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Context: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. Objective: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. Evidence Acquisition: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. Evidence Synthesis: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, −0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, −0.94; very low certainty evidence). Conclusions: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI. [ABSTRACT FROM AUTHOR]

Objectives: The static and dynamic correlations of postural stability to its three potential contributors, namely, proprioception, tactile sensation, and strength remain unclear among people with chronic ankle instability (CAI). This study aimed to compare static and dynamic postural stability, along with proprioception, tactile sensation, and strength between people with and without CAI and explore their correlations. Methods: Sixty-seven participants with CAI and 67 participants without CAI were enrolled in this study. Ankle proprioception, plantar tactile sensation, and lower limb strength were measured by a proprioception test device, a set of monofilaments, and a strength testing system, respectively. Static and dynamic postural stability were measured during standing and jump landing on a force plate and indicated by the root mean square of center of pressure and time to stability. Results: Compared to people without CAI, people with CAI had poorer postural stability, proprioception, tactile sensation, and strength. Both groups demonstrated correlation between proprioception and static postural stability, but only people without CAI showed correlation between proprioception and dynamic postural stability. Both groups demonstrated a correlation between tactile sensation and static postural stability, but not with dynamic stability. Both groups demonstrated a correlation between strength and both static and dynamic postural stability. Conclusions: People with CAI had deficits in static and dynamic postural stability, proprioception, tactile sensation, and strength. Among people with CAI, proprioception, tactile sensation, and strength can help maintain static postural stability; strength can help maintain dynamic postural stability, whereas proprioception may not provide sufficient information for dynamic postural stability. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction (BFR) is a rehabilitation tool which may introduce a constraint, similar to muscle fatigue, that challenge patients' sensorimotor system during balance exercises. The purpose of our study was to examine whether adding BFR to dynamic balance exercises produced a decrease in balance performance and an increase in ratings of perceived exertion and instability in individuals with chronic ankle instability (CAI) compared with dynamic balance exercises without BFR. Designs: Crossover design. Methods: Our sample included N = 25 young adults with a history of CAI. Participants completed 2 laboratory visits. At each visit, participants completed 4 sets (30×-15×-15×-15×) of dynamic balance exercises, performed similar to the modified star excursion balance test (SEBT), once with BFR and once with control (no BFR) conditions. We measured composite SEBT scores at baseline and during the final repetitions of each set of balance exercise (sets 1–4). We also measured ratings of perceived exertion and instability following each balance exercise set. Results: We observed no difference in composite SEBT scores between conditions at baseline; however, composite SEBT scores were significantly lower during all balance exercises sets 1 to 4 with the BFR condition compared with control. During the BFR condition, composite SEBT scores were significantly lower during all balance exercise sets compared with baseline. During the control condition, composite SEBT scores did not significantly change between baseline and each balance exercise set. Ratings of perceived exertion and instability scores were significantly greater in the BFR group compared with the control group during all balance exercise sets. Conclusions: Individuals with CAI demonstrated lower composite SEBT scores and greater perceived instability and exertion during dynamic balance exercise with BFR compared to without BFR. BFR introduced a novel muscle fatigue constraint during dynamic balance exercises in individuals with CAI. Additional research is needed to determine if adding BFR to balance training could improve clinical outcomes in CAI patients. [ABSTRACT FROM AUTHOR]

