Fibular Position in Individuals with Self-Reported Chronic Ankle Instability

Abstract

Study Design: Case control study. Objectives: The purpose of this study was to assess the position of the distal fibula in individuals with chronic ankle instability (CAI). Background: Recent literature has suggested that a positional fault of the fibula on the tibia may contribute to CAI; however, there is a lack of objective scientific evidence to support this claim. Methods and Measures: Thirty subjects with unilateral CAI (mean ± SD age, 20.3 ± 1.3 years) and 30 subjects with no previous history of ankle injury (mean ± SD age, 21.3 ± 3.8 years) participated in this study. Subjects completed a pair of subjective functional scales and fluoroscopic lateral images of both the right and left ankles were recorded. The distance from the anterior margin of the distal tibia to the anterior margin of the distal fibula was measured in millimeters. Nonparametric statistics were used to assess the relationship between fibular position and CAI status. Results: There were significant differences between the CAI and control group ankles (P = .045) and within the involved and uninvolved sides of the CAI group (P = .006). Those with CAI had a significantly more anterior fibular position on their involved ankle in relation to their uninvolved limb, and the ankles of the control group. Conclusions: The fibula was positioned significantly more anterior in relation to the tibia in subjects with unilateral CAI. It is unclear if repetitive bouts of ankle instability caused the anterior fibular position or if the more anterior position was a predisposing factor to injury. J Orthop Sports Phys Ther 2006;36:3-9.

Fibular Malalignment in Individuals With Chronic Ankle Instability

“…The present study analyzed the 3-D side-to-side difference of the position of the fibula with respect to the tibia. Although previous studies have reported fibular anteroposterior displacements in individuals with CAI, 2,15,29,30,50,54 the current study did not. Because anteroposterior displacement of the fibula may be related to the severity of lateral ankle ligament injury, further study that distinguishes the severity of lateral ankle sprain or the presence of mechanical instability is required.…”

“…2,15,50 In contrast, other studies using radiography have noted the presence of fibular anterior translation in the ankles with CAI. 29,30,54 Thus, there is no consistent reported pattern of fibular malalignment in the anteroposterior direction and, to our knowledge, no previous study has considered mediolateral malalignment. Most lateral ankle sprains involve injury to the lateral ankle ligaments (eg, the anterior talofibular or calcaneofibular ligament).…”

“…2,4,8,11,14,15,19,23,29,30,45,50,54,55 However, measurements obtained with these methods have been shown to be unreliable 4,5,37,42,44 and do not allow evaluation in planes other than the selected plane. In addition, differences in measurement of fibular alignment in some studies were based on the tibia, 29,30,54 whereas in other studies they were based on the talus, 2,15,50 making it difficult to compare findings across studies. The present study analyzed the 3-D side-to-side difference of the position of the fibula with respect to the tibia.…”

Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability

“…These findings suggest that targeting potential arthrokinematic restrictions of posterior talar glide results in comparatively greater improvement in range of motion initially and supports the hypothesis that ankle sprains may cause positional faults of the talus and fibula. (20, 41) As well, based on the changes reported, the joint mobilization group had a two-fold increase in dorsiflexion improvement at 2 weeks, but the variability of this improvement also increased. This suggests that 2 weeks of either STARS may be effective in enhancing dorsiflexion.…”

Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability

“…Restrictions in talocrural joint and distal tibiofibular joint mobility have been shown to occur in individuals with a history of lateral ankle sprain (Denegar et al, 2002;Whitman et al, 2009) and may be due to the slight anterior displacement of the fibula relative to the tibia (Hubbard and Hertel, 2008;Hubbard et al, 2006). This displacement is thought to occur due to lengthening or disruption of the anterior talofibular ligament (Denegar et al, 2002).…”