Balance Capabilities after Lateral Ankle Trauma and Intervention

Postural stability measures as diagnostic tools for chronic ankle instability: a comprehensive assessment

BACKGROUND

Chronic ankle instability (CAI) is characterized by recurrent sprains and persistent symptoms, which impair postural control. This study evaluates the diagnostic utility of various linear and nonlinear postural stability measures in distinguishing individuals with CAI from healthy controls.

METHODS

Postural stability was assessed in 24 participants (12 with CAI and 12 healthy controls) using a force platform under four conditions: hard surface with eyes open, hard surface with eyes closed, soft surface with eyes open, and soft surface with eyes closed. Linear measures of center of pressure (COP) included range in the anteroposterior (Rfa) and mediolateral (Rsw) directions, mean velocity (MV), and sway area. Nonlinear measures included approximate entropy (ApEn), the largest Lyapunov exponent, and correlation dimension (CD) with its standard deviation. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis to determine cutoff scores, allowing effective differentiation between CAI and healthy participants.

RESULT

AI individuals exhibited increased mediolateral COP sway and higher mean velocity on hard surfaces with both eyes open and closed. On soft surfaces with eyes closed, they showed significant deficits in sway area and mean velocity, reflecting challenges in postural control. ROC analysis revealed that certain linear and nonlinear measures showed strong diagnostic accuracy in distinguishing individuals with CAI from healthy controls. Nonlinear analysis revealed elevated ApEn and reduced CD in CAI participants, indicating greater postural irregularity and reduced dynamic stability. On a hard surface with eyes open both Rsw (cutoff: 1.18 cm, OR: 4.55) and ApEn (cutoff: 0.07, OR: 4.0) were particularly strong diagnostic indicators.

CONCLUSION

Linear and nonlinear postural stability measures effectively differentiate individuals with CAI from healthy controls. Key metrics, including Rsw, MV, ApEn, and CD, offer strong diagnostic value for early detection and personalized rehabilitation. Incorporating these measures into clinical practice may improve CAI management and patient outcomes.

ETHICAL CODE

IR.TUMS.FNM.REC.1400.236. March 14, 2022.

The effects of integrated traditional Chinese and western medicine rehabilitation programs on post-acute ankle sprain: A randomized controlled trial study protocol

BACKGROUND

Ankle sprain is a common clinical disease, which has the highest incidence rate among joint and ligament injuries. And acute ankle sprains can easily develop into chronic ankle instability, thereby increasing the difficulty of treatment. The current clinical guidelines for post-acute ankle sprains are still controversial. Pain and functional impairment are the most significant symptoms after ankle sprain. The main purpose of this study is to explore the safety and effectiveness of the intervention of integrated traditional Chinese and Western medicine rehabilitation programs on post-acute ankle sprains.

METHODS

This study is a single center, prospective, intervention randomized controlled trial with a control group. 174 patients of 18-35 years old with post-acute ankle sprain will be included. A randomized controlled study is conducted and divided into a control group and an experimental group. The control group receive routine treatment, while the experimental group receive integrated traditional Chinese and western medicine rehabilitation programs. The intervention lasted for a total of 2 weeks. The main outcome measures are Visual Analog Scale and Short Form McGill Pain Questionnaire; the secondary outcome measures are the Foot Ankle Ability Assessment Scale, AOFAS Ankle Posterior Foot Scale, torque and gait. This study protocol aims to evaluate the safety and effectiveness of integrated traditional Chinese and western medicine rehabilitation programs by comparing the results of two groups before and after treatment. This protocol will follow the SPIRIT guidance.

DISCUSSION

At present, there is a lack of rehabilitation management for post-acute ankle sprains. Therefore, this study has the potential to improve the healthcare for post-acute ankle sprains patients and might be used for future standardized evidence-based rehabilitation concepts.

TRIAL REGISTRATION

The trial was registered at Chinese Clinical Trial Registry https://www.chictr.org.cn/showproj.html?proj=234465 (Registration No.: ChiCTR2400087456). Date: 2024-07-29.

Contralateral thalamocortical connectivity is related to postural control in the uninvolved limb of older adults with history of ankle sprain

BACKGROUND

Sensorimotor brain connectivity is often overlooked when determining relationships between postural control and motor performance following musculoskeletal injury. Thalamocortical brain connectivity is of particular interest as it represents the temporal synchrony of functionally and anatomically linked brain regions. Importantly, adults over the age of 60 are especially vulnerable to musculoskeletal injury due to age-related declines in postural control and brain connectivity.

RESEARCH QUESTION

Is there a relationship between thalamocortical connectivity and static postural control in older adults with a history of LAS?

METHODS

Data were analyzed from twenty older adults (mean age = 67.0 ± 4.3 yrs; 13 females) with a history of LAS. The sensorimotor network (SMN) was identified from resting-state MRI data, and a priori thalamic and postcentral gyri regions of interest were selected in order to determine left and right hemisphere thalamocortical connectivity. Balance was assessed for the involved and non-involved limbs via center of pressure velocity (COPV) in the medial-lateral (ML) and anterior-posterior (AP) directions.

RESULTS

Contralateral thalamocortical connectivity was significantly associated with COPV_ML COPV_ML (r = -0.474, P = 0.05) and COPV_AP (r = -0.622, P = 0.008) in the non-involved limb. No significant association was observed between involved limb balance and contralateral thalamocortical connectivity (COPV_ML: r = -0.08, P = 0.77; COPV_AP: r = 0.12, P = 0.63).

SIGNIFICANCE

A significant relationship between thalamocortical connectivity and static postural control was observed in the non-involved, but not the involved limb in older adults with a history of LAS. Findings suggest that thalamocortical connectivity may lead to or be the product of LAS.

Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis

CONTEXT

Postural control deficits arising from injured ankles are central to chronic ankle instability (CAI) and its persistent symptoms. This is usually measured by recording the center of pressure (CoP) trajectory during static single-leg stance using a stable force plate. However, existing studies have produced conflicting results on whether this mode of measurement adequately reveals the postural deficits in CAI.

OBJECTIVE

To determine whether postural control during static single-leg stance is impaired in CAI patients when compared with uninjured healthy controls.

