 11 (14%) experienced a recurrence during the study period. Of the 81 athletes with a grade II injury, 23 (29%) experienced a recurrence during the study period. Of the 36 athletes with a grade IIIA injury, 2 (5.6%) experienced a recurrence during the study period. Of the 6 athletes with a grade IIIB injury, none experienced a recurrence during the study period. Conclusion Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury. Low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.

scholarly journals Effects of Dangguixu-san in patients with acute lateral ankle sprain: a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jae-Hong Kim ◽  
Cham-Kyul Lee ◽  
Eun-Yong Lee ◽  
Myoung-Rae Cho ◽  
Young-Su Lee ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Clinical Laboratory ◽  
Controlled Trial ◽  
Herbal Extract ◽  
Ankle Sprains ◽  
Long Term Effects ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Korean Medicine ◽  
Vas Scores

Abstract Background Dangguixu-san (DS), a herbal extract, is widely used in Korean medicine to treat pain and swelling caused by ankle sprain. However, there is insufficient evidence regarding the effects of DS on ankle sprains. Accordingly, we assessed the efficacy and safety of DS for the treatment of acute lateral ankle sprain (ALAS). Methods This study was a multicenter (two Korean hospitals), randomized, double-blind, placebo-controlled, parallel-arm clinical trial with a 1:1 allocation ratio that included a per-protocol analysis and sub-analysis based on symptom severity. Forty-eight participants (n = 28 at Semyung University Korean Medicine Hospital in Chungju; n = 20 at DongShin University Gwangju Korean Medicine Hospital) with grade I or II ALAS that occurred within 72 h before enrollment were randomized to a DS (n = 24) or placebo (n = 24) group. Both groups received acupuncture treatment once daily for 5 consecutive days and the trial medication (DS/placebo capsule) three times a day for 7 consecutive days. Primary (visual analog scale [VAS] scores for pain) and secondary (Foot and Ankle Outcome Scores [FAOS], edema, and European Quality of Life Five-Dimension-Five-Level Scale [EQ-5D-5L] scores) outcome measures were recorded at baseline (week 0), the end of the intervention (week 1), and 4 weeks after treatment completion (week 5). Results Forty-six participants completed the trial (n = 23 each). Changes in VAS scores, FAOS Symptom/Rigidity, and FAOS Ache from week 1 to week 5 showed significant differences between the two groups. Sub-analyses showed significant differences in changes of FAOS Ache (week 0 to week 5) and VAS scores, total FAOS, and EQ-5D-5L scores (week 1 to week 5) between the two subgroups (grade II). There were no adverse events and significant negative changes in clinical laboratory parameters in both groups. Conclusions Overall, the results of this study are in favor of DS combined with acupuncture and suggest that DS combined with acupuncture is a safe treatment with positive long-term effects in terms of pain reduction and symptom alleviation in patients with grade I or II ALAS. Trial registration Clinical Research Information Service KCT0002374. Registered on July 11, 2017; retrospectively registered.

scholarly journals Add-on effect of Kinesiotape in patients with acute lateral ankle sprain: a randomized controlled trial

2019 ◽  
Author(s):  
Jeong-Cheol Shin ◽  
Jae-Hong Kim ◽  
Dongwoo Nam ◽  
Gwang-Cheon Park ◽  
Jeong-Soon Lee
Keyword(s):  
Quality Of Life ◽  
Ankle Sprain ◽  
Recovery Of Function ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Randomized Controlled

Abstract Background: Evidence on the add-on effect of Kinesiotape (KT) on acupuncture for treating ankle sprains remains insufficient. We assessed the add-on effect of KT on ankle sprains by comparing acupuncture combined with KT (AcuKT) with acupuncture alone in patients with acute lateral ankle sprain (ALAS). Methods: This study was a multicenter, randomized, controlled clinical trial that included a per-protocol analysis of the add-on effect of KT on ALAS. The randomization was software-based and only the assessors were blinded. Sixty participants (20 each from three centers) with Grade I or II ALAS were randomly assigned to acupuncture (n=30) or AcuKT (n=30) group. Both groups received acupuncture treatment once daily, 5 days per week for 1 week. The AcuKT group received additional KT treatment. Visual analog scale (VAS) scores for pain and Foot and Ankle Outcome Score (FAOS) were obtained, and edema measurements were performed at baseline (Week 0), at the end of the intervention (Week 1), and at 4 weeks after intervention (Week 5). The European Quality of Life Five Dimension-Five Level Scale (EQ-5D-5L) measurements were conducted at Week 0, Week 1, Week 5, and Week 26 after the intervention. The number of recurrent ankle sprains was determined at 4, 8, 12, and 26 weeks after the intervention. Results: Fifty-six patients with ALAS completed the trial (AcuKT group, 27; acupuncture group, 29). There were significant changes in VAS score (AcuKT: p<0.001; acupuncture: p<0.001), FAOS (AcuKT: p<0.001; acupuncture: p<0.001), and EQ-5D-5L measurements (AcuKT: p<0.001; acupuncture: p<0.001) within both groups. There were no significant differences between groups in terms of any outcome and in a subanalysis based on symptom severity. Conclusions: These results indicate that AcuKT did not show positive add-on effects of KT on acupuncture in terms of pain reduction, edema, recovery of function, activities of daily living, quality of life, and relapse of ALAS.

