Foot impairments contribute to functional limitation in individuals with ankle sprain and chronic ankle instability

Fraser, John J.; Koldenhoven, Rachel M.; Jaffri, Abbis; Park, Joseph S.; Saliba, Susan A.; Hart, Joseph M.; Hertel, Jay

doi:10.1007/s00167-018-5028-x

Cited by 43 publications

(64 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparable to our data, several studies have provided evidence that concentric pronation and supination strength are impaired in CAI [10][11][12]. The novel finding in this study was that the joint angle in which the maximum pronation strength can be produced is significantly different between the two ankles (MAI 14°vs.…”

Section: Discussionsupporting

confidence: 50%

“…Furthermore, a recent systematic review found that impairments of peroneal reaction time and pronation strength strongly contribute to perceived ankle instability in a chronic population [10]. Also, strength deficits resulting from ankle injuries have been described especially in plantarflexion and pronation strength, while dorsiflexion and supination strength seems to remain rather unaffected [11,12]. It is thought that spinal and cortical pathways may lead to an inhibition of neuromuscular activity and thus contribute to these persisting deficiencies in CAI patients [13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Functional deficits in chronic mechanical ankle instability

Gehring

Mauch³

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background: The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization. Methods: We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles. Results: Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20°vs. 14°of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02). Conclusions: This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.

show abstract

Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Functional deficits in chronic mechanical ankle instability

Gehring

Mauch³

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Weakness of the muscles proximal to the unstable ankle, including deficits in concentric knee flexion and extension, 116 isometric hip abduction, 115,121 extension, 115,121 external rotation, 121,122 and eccentric hip flexion, 123 has also been identified among patients with CAI. Distally, weakness in hallux and lesser toe-flexion strength 108 and diminished volume of the flexor hallucis brevis and adductor hallucis oblique muscles 59 have been reported in patients.…”

Section: Motor-behavioral Impairmentsmentioning

confidence: 99%

An Updated Model of Chronic Ankle Instability

Hertel

Corbett

2019

Journal of Athletic Training

Self Cite

448

386

View full text Add to dashboard Cite

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

show abstract

“…This study was part of a larger investigation of foot impairments and functional limitations after LAS and CAI. 21 All participants completed the Godin Leisure Time Questionnaire and reported being physically active 3 times per week for at least 20 minutes. Volunteers were excluded if they had a self-reported history of fracture or surgery to the leg or foot, had any neurologic disorder that might affect balance (eg, diabetes mellitus, lumbosacral radiculopathy), had any soft tissue disorder (eg, Marfan syndrome, Ehlers-Danlos syndrome), were pregnant, or had any contraindication to manual therapy.…”

Section: Designmentioning

confidence: 99%

Ultrasonography of Gluteal and Fibularis Muscles During Exercises in Individuals With a History of Lateral Ankle Sprain

Koldenhoven

Fraser

Saliba

et al. 2019

Journal of Athletic Training

Self Cite

View full text Add to dashboard Cite

Context Individuals with a history of lateral ankle sprains (LASs) have ankle and hip neuromuscular changes compared with those who do not have a history of LAS. Objective To compare gluteus maximus (GMax), gluteus medius (GMed), and fibularis longus and brevis muscle activation using ultrasound imaging during tabletop exercises and lateral resistance-band walking in individuals with or without a history of LAS or chronic ankle instability (CAI). Design Cross-sectional study. Patients or Other Participants Sixty-seven young adults (27 males, 40 females). Groups were healthy = 16, coper = 17, LAS = 15, CAI = 19. The number of previous sprains was 0 ± 0 in the healthy group, 1.1 ± 0.3 in the coper group, 2.9 ± 2.4 in the LAS group, and 5.3 ± 5.9 in the CAI group. Main Outcome Measure(s) Ultrasound imaging measures of fibularis cross-sectional area (CSA) were collected during nonresisted and resisted ankle eversion. Gluteal muscle thicknesses were imaged during nonresisted and resisted side-lying abduction and during lateral resistance-band walking exercises (lower leg and forefoot band placement). Separate 4 × 2 repeated-measures analyses of variance and post hoc Fisher least significant difference tests were used to assess activation across groups and resistance conditions. Results All groups demonstrated 3.2% to 4.1% increased fibularis CSA during resisted eversion compared with nonresisted. During side-lying abduction, the LAS and CAI groups displayed increased GMax thickness (6.4% and 7.2%, respectively), and all but the CAI group (−0.4%) increased GMed thickness (5.3%–11.8%) with added resistance in hip abduction. During band walking, the healthy and LAS groups showed increased GMax thickness (4.8% and 8.1%, respectively), and all groups had increased GMed thickness (3.0%–5.8%) in forefoot position compared with the lower leg position. Although the values were not different, copers exhibited the greatest amount of GMed thickness during band-walking activities (copers = 23%–26%, healthy = 17%–23%, LAS = 11%–15%, CAI = 15%–19%). Conclusions All groups had increased fibularis CSA with resisted eversion. In side-lying hip abduction, individuals with CAI had greater GMax thickness than GMed thickness. Ultrasound imaging of fibularis CSA and gluteal muscle thickness may be clinically useful in assessing and treating patients with LAS or CAI.

show abstract

Foot impairments contribute to functional limitation in individuals with ankle sprain and chronic ankle instability

Abstract: II.

Cited by 43 publications

References 44 publications

Functional deficits in chronic mechanical ankle instability

Functional deficits in chronic mechanical ankle instability

An Updated Model of Chronic Ankle Instability

Ultrasonography of Gluteal and Fibularis Muscles During Exercises in Individuals With a History of Lateral Ankle Sprain

Contact Info

Product

Resources

About