DATA SOURCES

Literature databases, PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus, were searched from inception to April 1, 2022, using ankle-, injury-, and posture-related terms.

STUDY SELECTION

Two authors independently performed the step-by-step screening of article titles, abstracts, and full texts to select peer-reviewed studies investigating CoP trajectory during static single-leg stance using a stable force plate in CAI patients and healthy controls. A total of 13,637 studies were reviewed, and 38 studies (0.003%) met the selection criteria.

STUDY DESIGN

Meta-analyses of descriptive epidemiological study.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

CoP parameters, sway directions, visual condition, and numerical data (means and standard deviations) were extracted.

RESULTS

The injured ankles of CAI patients had higher standard deviations of sway amplitude in both anterior-posterior and medial-lateral directions (standardized mean difference [SMD] = 0.36 and 0.31, respectively) under conditions of open eyes than controls. Higher mean sway velocity in anterior-posterior, medial-lateral, and total directions (SMD = 0.41, 0.37, and 0.45, respectively) with closed eyes was also found.

CONCLUSION

CAI patients had deficits of postural control during static single-leg stance, and these deficits were identified by the CoP trajectory. Further methodological explorations of CoP parameters and corresponding test conditions are required to enhance the sensitivity and reliability of postural deficit assessments in CAI using force plates.

Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability

PURPOSE

This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI).

METHODS

Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes.

RESULTS

Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697).

CONCLUSIONS

In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.

Optical flow balance perturbations alter gait kinematics and variability in chronic ankle instability patients

BACKGROUND

Individuals with chronic ankle instability (CAI) have known balance impairments thought to be the result of an inability to reweight sensory information. CAI patients place greater emphasis on visual information during single-limb stance than healthy controls but this evidence is based on removing visual information during static conditions.

RESEARCH QUESTION

Does perturbed optical flow effect step kinematics and variability in those with CAI differently than healthy controls? What is the relationship among ankle laxity, plantar cutaneous sensation, and susceptibility to perturbed optical flow in those with CAI?

METHODS

17 CAI patients and 17 healthy individuals participated in a crossover experimental study. Participants walked on a treadmill at 1.25 m/s while watching a speed-matched virtual hallway with and without continuous mediolateral (ML) optical flow perturbations. Three-dimensional pelvic and foot kinematics were recorded at 100 Hz for at least 300 consecutive steps in each condition. Step width (SW) and step length (SL) values were calculated from consecutive heel positions. Gait variability was characterized as the standard deviation of step width (SWV), step length (SLV), and ML sacrum motion (SMV) across all steps performed in each condition.

RESULTS

The CAI group exhibited a greater change in SWV (p = 0.037), SLV (p = 0.040), and ML SMV (p = 0.047) from the perturbed to unperturbed conditions relative to the healthy controls. A condition main effect was also noted for SW (p < 0.001) and SL (p < 0.001) as ML optical flow perturbations resulted in significant changes in SW and SL relative to the normal walking condition.

SIGNIFICANCE

Walking with ML optical flow perturbations induced greater variability changes in those with CAI relative to controls. When combined with the existing literature, this finding suggests that CAI individuals have a greater reliance on visual information in both static and dynamic (i.e. walking gait) conditions relative to healthy individuals.

Dynamic reach deficits in those with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

The purpose of this review with meta-analyses was to determine the dynamic reach differences 1) between chronic ankle instability (CAI) and uninjured individuals, 2) between the limbs of an individual with CAI, and 3) between the uninvolved CAI limb and the healthy control limb across all possible reach directions of the Star Excursion Balance Test (SEBT).

METHODS

PubMed, CINAHL, SPORTDiscus, and Scopus databases were searched up to October 2021. Data were extracted from the retained studies and underwent methodological quality assessment and meta-analysis using random-effect models.

RESULTS

After screening, 33 articles were included for the analyses. In all possible SEBT reach directions, the CAI group demonstrated significantly decreased normalized dynamic reach distances relative to the uninjured control group (SMDs: -0.66 to -0.48, p ≤ 0.05). Similarly, the involved CAI limb demonstrated significantly decreased normalized dynamic reach distances relative to the uninvolved CAI limb (SMDs: -0.61 to -0.33, p ≤ 0.05). However, no differences were noted between the uninvolved CAI limb and the healthy control limb (SMDs: -0.22 to 0.09, p ≥ 0.13).

CONCLUSIONS

Our findings were that the involved limb of those with CAI has dynamic postural deficits relative to (i) an uninjured control group and (ii) relative to their uninvolved limb. However, the uninvolved limb of the CAI group does not differ from an uninjured control group in any reach direction.

Progressive Visual Occlusion and Postural Control Responses in Individuals With and Without Chronic Ankle Instability

CONTEXT

Prophylactic and rehabilitative balance training is needed to maximize postural control and develop appropriate sensory organization strategies. Partially occluding vision during functional exercise may promote appropriate sensory organization strategies, but little is known about the influence of partially occluded vision on postural control in those with and without a history of musculoskeletal injury.

OBJECTIVE

To determine the effect of increasing levels of visual occlusion on postural control in a heterogeneous sample of those with and without chronic ankle instability (CAI). The secondary objective was to explore postural control responses to increasing levels of visual occlusion among those with unilateral and bilateral CAI relative to uninjured controls.

DESIGN

Cross-sectional.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five participants with unilateral CAI, 10 with bilateral CAI, and 16 participants with no history of lower extremity injury.

MAIN OUTCOME MEASURES

All participants completed four 3-minute postural control assessments in double-limb stance under the following 4 visual conditions: (1) eyes open, (2) low occlusion, (3) high occlusion, and (4) eyes closed. Low- and high-occlusion conditions were produced using stroboscopic eyewear. Postural control outcomes included time-to-boundary minima means in the anteroposterior (TTB-AP) and mediolateral directions (TTB-ML). Repeated-measures analysis of variances tested the effects of visual condition on TTB-AP and TTB-ML.

RESULTS

Postural control under the eyes-open condition was significantly better (ie, higher) than the limited visual occlusion and eyes-closed conditions (P < .001) for TTB-AP and TTB-ML. For TTB-AP only, partially occluded vision resulted in better postural control than the eyes-closed condition (P ≤ .003).