Subjective and Objective Evaluation of the Functional Condition after a Single Lateral Sprain of the Ankle in Athletes

2018 ◽  
Vol 20 (6) ◽  
pp. 430-440
Author(s):  
Karolina Mojza ◽  
Krzysztof Krzak ◽  
Dawid Bączkowicz
Keyword(s):  
Functional Status ◽  
Ankle Sprain ◽  
Postural Stability ◽  
Dynamic Testing ◽  
Objective Assessment ◽  
Control Group ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Total P

Background. Ankle sprains can lead to functional deficits. However, few papers have investigated deficits following a single lateral ankle sprain as either assessed subjectively by the patient (e.g., with questionnaires) or measured objectively (e.g., by evaluation of postural stability). This paper aims to provide subjective and objective assessment of functional status in athletes after a single lateral ankle sprain. Material and methods. A lateral ankle sprain group (LAS) consisted of 20 athletes after a single lateral ankle sprain (mean age 23 ± 1.78 years). A control group (CTRL) comprised 20 athletes with no history of injury (mean age 22.5 ± 2.67 years). Subjective assessment was based on the Foot and Ankle Disability Index questionnaire (FADI-Q). A Biodex Balance System SD dynamic platform was used to assess postural stability. Static and dynamic testing was performed in single-leg stance. Results. Statistically significant differences were noted during the comparison of the LAS and CTRL groups in FADI-Q in the following parts: FADI (p=0,017) and FADI TOTAL (p=0,049). Moreover, statistically significant differences were noted in the LAS group between subjects with instability (N-STAB) and without instability (STAB) of the ankle in the parts FADI (p=0,006), FADI SPORT (p=0,011) and FADI TOTAL (p=0,002). During static and dynamic postural stability testing, no significant differences were found between sprained and healthy limbs, between the LAS and CTRL groups, or between the STAB and N-STAB groups. Conclusions. 1. A deterioration of subjective functional status after a single lateral ankle sprain was revealed. 2. A single ankle sprain is associated with a high risk of developing functional instability. 3. There were no differences in objective functional status between the groups.

scholarly journals Isolated partial tear of extensor digitorum longus tendon with overlying muscle herniation in acute ankle sports injury: role of high resolution musculoskeletal ultrasound

2021 ◽  
Author(s):  
Jeena Bordoloi Deka ◽  
Nilim Kumar Deka ◽  
Mohit V. Shah ◽  
Chandra Bortolotto ◽  
Ferdinando Draghi ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Extensor Digitorum Longus ◽  
Plantar Flexion ◽  
Extensor Digitorum ◽  
Return To Play ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Partial Tear ◽  
Early Return ◽  
Lateral Ankle Ligaments

AbstractLateral Ankle sprain is a common sports-related trauma with the mechanism of injury ranging from inversion to plantar flexion. These injuries commonly affect the ligaments but can also affect the associated soft tissue structures like the eversion muscles and tendons. Prompt and accurate diagnosis of such injuries is warranted so as to ensure early return to play and prevent long-term complications. Lateral ankle sprain injuries in sports may not always be associated with ligament injuries. We report a never before reported case of lateral ankle sprain injury in a soccer player with the unusual finding of isolated partial tear of Extensor digitorum longus muscle and its fascia leading to myo-fascial herniation. The lateral ankle ligaments were intact. The diagnosis was clinched on a high-frequency ultrasound scan supported by dynamic maneuvers which in fact proved to be superior to MRI as the latter failed to demonstrate the myo-fascial herniation in our case. We therefore propose that real-time ultrasound scanning with dynamic maneuvers should be the first line of investigation to assess sports injuries in anatomically complex joints like the ankle.

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