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Athletic trainers’ reasons for selecting or avoiding certain evaluation techniques for patients with an ankle sprain are not fully understood. Such information is important to facilitating evidence-based practice and eliminating barriers. The purpose of this qualitative study was to determine what factors influence athletic trainers’ selection or avoidance of specific outcomes used to determine patients’ return to activity readiness following an ankle sprain. Participants cited many factors that facilitate and inhibit their use of best-practice recommendations and alternative methods for evaluating patients with ankle sprains. Athletic trainers’ should continue to promote facilitators and eliminate barriers to the use of best practices.

Athletic trainers are commonly responsible for clearing patients with ankle sprains for return to activity. What criteria athletic trainers typically use to determine return to activity readiness in this population remains unclear. The purpose of this qualitative study was to examine criteria athletic trainers use to determine patients’ return to activity readiness following an ankle sprain. Participants varied in selected clinician-, patient-rated, and functional assessments for patients with ankle sprains. As many selected methods did not agree with expert consensus recommendations, more work is likely needed to instill best practices for evaluation of patients with ankle sprains.

Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still controversial. Diagnosis is difficult because of the overlapping clinical signs with talocrural instability and the absence of a reliable diagnostic reference test. This often results in misdiagnosis and inappropriate treatment. Recent research offers new insights in the pathophysiology of subtalar instability and the importance of the intrinsic subtalar ligaments. Recent publications clarify the local anatomical and biomechanical characteristics of the subtalar ligaments. The cervical ligament and interosseous talocalcaneal ligament seem to play an important function in the normal kinematics and stability of the subtalar joint. In addition to the calcaneofibular ligament (CFL), these ligaments seem to have an important role in the pathomechanics of subtalar instability (STI). These new insights have an impact on the approach to STI in clinical practice. Diagnosis of STI can be performed be performed by a step-by-step approach to raise the suspicion to STI. This approach consists of clinical signs, abnormalities of the subtalar ligaments on MRI and intraoperative evaluation. Surgical treatment should address all the aspects of the instability and focus on a restoration of the normal anatomical and biomechanical properties. Besides a low threshold to reconstruct the CFL, a reconstruction of the subtalar ligaments should be considered in complex cases of instability. The purpose of this review is to provide a comprehensive update of the current literature focused on the contribution of the different ligaments in the stability of the subtalar joint. This review aims to introduce the more recent findings in the earlier hypotheses on normal kinesiology, pathophysiology and relation with talocrural instability. The consequences of this improved understanding of pathophysiology on patient identification, treatment and future research are described. ispartof: FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY vol:11 ispartof: location:Switzerland status: published

[Purpose] The purpose of this study was to determine a preventive strategy for ankle sprain injury through a questionnaire survey of coaches of junior high school basketball teams. [Participants and Methods] The questionnaire comprised questions concerning coaches’ characteristics, prevention-related content, and collaboration with medical staff. We distributed the questionnaire to 108 coaches, of which 48 (41.7%) responded. [Results] The results revealed that none of the participant coaches had ever collaborated with medical staff. [Conclusion] Additional effort from medical staff is needed to hold seminars and contact coaches of junior high school teams in order to conduct an injury prevention program.

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.

Summary Aim: Balance training can help reduce the frequency of ankle joint injuries in adults, but data on young girls is relatively scant. Methods: Out of 91 female basketball players (7-16 years), 40 players were assigned to an experimental balance training group, and 51 players were assigned to a control group. Both groups performed their typical basketball training but the experimental group performed additional balance-focused exercises during the warm-up of their basketball training sessions. Results: A total of 47 girls (52 %) reported at least one ankle joint injury in their entire basketball history (52.5 % in the experimental, 50.9% in the control group). There was a positive correlation between the number of ankle joint injuries and age before the experiment (r = 0.34, p < 0.001). During the 12-month study period, girls who participated in balance training suffered significantly fewer ankle joint injuries than the control group (χ2 = 3.8423, df = 1, p-value < 0.05). Increased risk for ankle joint injury in the future was confirmed according to logistic regression for girls with previous ankle joint injury in history (4.33 times) and girls who did not participate in the balance training program (3.97 times). Conclusions: A progressive, barefoot balance training program that is simple and short enough to be performed during normal warm-ups can reduce the likelihood of suffering an ankle joint injury in young girls basketball players, which may be useful for athletes in other sports as well.

Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.