CONCLUSIONS

Partial and complete visual occlusion impaired postural control during dual-limb stance in a heterogeneous sample of those with and without CAI. Stroboscopic eyewear appears to induce postural control impairments to the same extent as complete visual occlusion in the mediolateral direction.

The effects of stroboscopic balance training on cortical activities in athletes with chronic ankle instability

OBJECTIVES

To investigate the effect of a 6-week stroboscopic balance training program on cortical activities in athletes with chronic ankle instability.

DESIGN

Randomized controlled trial.

SETTING

Single-center.

PARTICIPANTS

Thirty-nine participants were assigned to the strobe group (SG, n = 13), non-strobe group (NSG, n = 13), and control group (CG, n = 13).

MAIN OUTCOME MEASURES

Cortical activity and balance velocity were evaluated while the athletes were on the HUBER balance device. Electroencephalographic measurements of cortical activity were made at the transition from bipedal stance to single-leg stance.

RESULTS

The SG showed significant increases in Cz theta and alpha values and COP-v (center of pressure velocity) between pretest and posttest (p < 0.001, p = 0.003, p < 0.001). Posttest Cz theta was significantly higher in the SG compared to the CG (p = 0.009) and posttest Cz alpha was significantly higher in the SG compared to the NSG (p = 0.039) and CG (p = 0.001). Posttest COP-v was significantly higher in the SG than in the CG (p = 0.031) and NSG (p = 0.03).

CONCLUSIONS

Stroboscopic training may be clinically beneficial to improve balance parameters in athletes with CAI, and may have utility in sport-specific activity phases of rehabilitation to reduce visual input and increase motor control.

The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability

CONTEXT

Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control.

OBJECTIVE

To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain.

DESIGN

Retrospective cohort.

SETTING

Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation.

INTERVENTION(S)

Self-reported attendance or not of supervised rehabilitation at the time of initial injury.

MAIN OUTCOME MEASURES

Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral.

RESULTS

Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior-posterior direction (P = .030), and higher TTB anterior-posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation.

CONCLUSIONS

Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.

Eyes-Open Versus Eyes-Closed Somatosensory Motor Balance in Professional Soccer Players With Chronic Ankle Instability: A Case-Control Study

Background:

Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control.

Purpose:

To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups.

Results:

Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable.

Conclusion:

In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players.

Ultrasound Imaging of Crural Fascia and Epimysial Fascia Thicknesses in Basketball Players with Previous Ankle Sprains Versus Healthy Subjects

Background: Fascial layers may play an important role in locomotor mechanics. Recent researches have revealed an association between increases of fascia thickness and reduced joint flexibility in patients with chronic pain. The purpose of this study was to measure and compare, through the use of ultrasound imaging, the thickness of the deep/crural fascia in different points of the leg as well as the epimysial fascia thickness at level 2 of anterior compartment of leg, in male basketball players with history of recurrent ankle sprain and in healthy participants. Methods: A cross-sectional study has been performed using ultrasound imaging to measure deep/crural fascia thickness of anterior, lateral and posterior compartment of the leg at different levels with a new protocol in a sample of 30 subjects, 15 basketball players and 15 healthy participants. Results: Findings of fascial thickness revealed statistically significant differences (p < 0.01) in epimysial fascia thickness and in deep/crural fascia thickness between levels/compartments of the same group and between two groups. Moreover, Post 3 deep/crural fascia thicknesses (p < 0.001) were decreased showing statistically significant difference for the basketball players group respect the healthy participants group. Conclusions: These findings suggested that the posterior compartment was thicker than anterior compartment, probably due to a postural reason in both groups. Moreover, they showed an increase of thickness of the epimysial fascia in basketball players with previous ankle sprains. This variability underlines the importance to assess the fasciae and to make results comparable.

Center of pressure excursion and muscle activation during gait initiation in individuals with and without chronic ankle instability

The aim of the current study was to determine differences in center of pressure (COP)excursion and muscle activation during gait initiation (GI) in those with and without chronic ankle instability (CAI). Thirty-four participants, 17 per group, volunteered to participate. Participants were asked to stand barefoot on a force plate before initiating gait upon hearing an auditory cue. Reaction time, anticipatory postural adjustment phase time, as well as normalized peak COP excursion during the anticipatory postural adjustment phase was calculated. Response time of Soleus and Tibialis Anterior muscles were concurrently recorded via electromyography. The results demonstrate a longer reaction time and shorter anticipatory postural adjustment phase time in the CAI group (p < 0.05). No significant between group differences in peak normalized COP excursion were noted (p > 0.05). Muscle onset patterns differed between groups as those with CAI demonstrated earlier Soleus activation compared to the control group (p < 0.05). The results suggest that those with CAI have an altered GI motor control strategy as evidenced by reduced or absent Soleus muscle inhibition during APA phase of GI relative to controls. The APA phase is controlled by the secondary motor area, therefore, the presence of motor control alterations in CAI patients may be due to a supra-spinal alterations.

Can fibular reposition taping improve balance performance in individuals with chronic ankle instability? A randomized controlled trial

BACKGROUND

Lateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive.

OBJECTIVE

This study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability.

DESIGN

Randomized controlled trial.

METHODS

Sixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT).

RESULTS

The results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03).

CONCLUSION

Applying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT20171122037576N2.

Hop-Stabilization Training and Landing Biomechanics in Athletes With Chronic Ankle Instability: A Randomized Controlled Trial

CONTEXT

Hopping exercises are recommended as a functional training tool to prevent lower limb injury, but their effects on lower extremity biomechanics in those with chronic ankle instability (CAI) are unclear.

OBJECTIVE

To determine if jump-landing biomechanics change after a hop-stabilization intervention.

DESIGN

Randomized controlled clinical trial.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-eight male collegiate basketball players with CAI were divided into 2 groups: hop-training group (age = 22.78 ± 3.09 years, mass = 82.59 ± 9.51 kg, height = 187.96 ± 7.93 cm) and control group (age = 22.57 ± 2.76 years, mass = 78.35 ± 7.02 kg, height = 185.69 ± 7.28 cm).

INTERVENTION(S)

A 6-week supervised hop-stabilization training program that consisted of 18 training sessions.

MAIN OUTCOME MEASURE(S)

Lower extremity kinetics and kinematics during a jump-landing task and self-reported function were assessed before and after the 6-week training program.