Context: Individuals with chronic ankle instability (CAI) demonstrate reduced spinal reflex modulation and corticospinal excitability of the soleus, which may contribute to decreased balance performance. Objective: To determine the effects of a single session of balance training on Spinal-reflexive excitability modulation and corticospinal excitability in those with CAI. Design: Randomized controlled trials. Setting: Research laboratory. Participants: Thirty participants with CAI were randomly assigned to the balance training (BAL) or control (CON) group. Main Outcome Measures: Modulation of soleus spinal-reflexive excitability was measured by calculating relative change in normalized Hoffmann reflexes (ratio of the H-reflex to the M-wave) from prone to single-leg standing. Corticospinal excitability was assessed during single-leg stance using transcranial magnetic stimulation, outcomes of which included active motor threshold (AMT), motor evoked potential, and cortical silent period (CSP). Balance performance was measured with center of pressure velocity in anterior to posterior and medial to lateral directions. Separate 2x2 repeated-measures analyses of variance were employed to determine the effect of group (BAL and CON) and time (baseline and posttraining) on each dependent variable. Results: There were significant group by time interactions in the modulation of soleus spinal-reflexive excitability (F1.27 = 4.763, P=-04); CSP at 100% AMT (F F1.27 = 4.727, P = .04); and CSP at 120% AMT (F F1.27 16.057, f < .01). A large effect size suggests increased modulation of spinal-reflexive excitability (d = 0.81 [0.03 to 1.54]) of the soleus in BAL compared with CON at posttest, while CSP at 100% (d = 0.95 [0.17 to 1.70]) and 120% AMT (d = 1.10 [0.29 to 1.84]) was reduced in BAL when compared with CON at posttest. Conclusion: After a single session of balance training, individuals with CAI initiated increases in spinal reflex modulation and corticospinal excitability of the soleus. Thus, individuals with CAI who undergo balance training exhibit positive neural adaptations that are linked to improvements in balance performance. [ABSTRACT FROM AUTHOR]

Context: An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. Design: Cross-sectional study. Methods: Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test--the Y-Balance Test. Results: Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach a =.961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P< .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P<.001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P< .001). The exploratory factor analysis confirmed the single- factor structure of this scale. No floor/ceiling effects were observed. Conclusions: The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek- speaking individuals. [ABSTRACT FROM AUTHOR]

Objectives: Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI. Methods: A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (n = 20), plantar massage (n = 20), and control (n = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at p < 0.05. Results: Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (p > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (p > 0.05). Conclusion: The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population. [ABSTRACT FROM AUTHOR]

Many athletes with recurrent ankle sprains complain of neurophysiological deficits related to chronic ankle instability (CAI). However, it remains unclear how changes in the corticospinal pathway affect the potential risk of subsequent ankle sprains. The purpose of this study was to investigate whether the corticospinal excitability (input–output properties) and silent period (SP) could be related to the risk of subsequent ankle sprains among athletes. Forty-three male collegiate basketball athletes were enrolled, and 82 ankles were finally sorted into four ankle groups based on symptoms (CAI, sub-CAI, copers, and normal). The neurophysiological data was recorded in both ankles using transcranial magnetic stimulation (TMS) as baseline assessments. Subsequently, we prospectively followed the occurrence of subsequent ankle sprain injuries for 24 months (SG, subsequent ankle sprain group; NSG, non-sprain group). In the baseline assessment, we confirmed that the threshold of the input–output properties in the CAI group was higher than those in the normal group. After the follow-up, 22 ankles sustained subsequent ankle sprains (SGs). We also found that SGs exhibited a significantly longer SP at the middle and high stimulus intensities of TMS compared to NSGs (60 ankles) (middle: p = 0.012, Cohen's d = 0.644, and high: p = 0.020, Cohen's d = 0.590). These findings suggest that a prolonged SP could be a crucial factor affecting subsequent ankle sprains in athletes. To prevent further recurrent sports injuries, neurophysiologic probes, particularly a longer SP, might be a potential assessment tool to return to the field. [ABSTRACT FROM AUTHOR]

