Current Challenges in Chronic Ankle Instability

Lalevée, Matthieu; Anderson, David; Wilken, Jason M.

doi:10.1016/j.fcl.2022.11.003

Cited by 17 publications

(8 citation statements)

References 96 publications

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“…These results underscore the protocol's potential as a valuable tool in gait rehabilitation, particularly for individuals with IGT. Consequently, IGT-related foot and ankle pathologies, such as metatarsalgia, hallux valgus or rigidus, ankle instability, Achilles tendinopathy, or fasciitis, could benefit from the Stanish protocol [31][32][33][34]. However, the persistence of these effects over time and the potential for long-term gait improvement warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

Stretching and Eccentric Exercises Normalize Gait Parameters in Gastrocnemius Tightness Subjects

Hamza,

Martinez,

Sacco

et al. 2023

Applied Sciences

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Background: Isolated gastrocnemius tightness (IGT) is a prevalent condition linked to various foot pathologies. In a previous quantitative gait analysis study, we identified an increase in knee flexion during the midstance phase in IGT patients compared with controls. Although stretching and eccentric exercises (the Stanish protocol) are commonly used for IGT management, their impact on gait parameters remains poorly understood. This study aimed to assess the influence of a Stanish protocol on gait parameters in bilateral IGT subjects. Methods: We enrolled 10 asymptomatic bilateral IGT subjects and 10 controls. Quantitative gait analysis and dynamic baropodometry were carried out on each subject. A Stanish protocol was applied for 4 weeks (five sessions/week) by the IGT group, followed by a similar gait analysis. The ankle and knee range of motion and foot pressure distribution were assessed during the midstance phase of the gait. Results: An increase in knee flexion was initially present in the IGT group compared with controls (8.9 +/− 4.6 vs. 3.4 +/− 2.3 degrees, p < 0.001). There was no difference in the ankle range of motion and foot pressures between the groups at that time. Significant reductions in knee flexion during gait were observed in the IGT subjects after the Stanish protocol (8.9 +/− 4.6 to 3.7 +/− 2.3 degrees, p < 0.001) with a normalization of this parameter (3.4 +/− 2.3 in controls vs. 3.7 +/− 2.3 degrees in IGT, p = 0.72). There was no change in ankle range of motion and foot pressure after the Stanish protocol. Conclusions: Our findings support the effectiveness of the Stanish protocol in reducing knee flexion and normalizing gait in IGT subjects. This protocol not only offers a noninvasive approach for IGT-related issues management but could also enable prophylactic care in asymptomatic cases.

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Section: Discussionmentioning

confidence: 99%

Stretching and Eccentric Exercises Normalize Gait Parameters in Gastrocnemius Tightness Subjects

Hamza,

Martinez,

Sacco

et al. 2023

Applied Sciences

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“…Further study in weight-bearing positions of ankles will be required in future. Furthermore, the CAI is defined far beyond ligament laxity, though pathologic laxity of the ankle was the initial cause of the functional instability of the foot [ 16 , 22 ]. After adding the detailed inclusion criteria, our study mainly based on CAI patients, which also included some patients with ligament laxity after ankle sprains.…”

Section: Limitationsmentioning

confidence: 99%

The increased anterior talofibular ligament–posterior talofibular ligament angle on MRI may help evaluate chronic ankle instability

et al. 2023

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Purpose This study intended to compare the difference between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) angle with chronic ankle instability (CAI) patients and healthy volunteers, and to confirm whether using the ATFL–PTFL angle could be a reliable assessment method for CAI, so as to improve the accuracy and specificity of clinical diagnosis. Methods This retrospective study included 240 participants: 120 CAI patients and 120 healthy volunteers between 2015 and 2021. The ATFL–PTFL angle of the ankle region was gaged in the cross-sectional supine position on MRI between two groups. After participants undergoing a comprehensive MRI scanning, ATFL–PTFL angles were regarded as the main indicator of patients with the injured ATFLs and healthy volunteers to compare, and were measured by an experienced musculoskeletal radiologist. Moreover, other qualitative and quantitative indicators referring to anatomical and morphological characteristics of the AFTL were included in this study with MRI, such as the length, width, thickness, shape, continuity, and signal intensity of the ATFL, which can be used as secondary indicators. Results In the CAI group, the ATFL–PTFL angle was 90.8° ± 5.7°, which was significantly different from the non-CAI group where the ATFL–PTFL angle for 80.0° ± 3.7° (p < 0.001). As for the ATFL-MRI characteristics, the length (p = 0.003), width (p < 0.001), and thickness (p < 0.001) in the CAI group were also significantly different from the non-CAI group. Over 90% of the cases, patients of the CAI group had injured ATFL with an irregular shape, non-continuous, and high or mixed signal intensity. Conclusion Compared with healthy people, the ATFL–PTFL angle of most CAI patients is larger, which can be used as a secondary index to diagnose CAI. However, the MRI characteristic changes of ATFL may not relate to the increased ATFL–PTFL angle.

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“…Ultimately, PTTD may result in acquired flatfoot deformity over the course of several stages [14][15][16]. Pain, impaired function, and decreased quality of life are associated with all three of these disorders [17][18][19]. Despite an extensive volume of literature directed towards various interventions for these disorders, the effectiveness of current treatments still requires significant improvement [20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…Ultimately, PTTD may result in acquired flatfoot deformity over the course of several stages [14–16]. Pain, impaired function, and decreased quality of life are associated with all three of these disorders [17–19].…”

Section: Introductionmentioning

confidence: 99%

Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles

Moisan,

Chicoine,

McBride

et al. 2023

Journal of Foot and Ankle Research

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Background Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. Methods Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. Results Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). Conclusions Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.

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Current Challenges in Chronic Ankle Instability

Cited by 17 publications

References 96 publications

Stretching and Eccentric Exercises Normalize Gait Parameters in Gastrocnemius Tightness Subjects

Stretching and Eccentric Exercises Normalize Gait Parameters in Gastrocnemius Tightness Subjects

The increased anterior talofibular ligament–posterior talofibular ligament angle on MRI may help evaluate chronic ankle instability

Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles

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