Highlights • Experimental research involving patients with ankle sprain is largely unregistered. • Most conclusions of treatment effectiveness are based solely on statistical significance. • Just 9% of statistically significant findings compare favorably to key measures of minimum clinical importance. • There is a high risk of false-positive discovery in a core field of musculoskeletal research., Background Lateral ankle sprain is the most common musculoskeletal injury. Although clinical research in this field is growing, there is a broader concern that clinical trial outcomes are often false and fail to translate into patient benefits. Methods We audited 30 years of experimental research related to lateral ankle sprain management (n = 74 randomized controlled trials) to determine if reports of treatment effectiveness could be validated beyond statistical certainty. Results A total of 77% of trials reported positive treatment effects, but there was a high risk of false discovery. Most trials were unregistered and relied solely on statistical significance, or lack of statistical significance, rather than on interpreting key measures of minimum clinical importance (e.g., minimal detectable change, minimal clinically important difference). Conclusion Future clinical trials must adopt higher standards of reporting and data interpretation. This includes consideration of the ethical responsibility to preregister their research and interpretation of clinical outcomes beyond statistical significance., Graphical Abstract Image, graphical abstract

Background: Postural control deficit is a major characteristic in patients with chronic ankle instability (CAI). Elastic ankle tapings are commonly used to facilitate postural control in patients with CAI as well as prevent relapse of a lateral ankle sprain. However, equivocal evidence exists concerning the effect of elastic ankle taping on postural control. Objects: This study aimed to evaluate the effects of elastic ankle tapings using kinesio taping (KT) and dynamic taping (DT) on static and dynamic postural control in patients with CAI. Methods: Fifteen subjects with CAI were participated in this study. The participants performed tests under three conditions (barefoot, KT, and DT). Static postural control was evaluated using the one-leg standing test (OLST) and dynamic postural control using the modified Star Excursion Balance Test (mSEBT). One-way repeated-measures analysis of variance was used to compare center of pressure (CoP) data and normalized mSEBT reach distances among the three conditions (with α = 0.05). Results: The CoP parameters (path length, ellipse area, and mean velocity) of the OLST significantly decreased on applying KT and DT compared with those when barefoot. The normalized reach distances in the anteromedial (AM), medial (M), and posteromedial (PM) directions of the mSEBT significantly increased with DT compared to that in the control condition. Further, the higher reach distances with KT compared with those in the control condition were obtained in the M and PM directions of the mSEBT. No significant differences were identified in any of the OLST and SEBT parameters between the two different taping applications. Conclusion: KT and DT improved static postural control during the OLST compared with the control condition. Moreover, these tapes improved dynamic postural control during the mSEBT compared to the control. Therefore, elastic ankle tapings are useful prophylactic devices for the prevention and treatment of ankle sprain in people with CAI.

The present study investigated that Headway (Isometric, Isotonic and Proprioception) exercises are effective for acute & chronic ankle sprain injury, which was observed through experimental research. Ninety-four amateur cricketers of age, 15-35 years (Control Injured, N=48; Headway Rehab Group N=46) with a confirmed acute or chronic ankle sprain, selected from four different cities of Punjab, Pakistan was evaluated through Star Excursion Balance Test (SEBT), Single Leg Balance test (SLB) and subject to a set of progressively increasing exercises on ground known as Headway rehab exercises which consisted of Isometric, Isotonic and proprioception protocols. Another group of the same level of cricketers (N=40) was managed parallel for comparisons. The Control Injured and Headway Rehab Group was left with 40 subjects each because during the course of Headway exercise eight and six subjects left the study due to their personal reasons. Comparisons of pre and post-exercise (Control Injured Group) values showed a significant increase (p

Ankle sprains represents the most frequent musculoskeletal trauma incurred by patients attending emergency departments. The incidence of ankle sprains is high among the general population, and especially among athletes. The high incidence of ankle sprains among the general population and athletes translates into a significant socio-economic impact. Ankle sprains are often considered as innocuous, that will heal quickly without the need for medical intervention – as such, as many as 50% of individuals who incur an acute ankle sprain do not seek medical treatment. Absence of treatment increases the risk of developing residual symptoms, such as, pain, joint laxity and instability. Some individuals will self-report “feelings of ankle instability” and/or experience episodes of “giving-way” of the ankle joint that are often primarily associated with functional insufficiencies – which are grouped under the definition of functional ankle instability (FAI). The functional insufficiencies associated with FAI include impairments of: postural balance, proprioception, neuromuscular control , and muscle strength. If these functional insufficiencies persist, recurrent sprains are common, which leads to the development of chronic ankle instability (CAI). Compared to healthy controls, individuals with either FAI and/or CAI display lower levels of physical activity and sports participation, impaired quality of life33 and higher risk of developing post-traumatic ankle osteoarthritis. First line of treatment for individuals with FAI and/or CAI focuses on managing both physical and functional impairments. It is thus crucial to identify the spectrum of functional and biomechanical impairments which are associated with FAI and CAI in order to implement early and effective treatment. There are a few systematic reviews that investigated the biomechanical behavior of individuals with CAI during the performance of landing tasks, but which just reported the outcomes across studies and failed to provide any summary of data synthesis. Our aim is to perform a systematic review with meta-analysis of cross-sectional and case-control studies to investigate whether individuals with CAI and FAI display aberrant biomechanics during jumping/landing, hoping and pivoting/cutting tasks.