RESULTS

The hop-stabilization program resulted in improved self-reported function (P < .05), larger sagittal-plane hip- and knee-flexion angles, and greater ankle dorsiflexion (P < .05) relative to the control group. Reduced frontal-plane joint angles at the hip, knee, and ankle as well as decreased ground reaction forces and a longer time to peak ground reaction forces were observed in the hopping group compared with the control group after the intervention (P < .05).

CONCLUSIONS

The 6-week hop-stabilization training program altered jump-landing biomechanics in male collegiate basketball players with CAI. These results may provide a potential mechanistic explanation for improvements in patient-reported outcomes and reductions in injury risk after ankle-sprain rehabilitation programs that incorporate hop-stabilization exercises.

Cortical Measures of Motor Planning and Balance Training in Patients With Chronic Ankle Instability

CONTEXT

Motor planning, a prerequisite for goal-driven movement, is a complex process that occurs in the cortex. Evidence has suggested that motor planning is altered in patients with chronic ankle instability (CAI). We know balance training can improve balance, but we do not know if it also improves motor planning. Such changes in cortical activity can be assessed using electroencephalography.

OBJECTIVE

To evaluate changes in cortical measures of motor planning after balance training in patients with CAI.

DESIGN

Controlled laboratory study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifteen patients with CAI (age = 20.80 ± 2.37 years, height = 169.47 ± 7.95 cm, mass = 70.45 ± 19.25 kg).

INTERVENTION(S)

A 4-week progression-based balance-training program.

MAIN OUTCOME MEASURE(S)

Motor planning was assessed via electroencephalography before a lateral-stepping task. We calculated event-related spectral perturbations in the θ (4-8 Hz), α (8-12 Hz), β (14-25 Hz), and γ (30-50 Hz) bands. The change in power (in decibels) was calculated in each band for the 500 milliseconds before the onset of the lateral-stepping movement. Additional outcomes were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living and Sport subscales; the anterior-, posteromedial-, and posterolateral-reach directions of the Star Excursion Balance Test; and static balance. Patients completed 3 test sessions: baseline, 24- to 48-hour posttest, and 1-week posttest. Repeated-measures analyses of variance were used to assess changes over time. The α level was set at .05.

RESULTS

The FAAM-Activities of Daily Living subscale score was improved at both posttests (P < .05), and the FAAM-Sport subscale score was improved at the 1-week posttest (P = .008). Balance was better in all 3 directions of the Star Excursion Balance Test at both posttest sessions (P < .001). After balance training, no differences were identified in cortical activity at either posttest session (P > .05).

CONCLUSIONS

No improvements were identified in electroencephalography measures of motor planning during lateral stepping in patients with CAI. Improved balance suggested that sensorimotor adaptations occurred, but they may not have transferred to the lateral-stepping task or they may have been mediated via other processes in patients with CAI.

The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains

Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.

Time-to-boundary analysis of postural control following acute lateral ankle sprain

BACKGROUND

Acute lateral ankle sprain (ALAS) impairs unipedal balance both with the injured and uninjured limb, suggesting that balance during bipedal stance may also be compromised. However, a previous study failed to find such impairment because of poorly sensitive balance outcomes. Time-to-boundary (TTB) analysis may be sensitive enough for detecting latent deficits in bipedal balance following ALAS.

RESEARCH QUESTION

We aimed to examine postural stability during bipedal stance in patients with ALAS using TTB outcomes, and to determine bilateral deficits in unipedal balance.

METHODS

Twenty-seven patients with ALAS and 26 persons without a history of ALAS participated. ALAS was operationally defined as a traumatic injury to the lateral ligaments of the ankle joint occurring within 24-72 h. Both limbs of the control group were side-matched to those of the patients as either injured or uninjured limbs. All participants performed 3 trials of bipedal stance with eyes open and closed. Next, they completed 3 trials of unipedal stance on both the injured and uninjured limbs in both visual conditions. Order of limb and visual condition for each limb was randomly selected. Means and standard deviations of TTB minima in the anteroposterior and mediolateral directions were computed to assess balance, with lower values indicating poorer balance.

RESULTS

Independent t-tests revealed significant group differences for almost all measures (p=<0.001 to 0.021), indicating that the ALAS group presented poorer bipedal balance. For unipedal balance, there were no significant group-by-limb interactions for all measures (p > 0.05), indicating no side-to-side differences in the ALAS group. However, group main effects were found for all measures (p=<0.001 to 0.048), showing poorer unipedal balance in the ALAS group.

SIGNIFICANCE

TTB analysis revealed impaired balance during both unipedal and bipedal stance conditions following ALAS. These results support the emerging hypothesis that centrally mediated changes in postural control may occur following ALAS.

Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews

BACKGROUND

Many factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary contributing factors. However, readers are now faced with several systematic reviews that present conflicting findings.

OBJECTIVE

The aim of this systematic review and meta-analysis was to establish the statistical significance and effect size of primary factors contributing to CAI and to identify likely reasons for inconsistencies in the literature.

METHODS

Relevant health databases were searched: CINAHL, MEDLINE, PubMed, Scopus and SPORTDiscus. Systematic reviews were included if they answered a focused research question, clearly defined the search strategy criteria and study selection/inclusion and completed a comprehensive search of the literature. Included reviews needed to be published in a peer-reviewed journal and needed to review observational studies of factors and/or characteristics of persons with CAI, with or without meta-analysis. There was no language restriction. Studies using a non-systematic review methodology (e.g. primary studies and narrative reviews) were excluded. Methodological quality of systematic reviews was assessed using the modified R-AMSTAR tool. Meta-analysis on included primary studies was performed.

RESULTS

Only 17% of primary studies measured a clearly defined CAI population. There is strong evidence to support the contribution of dynamic balance, peroneal reaction time and eversion strength deficits and moderate evidence for proprioception and static balance deficits to non-specific ankle instability.

CONCLUSIONS

Evidence from previous systematic reviews does not accurately reflect the CAI population. For treatment of non-specific ankle instability, clinicians should focus on dynamic balance, reaction time and strength deficits; however, these findings may not be translated to the CAI population. Research should be updated with an adequately controlled CAI population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2016, CRD42016032592.

