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Xue X, Wang Y, Xu X, Li H, Li Q, Na Y, Tao W, Yu L, Jin Z, Li H, Wang R, Hua Y. Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Health 2024; 16:29-37. [PMID: 36872589 PMCID: PMC10732110 DOI: 10.1177/19417381231152490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
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.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiran Wang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyun Xu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weichu Tao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Le Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, China
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Lalevée M, Anderson DD, Wilken JM. Current Challenges in Chronic Ankle Instability: Review and Perspective. Foot Ankle Clin 2023; 28:129-143. [PMID: 36822682 DOI: 10.1016/j.fcl.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic ankle instability (CAI) is common, disabling, and represents a significant socioeconomic burden. Current treatment options are not adequately efficacious. CAI is multifaceted, yet it is commonly addressed in terms of either mechanical instability or functional impairment. Both are inherently linked. Basic research must be conducted to foster reliable translational research encompassing both mechanical and functional aspects. A review was conducted to identify CAI risk factors for inclusion in future studies, and we offer here opinions and perspectives for future research.
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Affiliation(s)
- Matthieu Lalevée
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France; Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, Rouen 76000, France
| | - Donald D Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242, USA; Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, 500 Newton Road, 1-249 Medical Education Building, Iowa City, IA 52242-1089, USA.
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Negishi K, Watanabe K, Teramoto A, Yamatsu K, Hayashi M. Three-dimensional motion analysis of the hindfoot resulting from simulated contraction of individual lower leg muscles utilizing Thiel-embalmed cadavers. Foot Ankle Surg 2022; 28:1040-1044. [PMID: 35210185 DOI: 10.1016/j.fas.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Joint movement within the foot is complex involving multiple muscles. We evaluated three-dimensional movement of the hindfoot through simulated traction of extrinsic tendons of the foot. METHODS Six Thiel-embalmed cadavers were utilized and thread was sutured to each tendon of the lower leg muscles. Traction of the thread was prescribed and the change of calcaneal position used to quantify foot motion was measured for each increment using a magnetic tracking system. RESULTS As the tendon traction length advanced, the angle of the calcaneus with respect to the tibia increased linearly. Eversion and abduction angles due to extensor digitorum longus (EDL) traction were significantly greater than that due to the peroneus longus. Plantarflexion due to Achilles tendon traction was significantly greater than that of other plantarflexors. CONCLUSIONS Our results demonstrated three-dimensional characteristics of hindfoot motion by simulated muscle contraction and importance of EDL as an evertor. These information should be applicable for tendon transfer procedures around the ankle and physical therapy for ankle dysfunction such as chronic ankle instability.
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Affiliation(s)
- Keisuke Negishi
- Graduate School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan.
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan
| | - Kenta Yamatsu
- Graduate School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan
| | - Mizuho Hayashi
- Graduate School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan
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Jeon W, Griffin L, Hsiao HY. Effects of initial foot position on postural responses to lateral standing surface perturbations in younger and older adults. Gait Posture 2021; 90:449-456. [PMID: 34600179 DOI: 10.1016/j.gaitpost.2021.09.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND An age-related decline in standing balance control in the medio-lateral direction is associated with increased risk of falls. A potential approach to improve postural stability is to change initial foot position (IFP). RESEARCH QUESTIONS In response to a lateral surface perturbation, how are lower extremity muscle activation levels different and what are the effects of different IFPs on muscle activation patterns and postural stability in younger versus older adults? METHODS Ten younger and ten older healthy adults participated in this study. Three IFPs were tested [Reference (REF): feet were placed parallel, shoulder-width apart; Toes-out with heels together (TOHT): heels together with toes pointing outward; Modified Semi-Tandem (M-ST): the heel of the anterior foot was placed by the big toe of the posterior foot]. Unexpected lateral translations of the standing surface were applied. Electromyographic (EMG) activity of the lower extremity muscles, standard deviation (SD) of the body's CoM acceleration (SD of CoMAccel), and center of pressure (CoP) sway area were compared across IFPs and age. RESULTS Activation levels of the muscles serving the ankle and gluteus medius were greater than for the knee joint muscles and gluteus maximus in the loaded leg across all IFPs in both groups. TOHT showed greater EMG peak amplitude of the soleus and fibularis longus compared to REF, and had smaller SD of CoMAccel and CoP sway area than M-ST. Compared to younger adults, older adults demonstrated lower EMG peak amplitude and delayed peak timing of the fibularis longus and greater SD of CoMAccel and CoP sway area in all IFPs during balance recovery. SIGNIFICANCE During standing balance recovery, ankle muscles and gluteus medius are important active responders to unexpected lateral surface perturbations and a toes-out IFP could be a viable option to enhance ankle muscle activation that diminishes with age to improve postural stability.