Ankle sprains are common musculoskeletal injuries. Ankle sprains can be differentiated in a simple sprain in which the lateral ligaments remained intact or in rupture of one or more ligaments. The anterior talofibular ligament (ATLF) is most commonly the first to rupture, followed by the combined injury of the ATFL and calcaneofibular ligament (CFL). Isolated CFL ruptures are rare. Ankle syndesmosis injuries (also known as ‘high ankle sprains’) are less common, accounting for 1 to 24% of all ankle injuries. Diagnosis is usually made by combining clinical history, physical exam, manual laxity testing and impairment-based assessment. Complementary imaging studies, including stress radiographs, magnetic resonance imaging (MRI), arthrography and ultrasonography are used to confirm the structural integrity of capsuloligamentous structures. Some of the key disadvantages of the imaging tools are exposure to radiation, invasive procedures, and associated high costs and time. Imaging is expensive and time-consuming, and adds little information beyond what the clinician can obtain via physical examination. Early and accurate diagnosis of ankle injuries is crucial for timely and effective management. In addition to the clinical history (history of sprain or other traumatic event) and physical exam (inspection and palpation), the manual clinical tests are a key component of the comprehensive physical examination. The diagnostic accuracy of these tests can vary, and differentiating between isolated ankle and syndesmosis injuries is challenging. Previous systematic reviews have examined the diagnostic accuracy of physical examination tests for ankle and syndesmosis injuries. These systematic reviews included only a few studies and do not provide pooling summary of diagnostic accuracy data due to the heterogeneity of the studies (different reference standards and varying methodological quality). Since then, at least five new studies have been published and a new systematic review with meta-analysis is thus warranted. Our purpose is to conduct a systematic review and meta-analysis on the diagnostic accuracy of clinical diagnosis for ankle and syndesmotic ligament injuries.

Le distorsioni di caviglia acute (Lateral Ankle Sprain, LAS) e/o le condizioni di instabilità cronica di caviglia (Chronic ANkle Instability, CAI) possono favorire lo sviluppo di debolezza a carico della muscolatura dell'anca? La ricerca scientifica ha affermato che la debolezza muscolare di anca rappresenta un fattore di rischio per l'insorgenza di distorsioni di caviglia, ma non ha ancora dimostrato il contrario: se ciò fosse vero, si determinerebbe un circolo vizioso di influenza reciproca tra articolazione di caviglia e di anca, con un impatto epidemiologico, economico e sociale importante che andrebbe a interferire negativamente sulla qualità della vita. Per rispondere a questa domanda, valuteremo tramite dinamometro manuale la forza isometrica della muscolatura dell'anca in seguito a una o più distorsioni di caviglia, tramite uno studio osservazionale eziologico caso-controllo e di coorte con coorte concorrente, che includerà 140 soggetti suddivisi in 5 gruppi: gruppo controllo, gruppi LAS e CAI retrospettivi, gruppi LAS e CAI prospettici. La prima misurazione di forza isometrica dell'anca, sarà seguita da altre 3 misurazioni (follow up a 3, 6, 12 mesi dalla prima misurazione), per valutare e monitorare l'influenza delle distorsioni di caviglia a carico della muscolatura dell'anca in un arco di tempo di 12 mesi. Confermando la nostra ipotesi, potremmo dare un importante contributo all'attuale intervento riabilitativo nella gestione delle distorsioni di caviglia acute e delle instabilità croniche di caviglia.

Background The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons. Purpose To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles. Material and Methods We designed an observational study with repeated measures taken from a convenience sample of 20 participants diagnosed with acute or chronic ankle sprain. Two independent raters took three separate records from the CSA of ankle tendon images of each MRI slice. The intra-class correlation coefficient (ICC) and 95% limits of agreement (LoA) defined the quality (associations) and magnitude (differences), respectively, of intra- and inter-rater reliability on the measures plotted by the Bland–Altman method. Results Data showed very high intra- and inter-rater correlations for measures taken from all tendons analyzed (ICC 0.952–0.999). It also revealed an excellent agreement between raters (0.12%–2.3%), with bias no higher than 2 mm2 and LoA in the range of 4.4–7.9 mm2. The differences between repeated measures recorded from the thinnest tendons (fibularis longus and brevis) revealed the lowest bias and narrowest 95% LoA. Conclusion Reliability for the CSA of ankle tendons measured from MRI taken by independent rates was very high, with the smallest differences between raters observed when the thinnest tendon was analyzed.

Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention.To determine the prevalence of running-related injuries and describe factors related to a history of injury.Retrospective cross-sectional study.Survey distributed online to middle school runners.Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation.Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age.Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858).Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p .001).Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

Context Basketball has remained a popular sport for players and spectators in the United States since before the first National Collegiate Athletic Association men's championship tournament in 1939. Background Routine examinations of men's basketball injuries are important for identifying emerging temporal patterns. Methods Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014–2015 through 2018–2019 athletic seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates. Results The overall injury rate was 7.28 per 1000 athlete exposures, with competition rates twice those of practices (injury rate ratio = 2.07; 95% CI = 1.93, 2.22). Injuries to the ankle (22.2%), knee (13.0%), head/face (11.3%), and hand/wrist (10.1%) accounted for most reported injuries, with sprains (30.4%), contusions (14.3%), and strains (13.9%) most commonly reported. Ankle sprain rates initially trended upward and decreased between 2017–2018 and 2018–2019; concussion rates remained relatively stable during 2014–2015 through 2018–2019. Conclusions Findings suggest that common injury rates are trending downward relative to previous study findings.

Objective Investigate effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain. Methods Searches were conducted on six databases for randomized or quasi-randomized controlled trials (RCTs) evaluating effectiveness of cryotherapy for pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain. Selection of trials, data extraction and methodological quality assessment of included trials were conducted independently by two reviewers with discrepancies resolved by a third reviewer. Estimates were presented as mean differences (MDs) with 95% confidence intervals (CIs). The quality of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. Results Two RCTs with high risk of bias were included. Both evaluated the additional effects of cryotherapy, comparing cryotherapy combined with other intervention versus other intervention stand-alone. Uncertain evidence shows that cryotherapy does not enhance effects of other intervention on swelling (MD = 6.0; 95%CI: 0.5 to 12.5), pain intensity (MD = −0.03; 95%CI: 0.34 to 0.28) and range of motion (p > 0.05). Conclusions Current literature lacks evidence supporting the use of cryotherapy on management of acute ankle sprain. There is an urgent call for larger high-quality randomized controlled trials.

Background and Objectives: The aim of this study was to assess the impact of ankle muscles on performance of the Star Excursion Balance Test (SEBT) among individuals with stable ankles, a history of ankle sprain, and chronic ankle instability (CAI). Materials and Methods: Sixty subjects (twenty per group) performed the SEBT in each of the anterior (A), posteromedial (PM), and posterolateral (PL) directions. Normalized maximum reach distance (NMRD) and normalized mean amplitude of the tibialis anterior (NMA_TA), fibularis longus (NMA_FL), and medial gastrocnemius (NMA_MG) were measured during performance of the SEBT. Results: Copers have greater NMRD than subjects with stable ankles and those with CAI, and subjects with stable ankles also have greater NMRD than those with CAI in only the PL direction. Subjects with stable ankles and those with CAI showed greater NMA_TA than copers. The A direction showed greater NMA_TA than the PM and PL directions. Copers showed greater NMA_FL than subjects with stable ankles. Subjects with CAI showed greater NMA_MG than copers and subjects with stable ankles. The A and PL directions showed greater NMA_MG than the PM direction. Conclusions: Overall, copers and/or subjects with CAI demonstrated altered neuromuscular function by compensating for their ankle muscles when compared to subjects with stable ankles due to a history of ankle sprain.

Contacting the base is a common injury mechanism for base runners in softball, with ankle sprains being the most common type of injury, but it is not known how the base affects lower extremity mechanics. The purpose of this study was to analyze lower extremity biomechanics while rounding a base. Sixteen recreationally active females with previous softball experience completed two base rounding conditions. A base was securely placed on the force place for the with base (WB) condition, and an outline of the base was taped on the force plate for the no base (NB) condition. Three-dimensional right-leg hip, knee, and ankle kinematics and kinetics were measured during the stance phase of the base rounding and analyzed using statistical parametric mapping (SPM). The WB condition resulted in decreased hip abduction ( p = 0.034), increased dorsiflexion ( p = 0.012), and decreased inversion ( p

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Chronic lateral ankle instability is the sensation of the ankle giving way along with recurrent sprains, chronic pain and swelling of the ankle for 1 year. The lateral ankle complex comprises the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The anterior talofibular ligament is the most commonly injured ligament of the lateral ankle. Evaluation comprises a history and physical with concomitant imaging to confirm the diagnosis and can be used to evaluate for concurrent pathology. The most popular treatment is a direct anatomic repair; however, additional options can be used in specific patient populations.

The aim of the present report was to find out the effect of 448 kHz Capacitive Resistive Monopolar Radiofrequency (CRMRF) in acute ankle sprain. A patient with right unilateral acute ankle sprain participated in the present case study. The patient followed a course of 448 kHz CRMRF twice per day for seven consecutive days. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. There was a decline in pain and a rise in function in all evaluations. The results of the present trial suggest that a course of 448 kHz CRMRF as described in the present trial can produce significant improvements in terms of pain and disability in acute ankle sprain; however, larger studies are required confirming these results.