Prevention of musculoskeletal injuries in recreational field hockey: the systematic development of an intervention and its feasibility

Objective

This article describes the systematic development of an intervention for the prevention of lower extremity injuries in field hockey and the assessment of its feasibility.

Methods

The intervention was developed according to the first four steps of the intervention mapping and knowledge transfer scheme processes, mostly based on focus group interviews with experts in field hockey and injury prevention (needs assessment; objective and target groups; content selection; development). Subsequently, a quasi-experimental research (one-group post-test design) was conducted among 35 young field hockey players and 7 coaches. Participants were asked to use the intervention for 3 weeks, and the degrees of relevancy, suitability, satisfaction and usability of the intervention were assessed by means of a questionnaire and a group interview.

Results

First, the needs assessment conducted among the main actors within recreational field hockey revealed that an injury prevention intervention was needed, ideally delivered through videos via an application for smartphone/tablet or website. Second, the objective and target groups of the intervention were defined, namely to prevent or reduce the occurrence of lower extremity injuries among both young and adult recreational field hockey players. Third, warming-up exercises were selected as preventive measures and strategies (eg, core stability, strength, coordination). Last, the 'Warming-Up Hockey' intervention was developed, consisting of a warm-up programme (delivered by coaches including more than 50 unique exercises). The relevancy, satisfaction and usability of 'Warming-Up Hockey' were positively evaluated, but two main alterations were made: the duration of the 'Warming-up Hockey' was reduced from 16 to 12  min and a match-specific warm-up was added.

Conclusion

The feasibility of 'Warming-Up Hockey' was positively assessed by players and coaches. Prior to its nationwide implementation, the effectiveness of the intervention on injury reduction among field hockey players should be conducted.

Antagonist co-activation during short and medium latency responses in subjects with chronic ankle instability

PURPOSE

This study aims to evaluate bilateral ankle antagonist co-activation during compensatory postural responses, including short latency responses (SLR) and medium latency responses (MLR), in response to a unilateral sudden ankle inversion in subjects with chronic ankle instability (CAI).

METHODS

Twenty-four participants with CAI and 20 controls participated in the present study. Bilateral eletromyography of peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA) and soleus (SOL) muscles was collected during a unilateral sudden inversion perturbation (30°) to assess antagonist co-activation of SOL/TA and TA/P pairs during SLR and MLR in both support and perturbed positions.

RESULTS

Compared to control group, participants with CAI presented: (1) bilateral increased antagonist co-activation of SOL/TA MLR in the support position; and (2) decreased antagonist co-activation of TA/P MLR of uninjured limb in the support position and of injured limb in the perturbed position.

CONCLUSIONS

CAI involves deregulation of ankle antagonist co-activation of MLR in both injured and uninjured limbs.

The effect of sensory-targeted ankle rehabilitation strategies on single-leg center of pressure elements in those with chronic ankle instability: A randomized clinical trial

OBJECTIVES

To determine the effects of sensory-targeted ankle rehabilitation strategies on laboratory-oriented measures of single-leg balance in those with chronic ankle instability.

DESIGN

Non-inferiority randomized controlled trial.

METHODS

Seventy-seven participants with self-reported chronic ankle instability were randomized into 4 treatment groups: Ankle joint mobilization, plantar massage, triceps surae stretching, and a control group. All participants performed 3 trials of single-leg balance on a force plate with eyes open and closed at 3 time points (baseline, immediately after the first treatment, and following 6 treatments over 2 weeks). The spatial (standard deviation), temporal (velocity), and spatiotemporal (time-to-boundary) elements of center of pressure excursions in single-leg balance were evaluated with eyes open and eyes closed at each time point. Immediate and final change scores were calculated for each group from the baseline values on these variables.

RESULTS

Joint mobilization produced immediate improvements in the temporal elements with eyes open and closed that exceeded the minimum detectable changes for these measures. Plantar massage and triceps surae stretching also enhanced the temporal element after a single treatment, but only with eyes closed. No substantial benefit of any of the interventions were found after 2-weeks of treatment, regardless of treatment group.

CONCLUSIONS

Sensory-targeted ankle rehabilitation strategies substantially improve single-leg postural control after one treatment, but these changes are short-lived. Future research is needed to determine whether combinations of sensory-targeted ankle rehabilitation strategies with other therapeutic interventions potentially improve single-leg balance stability in those with CAI compared to use in isolation.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01541657.

Nonelastic and Kinesio Tex Tapes Improve Perceived Stability But Not Postural Control in Participants With Chronic Ankle Instability

The development of chronic ankle instability (CAI) is common following a lateral ankle sprain. Taping using nonelastic and Kinesio Tex (KT) tapes remain popular treatment strategies. The purpose of this investigation was to determine if KT tape improves static and dynamic postural control relative to nonelastic tape and a control condition. Twenty-four participants completed all three conditions. No immediate improvements in postural control were noted in either taping condition. Both nonelastic and KT tape improved perceived stability relative to the control condition. In conclusion, nonelastic and KT tape should not be used to immediately improve postural control in CAI participants.

Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability

CONTEXT

  One of the major concerns after an acute lateral ankle sprain is the potential for development of chronic ankle instability (CAI). The existing research has determined that clinician-delivered plantar massage improves postural control in those with CAI. However, the effectiveness of self-administered treatments and the underlying cause of any improvements remain unclear.

OBJECTIVES

  To determine (1) the effectiveness of a self-administered plantar-massage treatment in those with CAI and (2) whether the postural-control improvements were due to the stimulation of the plantar cutaneous receptors.

DESIGN

  Crossover study.

SETTING

  University setting.

PATIENTS OR OTHER PARTICIPANTS

  A total of 20 physically active individuals (6 men and 14 women) with self-reported CAI.

INTERVENTION(S)

  All participants completed 3 test sessions involving 3 treatments: a clinician-delivered manual plantar massage, a patient-delivered self-massage with a ball, and a clinician-delivered sensory brush massage.

MAIN OUTCOME MEASURE(S)

  Postural control was assessed using single-legged balance with eyes open and the Star Excursion Balance Test.