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Affiliation(s)
- Woohyoung Jeon
- Department of Kinesiology and Health Education, 2109 San Jacinto Blvd, D3700, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Lisa Griffin
- Department of Kinesiology and Health Education, 2109 San Jacinto Blvd, D3700, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, 2109 San Jacinto Blvd, D3700, University of Texas at Austin, Austin, TX, 78712, USA.
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Huang PY, Jankaew A, Lin CF. Effects of Plyometric and Balance Training on Neuromuscular Control of Recreational Athletes with Functional Ankle Instability: A Randomized Controlled Laboratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105269. [PMID: 34063454 PMCID: PMC8156931 DOI: 10.3390/ijerph18105269] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022]
Abstract
Plyometric exercise has been suggested for knee injury prevention in sports participation, but studies on ankle plyometric training are limited. This study aims to investigate the change of joint position sense and neuromuscular activity of the unstable ankle after six-week integrated balance/plyometric training and six-week plyometric training. Thirty recreational athletes with functional ankle instability were allocated into three groups: plyometric group (P) vs. plyometric integrated with balance training group (BP) vs. control group (C). Ankle joint position sense, integrated electromyography (EMG), and balance adjusting time during medial single-leg drop-landing tasks were measured before and after the training period. Following the six-week period, both training groups exhibited a lower absolute error in plantar flexion (P group: pre: 3.79° ± 1.98°, post: 2.20° ± 1.31°, p = 0.016; BP group: pre: 4.10° ± 1.87°, post: 2.94° ± 1.01°, p = 0.045), and the integrated group showed a lower absolute error in inversion angles (pre 2.24° ± 1.44° and post 1.48° ± 0.93°, p = 0.022), and an increased integrated EMG of ankle plantar flexors before landing. The plyometric group exhibited a higher integrated EMG of the tibialis anterior before and after landing (pre: 102.88 ± 20.93, post: 119.29 ± 38.33, p = 0.009 in post-landing) and a shorter adjusting time of the plantar flexor following landing as compared to the pre-training condition (pre: 2.85 ± 1.15 s, post: 1.87 ± 0.97 s, p = 0.006). In conclusion, both programs improved ankle joint position sense and muscle activation of the ankle plantar flexors during single-leg drop landing. The plyometric group showed a reduced adjusting time of the ankle plantar flexor following the impact from drop landing.
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Affiliation(s)
- Pi-Yin Huang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Amornthep Jankaew
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Physical Therapy Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: ; Tel.: +886-6235-3535 (ext. 5911)
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侯 宗, 敖 英, 胡 跃, 焦 晨, 郭 秦, 黄 红, 任 爽, 张 思, 谢 兴, 陈 临, 赵 峰, 皮 彦, 李 楠, 江 东. [Characteristics and related factors of plantar pressure in the chronic ankle instability individuals]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:279-285. [PMID: 33879898 PMCID: PMC8072434 DOI: 10.19723/j.issn.1671-167x.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals. METHODS From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed. RESULTS The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P < 0.05) and lateral/medial direction (P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P < 0.05). (3) The women (P < 0.05) and the individuals with higher Beighton scores (P < 0.05) showed worse balance control deficit in the lateral/medial direction. CONCLUSION CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.