PURPOSE:This study aimed to identify differences in ankle laxity in chronic ankle instability (CAI), coper, and control groups, and a correlation between ankle laxity, self-reported function, and perceived instability.METHODS: Sixty-six participants (22 CAI patients, 22 copers, and 22 controls) selected by recommendations of the International Ankle Consortium volunteered for this study. Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sports, and Ankle Instability Instrument (AII) were used to assess participants’ self-reported function and perceived instability. The FAAMADL and FAAM-Sports are reported as a percentage. Higher scores indicate better function. The AII is reported as “yes” responses while more “yes” responses indicate higher instability. Three trials of anterior/posterior (A/P) displacement and inversion/eversion (I/E) displacement were assessed by an instrumented ankle arthrometer. Greater displacement indicates higher laxity. The ankle positioned in sagittal- and frontal-plane neutral while A/P and I/E displacement were assessed with 125 N and 4 N-m, respectively. The means of three trials were used for data analysis. One-way ANOVA and Tukey post-hoc comparisons (α=0.05) were performed to identify differences in ankle laxity between groups. Pearson correlation analysis was performed to identify a relationship between ankle laxity, self-reported function, and perceived instability.RESULTS: CAI patients show greater A/P displacement compared to control group (p

Objective The primary aim was to determine differences in talocrural and subtalar joint (STJ) articular cartilage composition, using T1ρ magnetic resonance imaging (MRI) relaxation times, between limbs in individuals with unilateral chronic ankle instability (CAI) and compare with an uninjured control. Our secondary purpose was to determine the association between talocrural and STJ composition in limbs with and without CAI. Design T1ρ MRI relaxation times were collected on 15 CAI (11 females, 21.13 ± 1.81 years, body mass index [BMI] = 23.96 ± 2.74 kg/m2) and 15 uninjured control individuals (11 females, 21.07 ± 2.55 years, BMI = 24.59 ± 3.44 kg/m2). Talocrural cartilage was segmented manually to identify the overall talar dome. The SJT cartilage was segmented manually to identify the anterior, medial, and posterior regions of interest consistent with STJ anatomical articulations. For each segmented area, a T1ρ relaxation time mean and variability value was calculated. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Results Individuals with CAI demonstrated a higher involved limb talocrural T1ρ mean and variability relative to their contralateral limb ( P < 0.05) and the healthy control limb ( P < 0.05). The CAI-involved limb also had a higher posterior STJ T1ρ mean relative to the healthy control limb ( P < 0.05). In healthy controls ( P < 0.05), but not the CAI-involved or contralateral limbs (p>0.05), talocrural and posterior STJ composition measures were positively associated. Conclusions Individuals with CAI have lower proteoglycan content in both the talocrural and posterior STJ in their involved limbs relative to the contralateral and a healthy control limb. Cartilage composition findings may be consistent with the early development of posttraumatic osteoarthritis.

Introduction: Acute ankle sprains are a common type of musculoskeletal injury. With the increased popularity of MRI post-ankle sprain, more cases of bone marrow edema or bone bruise are detected. This is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema. This study aims to analyze if the presence of ankle ligament injury presents any significant statistical relation with the specific location. Materials and Methods: We reviewed 50 MRI performed during 2015-2018 for patients who reported ankle pain and signs of instability. Two different radiologists evaluated the series. Bone marrow edema location and specific ligament lesions were contrasted to find possible associations. Chi-Square was used to analyzethe differences. Results: The anterior talofibular ligament was the most commonly injured ligament (84%). CFL injury occurred in 27 cases (54%). There were no differences between the presence of bone marrow edema and the ligament injured after an ankle sprain (p>0,05). Overall, the most common location of bone marrow edema was the head and neck of the talus (64%). There was no statistical relationship between bone marrow edema location and the injured ligament (p>0,05). Conclusion: Bone marrow edema is a frequent finding after a ligament injury following ankle sprains. However, this finding is not directly related to a specific location of the injured ligament. The location of bone marrow edema is not related to specific ligament injuries. MRI findings of bone marrow edema must not change the management of patients with acute ankle sprains. Level of Evidence: II

Ankle sprain has a great effect on morbidity and complications of chronic diseases. Experts have come to a consensus where ankle sprain can be managed by rest, ice, compression and elevation, non-steroidal anti-inflammatory drugs, immobilisation, functional support such as the use of an ankle brace, exercise, surgery and other therapies that include physiotherapy modalities and acupuncture. However, the time required for healing is still relatively long in addition to post-operative complications. Because of the challenges and setbacks faced by interventions to manage ankle sprains and in view of the recent trend and development in the field of regenerative medicine, this article discusses future treatments focusing on a personalised and holistic approach for ankle sprain management. This narrative review provides a novel idea for incorporating regenerative medicine into conventional therapy as an intervention for ankle sprain based on theoretical concepts and available evidence on regenerative medicine involving ligament injuries.

LAY SUMMARY Physiotherapists employed in Canadian Armed Forces Health Services Centres maintained or improved their awareness and use of recommended assessments and treatments of ankle sprains six months after participating in a distance learning presentation. Further improvements may require administrative support locally, nationally, or both.