RESULTS

  Static postural control improved (P ≤ .014) after each of the interventions. However, no changes in dynamic postural control after any of the interventions were observed (P > .05). No differences were observed between a clinician-delivered manual plantar massage and either a patient-delivered self-massage with a ball or a clinician-delivered sensory brush massage in any postural-control outcome.

CONCLUSIONS

  In those with CAI, single 5-minute sessions of traditional plantar massage, self-administered massage, and sensory brush massage each resulted in comparable static postural-control improvements. The results also provide empirical evidence suggesting that the mechanism for the postural-control improvements is the stimulation of the plantar cutaneous receptors.

Association of endothelial nitric oxide synthase polymorphisms with an increased risk of erectile dysfunction

The purpose of our meta-analysis is to examine the associations between three single nucleotide polymorphisms of endothelial nitric oxide synthase (eNOS) gene, G894T, intron 4 and T-786C, and the risk of erectile dysfunction. An electronic database search was performed to identify case-control studies reporting the association between single nucleotide polymorphisms of eNOS gene and erectile dysfunction. Stringent inclusion and exclusion criteria were employed to select high-quality studies for this meta-analysis. Comprehensive Meta-analysis 2.0 software (Biostat Inc., Englewood, New Jersey, USA) was used for statistical analysis of the data extracted from the selected studies. From the initial 203 articles retrieved from database search, this meta-analysis finally selected 12 high-quality case-control studies that conformed to our inclusion criteria. The 12 studies contained a total of 1962 patients with erectile dysfunction and 1752 healthy controls. The results of our meta-analysis showed that G894T correlated with an increased risk erectile dysfunction under both the allele and dominant models (allele: OR = 1.556, 95% CI = 1.064–2.275, P = 0.023; dominant: OR = 1.613, 95% CI = 1.050–2.476, P = 0.029). A similar association was found between T-786C and erectile dysfunction under the allele model (OR = 1.679, 95% CI = 1.341–2.102, P < 0.001), but not under the dominant model (all P > 0.05). Our meta-analysis showed that the two single nucleotide polymorphisms in eNOS gene, G894T and T-786C, are strongly associated with the risk of erectile dysfunction.

Postural stability for taekwondo athletes with repetitive ankle sprains during a single-leg stance

[Purpose] The purpose of this study is to investigate postural stability in such group of taekwondo athletes by measuring the center-of-pressure variables in both the injured limb and uninjured limb during a single-leg stance with eyes closed. [Subjects and Methods] The study includes eleven taekwondo athletes with repetitive ankle sprains (RASs) and eleven healthy taekwondo athletes (the controls) at the college level participating in taekwondo training sessions. For the controls, the "injured" limb was taken to be the left limb. [Results] The postural stability measured in both the anteroposterior and mediolateral directions using center-of-pressure variables was lower in the uninjured limb of the RAS group than in the control group during a single-leg stance with eyes closed. However, for the injured limb, there were no significant differences between the two groups. Furthermore, compared to the RAS group, the control group had higher stability in the injured limb than in the uninjured limb. [Conclusion] Individuals with RASs should ensure improvements in their proprioceptive and neuromuscular functions, as well as muscle strength, through an adequate period of rehabilitation to reduce the risk of re-injury.

Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space

CONTEXT

  Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known.

OBJECTIVE

  To measure knee-joint space after a single surgically induced ankle sprain in mice.

DESIGN

  Randomized controlled trial.

SETTING

  University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice.

MAIN OUTCOME MEASURE(S)

  Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs.

RESULTS

  Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups.

CONCLUSIONS

  Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function.

Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability

INTRODUCTION

Deficient sensory input from damaged ankle ligament receptors is thought to contribute to sensorimotor deficits in those with chronic ankle instability (CAI). Targeting other viable sensory receptors may then enhance sensorimotor control in these patients. The purpose of this randomized controlled trial was to evaluate the effects of 2 wk of sensory-targeted ankle rehabilitation strategies (STARS) on patient- and clinician-oriented outcomes in those with CAI.

METHODS

Eighty patients with self-reported CAI participated. All patients completed patient-oriented questionnaires capturing self-reported function as well as the weight-bearing lunge test and an eyes-closed single-limb balance test. After baseline testing, patients were randomly allocated to four STARS groups: joint mobilization, plantar massage, triceps surae stretching, or control. Each patient in the intervention groups received six 5-min treatments of their respective STARS over 2 wk. All subjects were reassessed on patient- and clinician-oriented measures immediately after the intervention and completed a 1-month follow-up that consisted of patient-oriented measures. Change scores of the three STARS groups were compared with the control using independent t-tests and Hedges' g effect sizes with 95% confidence intervals.

RESULTS

The joint mobilization group had the greatest weight-bearing lunge test improvement. Plantar massage had the most meaningful single-limb balance improvement. All STARS groups improved patient-oriented outcomes with joint mobilization having the most meaningful effect immediately after the intervention and plantar massage at the 1-month follow-up.

CONCLUSION

Each STARS treatment offers unique contributions to the patient- and clinician-oriented rehabilitation outcomes of those with CAI. Both joint mobilization and plantar massage appear to demonstrate the greatest potential to improve sensorimotor function in those with CAI.

Efficacy of Continuous Positive Airway Pressure in the Treatment of Chronic Obstructive Pulmonary Disease Combined With Respiratory Failure

Our aim is to investigate the efficacy of continuous positive airway pressure (CPAP) in chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Electronic and manual searches were applied to retrieve published studies relevant to CPAP, COPD, and respiratory failure. The retrieved studies were screened based on stringent inclusion and exclusion criteria to identify high-quality clinical studies for meta-analysis. Comprehensive meta-analysis 2.0 was conducted to statistical analysis. Initially, we retrieved 958 studies based on stringent inclusion and exclusion criteria, 10 studies, containing a total of 372 patients with COPD combined with respiratory failure, were selected for meta-analysis. The result of our meta-analysis revealed that partial pressure of carbon dioxide (PaCO2) in patients with COPD combined with respiratory failure was significantly lower 24 hours after CPAP treatment, and partial pressure of oxygen (PaO2) and pH were markedly higher 24 hours after CPAP treatment in the same patient group, indicating statistically significant differences as a result of CPAP treatment. Subgroup analysis based on ethnicity demonstrated that PaCO2 in patients with COPD combined with respiratory failure is evidently lower 24 hours after CPAP treatment among whites, but no such statistical correlation was observed among Asians. The results of this meta-analysis indicate that CPAP can effectively improve the respiratory function of patients with COPD combined with respiratory failure, and CPAP can be an effective way of treating COPD.