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Affiliation(s)
- 宗辰 侯
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 英芳 敖
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 跃林 胡
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 晨 焦
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 秦炜 郭
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 红拾 黄
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 爽 任
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 思 张
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 兴 谢
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 临新 陈
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 峰 赵
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 彦斌 皮
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 楠 李
- 临床流行病学研究中心,北京 100191Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - 东 江
- 北京大学第三医院运动医学科,北京 100191Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
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Murata K, Kumai T, Hirose N. Lateral Ankle Sprains and Their Association with Physical Function in Young Soccer Players. Open Access J Sports Med 2021; 12:1-10. [PMID: 33469390 PMCID: PMC7811480 DOI: 10.2147/oajsm.s283421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Lateral ankle sprain (LAS) in childhood can result in lateral malleolus avulsion fractures; additionally, bone nonunion may occur. Physical maturity relates to the development of bone morphology and physical functionality. It is unknown how changes in physical functionality attributable to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels. Subjects and Methods Two hundred and ninety young soccer players aged 6–15 years were included. The presence of ALM was assessed using ultrasonography. The subjects were allocated to three groups based on physical maturity (Pre-, Mid-, and Post-peak height velocity age [PHVA]). The prevalence of ALM and the relationship between ALM and physical maturity were examined for body composition, foot pressure distribution, foot alignment, ankle mobility, and single-leg balance. Results The prevalence of ALM was 17.6%. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the Pre-PHVA group (P < 0.05). In the ALM group, the center of pressure during heel raising was distributed laterally in the Post-PHVA (P < 0.01), and the weight-bearing dorsiflexion angle was decreased in the Mid- and Post-PHVA (P < 0.05). Conclusion In the Post-PHVA young soccer players, decreased ankle dorsiflexion and eversion and increased one-leg hop distance were observed. The ALM group exhibited lateral loading during heel raising in the Post-PHVA group and decreased weight-bearing ankle dorsiflexion angle in the Mid- and Post-PHVA groups. The findings indicate the importance of secondary prevention of LAS and ultrasonography. Prospective studies of LAS in young athletes are required in the future.
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Affiliation(s)
- Kenichiro Murata
- Graduate School of Sport Sciences, Waseda University, Nishi-tokyo, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Yoshida T, Suzuki T. Relationship between chronic ankle sprain instability and ultrasonographic evaluation of the peroneus during a single-leg standing task. J Phys Ther Sci 2020; 32:33-37. [PMID: 32082025 PMCID: PMC7008020 DOI: 10.1589/jpts.32.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to examine the relationship between chronic ankle sprain
instability and ultrasonography of the peroneus muscles during a single-leg standing task.
[Participants and Methods] We examined nine college-aged students with a history of
lateral ankle joint sprain with chronic ankle sprain instability scores less than 24.
Participants underwent ultrasonographic measurement of the pennation angle and muscle
thickness of the peroneal and gastrocnemius muscle groups of both legs. In addition,
participants were evaluated for fluctuation by the root mean square calculated from
accelerations in the anteroposterior, lateral-horizontal, and vertical directions during
the single-leg standing position by affixing the accelerometer to their waist. Measurement
results were compared between sprain and non-sprain sides. [Results] Ultrasonography
revealed a significant reduction in the feathered pennation angle of the long peroneal
muscle on the side of the sprain, but no other significant differences. Also, significant
extension was observed on the side of the sprain in the anteroposterior and vertical
directions during single-leg standing; however, no significant differences were found in
the lateral-horizontal direction. [Conclusion] Participants with chronic ankle sprain
instability exhibited greater fluctuation in the anteroposterior and vertical directions.
Such fluctuations are believed to be compensatory in nature because the feathered horn of
the long peroneal muscle is decreased, and pronation of the forefoot is difficult during
one-leg standing.
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Affiliation(s)
- Takaki Yoshida
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences: 2-11-1 Wakaba, Kumatori, Sennan, Osaka 590-0482, Japan
| | - Toshiaki Suzuki
- Faculty of Health Sciences, Kansai University of Health Sciences, Japan
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