Lateral ankle sprain is very common in sports. Recently, there was a wearable assistive technology that stimulates the peroneal muscles to prevent this injury, but it requires a monitoring system to detect injury hazards and actuate the protection. This study presents the feasibility of a uniaxial gyroscope to monitor the peak ankle inversion velocity during common sporting motion and simulated ankle sprain motion. Ten males performed walking, running, 45-deg cutting, vertical jump-landing, stepping-down from a block, 5 kinds of simulated ankle sprain motion on sprain simulators, and a manual ankle-twisting motion in a biomechanics laboratory. The peak ankle inversion velocity was collected by an optical motion analysis system at 120 Hz. Besides, a uniaxial gyroscope was attached to the heel to collect the peak twisting velocity at 500 Hz. Pearson test showed a strong or high positive correlation between the two parameters. Independent t-test showed no difference between the two parameters in all testing motions except the manual ankle-twisting test which the value was 82% of that from the optical motion capture system and both values are above the threshold, 300 deg/s. We concluded the method is applicable to detect the hazard of lateral ankle sprain injury.

Background: The incidence of Venous Thromboembolism (VTE) and its prophylaxis in patients with an ankle injury and cast immobilization are controversial. Objectives: This study aimed to investigate the effect of aspirin and enoxaparin on VTE prevention in patients with an ankle sprain and cast immobilization. Methods: In a double-blind, randomized clinical trial, 90 eligible patients were divided into three groups: patients who did not receive the drugs (the control group), patients who received aspirin (325 mg/d) for 3 weeks (the ASA group), and patients who received enoxaparin (40 mg/d subcutaneously) for 3 weeks (the enoxaparin group). After 3 weeks, the plaster was opened, and the D-dimer level was measured if there was a VTE symptom during the study. Otherwise, at the end of the study, the bilateral lower-limb Complete Compression Ultrasonography (CCUS) and color Doppler ultrasound were used to image the lower limb venous system. Results: Sixty-eight patients completed the study. The mean±SD values of D-dimer in the control, ASA, and enoxaparin groups were 0.33 (0.47) μg/dL (Median=0.18 μg/dL), 0.32 (0.14) μg/dL (Median=0.3 μg/dL) and 0.32 (0.25) μg/dL (Median=0.21 μg/dL), respectively (P>0.05). The positive D-dimer was seen in 2 patients (8%) of the control group, 2 patients (8.3%) of the ASA group, and 2 patients (10.5%) of the enoxaparin group (P>0.05). The color Doppler ultrasound was negative in all patients. Conclusion: Because none of the 68 patients in the current study developed VTE during our 30 days follow-up period, it seems that prophylaxis treatment is unnecessary in patients with an ankle sprain and cast immobilization. Further studies on more patients with a longer period of follow-up are recommended.

Background:The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB.Methods:Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm.Results:Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST ( P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL ( P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group ( P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group ( P = .144).Conclusion:Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity.Level of Evidence:Level II, prospective comparative study.

Peroneal muscle fatigue could result in ankle inversion sprain injuries. This study investigated the peroneal muscle reaction time during a simulated prolonged football protocol. Nine male footballers completed a 105-minute simulated prolonged football protocol. The peroneal muscle reaction time to an ankle inversion perturbation was measured every 15 minutes by a surface electromyography system sampling at 1000 Hz. One-way repeated ANOVA with post-hoc paired t-test showed a steady upward trend starting from 48.9 ms at baseline to 57.1 ms at the end of the first half, followed by a recovery back to 50.9 ms at the start of the second half and a further delay in the last 30 minutes to 60.2 ms at the end of the protocol. Delayed peroneal muscle reaction was found after 30 minutes of the first half and 15 minutes of the second half of a football match. The risk of ankle sprain could increase in the latter minutes in each half protocol. Thus, prevention injury training strategies should focus on these specific durations in football matches.

Ankle sprain is the most common injury in performance sports. Two of the most common residual symptoms of an ankle sprain are: the occurrence of chronic joint instability and agonist-antagonist muscle imbalances, expressed numerically by the values ​​of the muscle coactivation index. The purpose of the research was to demonstrate that the use of proprioceptive exercises leads to the improvement of the degree of chronic joint instability and of the values ​​of the muscle coactivation index. The research had a number of 22 subjects, handball players, whose age was between 15 and 16 years. The degree of joint instability was established by using the “Foot and Ankle Disability Index” Questionnaire, while the values ​​of the muscle coactivation index were calculated following the electromyographic measurements. The obtained results highlight the efficiency of the proposed proprioceptive exercise programme, the statistical significance of the obtained results (by improving the initial and final values), as well as the existence of correlations between all evaluated parameters (muscle coactivation index, number of ankle sprains and degree of joint instability). The conclusions of the research underline the efficiency of proprioceptive exercises in diminishing the degree of chronic joint instability and in improving the values ​​of the muscle coactivation index. Based on the results obtained, the research acquires an important practical value, because the proposed intervention programme has applicability in all sports sectors.