Serum leptin levels may be correlated with cerebral infarction

BACKGROUND

To investigate the relation between serum leptin levels and cerebral infarction (CI) by meta-analysis.

MATERIALS AND METHODS

Scientific literature databases were searched for studies published in Chinese and English. After retrieving relevant articles through database searches and screening using predefined selection criteria, high-quality studies related to our research topic were selected for inclusion in this meta-analysis. All statistical analyses were conducted using Comprehensive Meta-Analysis 2.0 (CMA 2.0, Biostat Inc., Englewood, New Jersey, USA).

RESULTS

The study results revealed that serum leptin levels were significantly higher in CI patients as compared to normal controls. The outcomes of subgroup analysis by ethnicity suggested that the serum leptin levels in CI patients were significantly higher than normal controls in both Asian and Caucasian populations. Further, subgroup analysis based on the detection method indicated that the serum leptin levels in CI patients were significantly higher compared with normal controls when measured by radioimmunoassay (RIA) but enzyme-linked immunosorbent assay (ELISA)-based measurements did not show such statistically significant differences.

CONCLUSION

Our meta-analysis results suggest that serum leptin levels in CI patients may be closely correlated with CI risks.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BACKGROUND

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports.

OBJECTIVE

To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI.

DESIGN

Overview of intervention systematic reviews.

PARTICIPANTS

Individuals with acute ankle sprain/CAI.

MAIN OUTCOME MEASUREMENTS

The primary outcomes were injury/reinjury incidence and function.

RESULTS

46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains.

CONCLUSIONS

For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.

Predicting balance improvements following STARS treatments in chronic ankle instability participants

OBJECTIVES

Sensory Targeted Ankle Rehabilitation Strategies that stimulate sensory receptors improve postural control in chronic ankle instability participants. However, not all participants have equal responses. Therefore, identifying predictors of treatment success is needed to improve clinician efficiency when treating chronic ankle instability. Therefore, the purpose was to identify predictors of successfully improving postural control in chronic ankle instability participants.

DESIGN

Secondary data analysis.

METHODS

Fifty-nine participants with self-reported chronic ankle instability participated. The condition was defined as a history of at least two episodes of "giving way" within the past 6 months; and limitations in self-reported function as measured by the Foot and Ankle Ability Measure. Participants were randomized into three treatment groups (plantar massage, ankle joint mobilization, calf stretching) that received 6, 5-min treatment sessions over a 2-week period. The main outcome measure was treatment success, defined as a participant exceeding the minimal detectable change score for a clinician-oriented single limb balance test.

RESULTS

Participants with ≥3 balance test errors had a 73% probability of treatment success following ankle joint mobilizations. Participants with a self-reported function between limb difference <16.07% and who made >2.5 errors had a 99% probability of treatment success following plantar massage. Those who sustained ≥11 ankle sprains had a 94% treatment success probability following calf stretching.

CONCLUSIONS

Self-reported functional deficits, worse single limb balance, and number of previous ankle sprains are important characteristics when determining if chronic ankle instability participants will have an increased probability of treatment success.

Foot and Ankle Injuries in Runners

Foot and ankle injuries account for nearly one-third of running injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are 3 of the most common types of injuries sustained during training. Other common injuries include other tendinopathies of the foot and ankle, bone stress injuries, nerve conditions including neuromas, and joint disease including osteoarthritis. This review provides an evidence-based framework for the evaluation and optimal management of these conditions to ensure safe return to running participation and reduce risk for future injury.

Evaluation of Adenosine Triphosphate-Binding Cassette Transporter A1 (ABCA1) R219K and C-Reactive Protein Gene (CRP) +1059G/C Gene Polymorphisms in Susceptibility to Coronary Heart Disease

Background

This meta-analysis investigated the correlation of ABCA1 R219K and CRP +1059G/C gene polymorphisms with susceptibility to coronary heart disease (CHD).

Material/Methods

We searched PubMed, Springer link, Wiley, EBSCO, Ovid, Wanfang database, VIP database, and China National Knowledge Infrastructure (CNKI) databases to retrieve published studies by keyword. Searches were filtered using our stringent inclusion and exclusion criteria. Resultant high-quality data collected from the final selected studies were analyzed using Comprehensive Meta-analysis 2.0 software. Eleven case-control studies involving 3053 CHD patients and 3403 healthy controls met our inclusion criteria. Seven studies were conducted in Asian populations, 3 studies were done in Caucasian populations, and 1 was in an African population.

Results

Our major finding was that ABCA1 R219K polymorphism increased susceptibility to CHD in allele model (OR=0.729, 95% CI=0.559~0.949, P=0.019) and dominant model (OR=0.698, 95% CI=0.507~0.961, P=0.027). By contrast, we were unable to find any significant association between the CRP +1059G/C polymorphism and susceptibility to CHD (allele model: OR=1.170, 95% CI=0.782~1.751, P=0.444; dominant model: OR=1.175, 95% CI=0.768~1.797, P=0.457).

Conclusions

This meta-analysis provides convincing evidence that polymorphism of ABCA1 R219K is associated with susceptibility to CHD while the CRP +1059G/C polymorphism appears to have no correlation with susceptibility to CHD.

Polymorphisms of CASR gene increase the risk of primary hyperparathyroidism

OBJECTIVE

To evaluate correlations between polymorphisms of calcium-sensing receptor (CASR) gene [A986S (rs1081725), R990G (rs1042636) and Q1011E (rs1801726)] and the risk of primary hyperparathyroidism (PHPT) among human population.

METHODS

Relevant studies were retrieved from online databases using computer-based search strategies, which were then supplemented by manual search strategies. Case-control studies related to our topic were identified based on strict inclusion and exclusion criteria. Statistical analyses were conducted using the Comprehensive Meta-analysis 2.0 (Biostat Inc., Englewood, NJ, USA).