Delayed peroneal reaction time and impaired single-legged dynamic stability were risk factors of lateral ankle sprain (LAS), yet no study explored the change of them during a football match. The aim is to explore the change of peroneal reaction time and single-legged dynamic stability during a football simulation protocol. Twelve collegiate football players voluntarily completed a 105-min football match simulation protocol in which peroneal reaction time, root-mean-square of mediolateral ground reaction force in first 0.4 s (RMS ML 0.4), and the mean mediolateral ground reaction force in the late stage (late dynamic MLGRF), were measured for both legs at 15-min intervals during the protocol. Peroneal reaction time was tested using an electromyography (EMG) system. The ground reaction force variables were measured from GRF data after a single-legged drop-jump landing. Repeated measures one-way MANOVA was conducted to evaluate variables over time and leg dominance. Statistical significance was set at

Following lower leg sprain, leftover indications are frequently clear, and proprioceptive preparing is a treatment approach. Proof, be that as it may, is restricted and the ideal program must be recognized. To examine the aftereffects of proprioceptive preparing programs and neuromuscular offsetting in people with intense low lower leg sprain. Members were selected from a physiotherapy place for lower leg sprain recovery. In a pre-post treatment, 20 people were haphazardly apportioned to a proprioceptive preparing and neuromuscular adjusting gathering .The gathering got restoration meetings, inside 12-week time frame. Dorsiflexion scope of movement (ROM), torment, utilitarian and equilibrium execution were evaluated at gauge, toward the finish of preparing and a month and a half in the wake of preparing. Subsequent information were accommodated 20 people. 6 and12 weeks in the wake of preparing, factually huge enhancements were found in dorsiflexion ROM and most useful execution measures. Huge enhancements were found in VAS score ,AOFAS score and remaining shakiness at 6 and 12 weeks after restoration .early neuromuscular balance&proprioception preparing are suggested in clinical practice for improving lower leg ROM and utilitarian execution in people with sprain. Equilibrium programs are likewise suggested for help with discomfort.

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Background: Clinically, a discrepancy of fibular position in relation to the tibia has been proposed as a factor in the persistence of chronic ankle instability (CAI). Previous studies have produced conflicting findings, perhaps due to varying radiological methods and measurement of participants in non-weight-bearing positions. Objectives: To compare normalized-fibular position in weight-bearing in individuals with CAI with healthy controls. Design: A weight-bearing lateral X-ray was taken of the affected ankle of 33 adults with CAI and 33 matched controls. The distance between the anterior edges of the distal fibula and tibia was recorded, and then normalized as a proportion of maximal tibial width. Normalized-fibular position was compared between groups using independent t-tests. Intra-class correlation coefficients (ICC(2,1)) were calculated to determine reliability of measurements. A receiver-operating characteristic (ROC) curve was used to determine sensitivity, specificity, and a cutoff score to differentiate individuals with CAI from controls using normalized-fibular position. Results: Normalized fibular position was significantly different (CAI, 29.7 (6.6)%; healthy, 26.7 (4.8)%) between the groups. Measurement of intra-rater (0.99, 95%CI = 0.98 to 1.00) and inter-rater (0.98, 95%CI = 0.96 to 0.99) reliability were both excellent. The threshold normalized-fibular position was 27%, with a score more than 27% indicating a greater chance of being in the CAI group. Sensitivity was 69.7% and specificity was 54.5% for this threshold. Conclusion: A slightly anteriorly positioned fibula in relation to the tibia was observed in people with CAI. Specificity/sensitivity scores for normalized-fibular position indicate that it has little ability to predict CAI alone.

Introduction: The use of ultrasonography for diagnosing musculoskeletal injuries, especially fractures, in the emergency department is on the rise because of its good diagnostic value. This study aimed to evaluate the diagnostic value of bedside ultrasonography in detecting the patients suffering from lateral malleolar fractures with an ankle sprain mechanism. Methods: This prospective study was conducted on patients having acute ankle injuries with ankle sprain mechanism and diagnosed with lateral malleolar tenderness. All patients underwent bedside ultrasonography with a 7.5 - 10 MHz probe by an emergency medicine specialist who was assisted by a radiologist. Next, they underwent lateral ankle and anteroposterior (AP) X-rays by another emergency medicine specialist who was blinded from the ultrasonography results. The ultrasonography and X-Ray results were then compared. Results: A total of 244 patients participated in this study, of whom 92 (37.70%) were diagnosed with lateral malleolar fracture through bedside ultrasonography and X-Ray tests. The results showed that ultrasonography had a sensitivity of 96.84% and a specificity of 97.31%. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 36.07 and 0.0325, respectively, and the positive and negative predictive values of bedside ultrasonography were 95.83% and 97.98%, respectively. Finally, the results indicated a percent agreement (accuracy) of 97.13% between the two tests with Kappa coefficient of 0.94 (z = 14.68, P value < 0.01). Conclusion: The results of this study showed that bedside ultrasonography has a high sensitivity and specificity in the diagnosis of lateral malleolar fractures with an ankle sprain mechanism. Conducting further studies will lead to the use of this diagnostic test in the emergency department.

Background: When intraoperative computed tomography (CT) is unavailable, open syndesmosis assessment is a universally available, safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved upon with a validated technique for assessing the accuracy of open syndesmosis reductions. The “tibiofibular line” (TFL) is a CT-based technique found to be sensitive for malreduction. The purpose of this study was to assess the feasibility of adapting the CT-TFL method into a reliable intraoperative open technique by refining the methodology of previous work exploring the clinical TFL technique. Methods: Three observers were instructed to clinically simulate the TFL on cadaveric lower limbs. For each specimen, observers repeated and recorded 3 clinical TFL measurements for each of 4 measurement series representing different degrees of fibula reduction. Intraclass correlation was used to assess intra- and interobserver reliabilities. Results: Mean intraobserver reliability was .88. Mean interobserver reliability was .75. Both intra- and interobserver reliabilities were highest for anatomic syndesmosis reduction. Conclusion: The findings of excellent to near perfect intraobserver and good to excellent interobserver reliability indicate the feasibility of translating the CT-TFL into a reliable open technique. Levels of Evidence: Level III: Diagnostic study

Supervised physical therapy is the recommended care for an ankle sprain. Yet, recent evidence indicates some ankle sprain patients may not receive the recommended care, and instead, prescribed medication to alleviate symptoms. Therefore, the purpose of this study is to describe the percentage of patients reporting to an office-based physician in the U.S. that were or were not referred to physical therapy. Secondly, to describe the percentage of ankle sprain patients with or without medication administered, supplied or ordered.This was a secondary analysis of the cross-sectional National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. The NAMCS is a multi-stage probability sample survey of visits to office-based physicians. The percentage and associated 95% confidence intervals (CI) were calculated for visits that had a physical therapy referral or a non-steroidal anti-inflammatory drug (NSAID), opioid and non-opioid analgesics administered, supplied or ordered. Sampled data were weighted to produce national-level estimates.A physical therapy referral was given for 16.8% (95% CI: 13.2, 21.2) of ankle sprain visits. Approximately 34.5% (95%CI: 30.5, 38.7) of all ankle sprain visits had a medication administered, supplied or ordered. NSAIDs (72.1%; 95% CI: 66.9,76.8) and opioids (21.0%; 95% CI: 16.3, 26.5) were the two most common types of medication.NSAIDs and opioid medication combined were administered, supplied or ordered more frequently than a referral to physical therapy. These findings provide evidence that suggests many ankle sprain patients reporting to an office-based physician are not receiving the recommended care; physical therapy. Rather, medication appears to be the primary type of care provided to patients. These data are important because it gives a focused area to improve the treatment of an ankle sprain by developing strategies that ensure all patients are provided the recommended care from the onset of entering the healthcare system.

Objective The purpose of this study was to determine if WBV performed concurrently with static stretching was more effective than static stretching alone to increase dorsiflexion ROM (DFROM) in individuals with chronic ankle instability (CAI). Design Controlled laboratory study. Participants Thirty-nine participants with CAI (history of ankle sprain, a feeling of “giving way” during activity, and a qualifying Foot and Ankle Ability Measure Ankle score) were divided into 3 groups (normative (N), static stretch (SS), and static stretch with vibration (SV)). Participants stretched the triceps surae 4 days/wk for 3 wks. Vibration was imposed at 34 Hz and 1.8 mm. Main outcome measures DFROM was assessed in a straight and bent-leg position. Results No differences were detected at any time in the N or SS group, however SS did exhibit large effect sizes with 95% confidence intervals (CI) that did not cross zero from baseline to 3 weeks for both measures. The SV group demonstrated increased DFROM from baseline for both time points and a large effect size with 95% CI that did not cross zero from post tx-1 to post tx-2. Conclusions Static stretching with WBV increases DFROM in participants with CAI more effectively than static stretching alone.

Background: Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility. Aim: To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions. Methods: Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5–0–5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system. Results: In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5–0–5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests. Conclusion: In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM.

Background: Ankle sprain in the Lead Leg Side (ALLS) is common in fencing athletes, and studies comparing the ankle range of motion (ROM) and strength of both legs are insufficient. Objectvies: To compare the ankle ROM and hip strength between two legs in fencing athletes who has ankle instability in the lead leg side. Design: Cross-sectional design. Methods: Seven fencing athletes with ankle instability participated in this study, and they randomly assigned into ankle in the Lead Leg Side (ALLS) and ankle in the Rear Leg Side (ARLS). Instability was determined by the Cumberland Ankle Instability Tool (CAIT), and then joint ROM and hip muscle strength were measured. Results: There were significant differences in dorsiflexion ROM, hip strength (extension and abduction) between the ALLS with ankle instability and ARLS (P