RESULTS

We retrieved 202 studies from online databases and other sources initially and eventually enrolled six studies into our meta-analysis. These six studies contained a sum of 693 PHPT patients and 1252 healthy controls. Our meta-analysis results showed that single nucleotide polymorphisms (SNPs) of CASR gene A986S (rs1081725) and R990G (rs1042636), but not Q1011E (rs1801726), may increase the risk of PHPT [A986S (rs1081725): allele model: P = 0.013; dominant model: P = 0.044; R990G (rs1042636): allele model: P = 0.023; dominant model: P = 0.026)]. Subgroup analyses based on ethnicity showed that among Asians, A986S (rs1081725) increased the PHPT risk (P = 0.04) under the allele model, but not under the dominant model. Among Caucasians, there was no association between gene frequencies and PHPT under both the allele and dominant model. In Asians, no significant association was observed between R990G (rs1042636) and PHPT risk, but in Caucasians, R990G (rs1042636) significantly increased the incidence of PHPT [R990G (rs1042636): allele model: P = 0.015; dominant model: P = 0.009)].

CONCLUSION

Our results indicate that SNPs of CASR gene A986S (rs1081725) and R990G (rs1042636) may increase the risk of PHPT, and the polymorphisms can potentially be used as important biological markers for early diagnosis of PHPT.

Development of an efficient rehabilitation exercise program for functional recovery in chronic ankle instability

[Purpose] The aim of the present study was to construct an integrated rehabilitation exercise program to prevent chronic pain and improve motor ability in cases of ankle injury and re-injury. [Subjects and Methods] Twenty-six male soccer players who required functional strength exercises due to repeated ankle injury were the subjects. A 12-week rehabilitation exercise program was constructed with the aim of improving muscle strength in the ankle and dynamic coordination of the lower limb. Muscle strength and dynamic coordination were evaluated using the Y Balance Test, and isokinetic muscle strength of ankle dorsiflexion, plantarflexion, inversion, and eversion were measured before and after the 12-week program. [Results] Following 12 weeks of rehabilitation exercise, there were statistically significant improvements in the ratios of dorsiflexor strength to plantarflexor strength, eversion strength, and inversion strength on the left side. The other variables showed no significant changes. [Conclusion] The rehabilitation exercise program for chronic ankle instability helped to reduce pain, and to restore normal joint range of motion, muscle strength and endurance, and functional ability. Active protocols to improve complex functions need to be developed to complement these results.

Comparisons of knee and ankle joint angles and ground reaction force according to functional differences during single-leg drop landing

[Purpose] The purpose of this study was to determine potential predictors of functional instability of the knee and ankle joints during single-leg drop landing based on the prior history of injury. [Subjects and Methods] The subjects were 24 collegiate soccer players without pain or dysfunction. To compare the differences between the stable and unstable sides during single-leg drop landing, 8 motion analysis cameras and a force plate were used. The Cortex 4 software was used for a biomechanical analysis of 3 events. An independent t-test was used for statistical comparison between both sides; p<0.05 indicated significance. [Results] The knee joint movements showed gradual flexion in the sagittal plane. The unstable-side ankle joint showed plantar flexion of approximately 2° relative to the stable side. In the coronal plane, the unstable-side knee joint differed from the stable side in its tendency for valgus movement. The unstable-side ankle joint showed contrasting movement compared with the stable side, and the difference was significant. Regarding the vertical ground reaction force, the stable side showed maximum knee flexion that was approximately 0.1 BW lower than that of the unstable side. [Conclusion] Increasing the flexion angle of the knee joint can help prevent injury during landing.

Effects of reduced plantar cutaneous sensation on static postural control in individuals with and without chronic ankle instability

OBJECTIVES

The purpose of this study was to determine how reduced plantar cutaneous sensation influences static postural control in individuals with and without CAI.

DESIGN

A case-control study design.

METHODS

Twenty-six individuals with self-reported CAI and 26 matched healthy controls participated in this study. The plantar aspect of the participants' foot was then submersed in ice water (0°C) for 10min to reduce plantar sensation. Before and after the cooling procedure, plantar cutaneous sensation thresholds and single leg balance with eyes open and closed were assessed.

RESULTS

Significantly, higher scores were observed in both groups after ice water submersion (p<0.001) indicating a significant reduction in the plantar cutaneous sensitivity after the cooling procedure. In single limb balance with eyes open, there were significant intervention main effects for the TTB ML mean (p<0.001), TTB AP mean (p=0.035) and TTB ML SD (p=0.021); indicating postural control improvement in both groups post-cooling. In single limb balance with eyes closed, Group×Intervention interactions were observed for the TTB AP mean (p=0.003) and TTB AP SD (p=0.017); indicating postural control deficits in CAI group post-cooling, but no changes in the control group.

CONCLUSIONS

The main finding of this study was that reduced plantar cutaneous sensation induced by an ice submersion procedure caused eyes closed postural control impairments in those with CAI but not healthy controls. The present investigation demonstrated that the ability to dynamically reweight among sensory inputs to maintain postural stability appears to be diminished in CAI patients compared to healthy controls.

Interrater and intrarater reliability of the semmes-weinstein monofilament 4-2-1 stepping algorithm

INTRODUCTION

Semmes-Weinstein Monofilaments (SWM) are used to examine light touch sensation of the skin. Reliability of the 4-2-1 stepping algorithm approach for determining light touch detection thresholds has not been examined. The purpose of this study was to determine the interrater and intrarater reliability of the SWM 4-2-1 stepping algorithm on the plantar surface of the foot.

METHODS

Four raters with varying levels of SWM assessment experience tested light touch sensation over the plantar aspect of the first metatarsal head in 14 healthy adults. During the initial session, all raters performed the 4-2-1 stepping algorithm technique on each subject to determine interrater reliability. One week later, subjects were reassessed by 2 raters to determine intrarater reliability.

RESULTS

Interrater reliability ranged from moderate-to-good (ICC2,1  = 0.62-0.92). Intrarater reliability also ranged from moderate-to-good (ICC2,1  = 0.61-0.85).

CONCLUSIONS

The 4-2-1 stepping algorithm demonstrated acceptable interrater and intrarater reliability when measured in healthy adults. Muscle Nerve 53: 918-924, 2016.

WITHDRAWN: The MSX1 gene polymorphisms rs12532 and rs1001179 confer an increased risk of non syndromic orofacial clefts

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