The ankle infrequently develops primary osteoarthritis (OA), especially when compared to the hip and the knee. Ankle OA instead generally develops only after trauma. The consequences of end‐stage ankle OA can nonetheless be extremely debilitating, with impairment comparable to that of end‐stage kidney disease or congestive heart failure. Disconcertingly, evidence suggests that ankle OA can develop more often than is generally appreciated after even low‐energy rotational ankle fractures and chronic instability associated with recurrent ankle sprains, albeit at a slower rate than after more severe trauma. The mechanisms whereby ankle OA develops after trauma are poorly understood, but mechanical factors are implicated. A better understanding of the prevalence and mechanical etiology of post‐traumatic ankle OA can lead to better prevention and mitigation. New surgical and conservative interventions, including improved ligamentous repair strategies and custom carbon fiber bracing, hold promise for advancing treatment that may prevent residual ankle instability and the development of ankle OA. Studies are needed to fill in key knowledge gaps here related to etiology so that the interventions can target key factors. New technologies, including weight bearing CT and biplane fluoroscopy, offer fresh opportunities to better understand the relationships between trauma, ankle alignment, residual ankle instability, OA development, and foot/ankle function. This paper begins by reviewing the epidemiology of post‐traumatic ankle OA, presents evidence suggesting that new treatment options might be successful at preventing ankle OA, and then highlights recent technical advances in understanding of the origins of ankle OA to identify directions for future research. [ABSTRACT FROM AUTHOR]

Purpose: Posture re-education is a common method to improve the posture of athletes. This study aims to compare two methods of proprioceptive exercise, one with visual biofeedback and one without traditional method, in athletes with chronic ankle instability. Method: This research was quasi-experimental where 30 male athletes with CAI from sports Futsal, volleyball, and handball were selected. Subjects were randomly divided into 2 groups with 15 athletes placed in each group: proprioceptive exercise with visual biofeedback and proprioceptive exercise without visual biofeedback. They following parameters were evaluated using the respective tests: joint angle reconstruction error using tests to ankle Joint Position Sense (JPS), number of errors in maintaining balance using Balance Error Scoring System (BESS), and rate of reaching the maximum distance using Y balance test. Result: Comparison of the two groups in terms of variable dorsiflexion (P = 0.028, η2 = 0/166) and plantarflexion (P = 0.013, η2 = 0/209) proprioception of athletes' ankles indicated that reconstruction angle difference by degree, static postural control by number of errors (P = 0.012, η2 = 0/213), and dynamic postural control in anterior (P = 0.001, η2 = 0.570), posterior–medial (P = 0.001, η2 = 0.759), and posterior–lateral (P = 0.030, η2 = 0.163) by centimeter were significant. Conclusion: In most of the results, the effect size is small for this reason when proprioceptive exercise is combined with visual biofeedback. Athletes may utilize feedback to make slight improvements in their performance and adjust their movements. [ABSTRACT FROM AUTHOR]

Introduction: Chronic ankle instability can impair balance, ankle range of motion, and strength. Neurofeedback training was recently used to rehabilitate musculoskeletal injuries. This study investigated the effectiveness of adding neurofeedback training to neuromuscular training on the balance, limit of stability, ankle range of motion, and strength of athletes with chronic ankle instability. Methods: This study was three arms and a single-blind randomized control trial. Participants were 62 young male athletes with chronic ankle instability who were randomly divided into 3 groups; combination group, neuromuscular group, and control group. Eight weeks of intervention were carried out in training groups. Outcome measures were balance control, the limit of stability, ankle range of motion, and strength. Results: The study results indicated that neurofeedback training + neuromuscular training and neuromuscular training alone improved balance, the limit of stability, ankle range of motion, and strength. Also, neurofeedback training + neuromuscular training was more effective than neuromuscular training alone in variables of dynamic balance in anterior–posterior (p = 0.031), the limit of stability in the left (p = 0.003), forward-left (p = 0.045), and backward-right (p = 0.048). Conclusion: Considering that the improvement in dynamic balance in anterior–posterior, the limit of stability in the left, forward-left, and backward-right was greater in the combined (neurofeedback training + neuromuscular training) group compared to neuromuscular training alone, neurofeedback training can be considered as a complementary program to rehabilitation protocols for chronic ankle instability. Trial registration: IRCTID, IRCT20211018052799N1. Registered 1 December 2021 [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: Football players often use quick change of direction, sudden acceleration and explosive movements. This is why chronic ankle instability is one of the most common conditions affecting this athlete population. This study investigates the effects of neuro-vestibular-ocular exercises and myofascial release on proprioception and performance in football players with chronic ankle instability. MATERIALS AND METHODS: This randomized controlled clinical trial included 60 football players aged 18–30. The players were randomly divided into two groups. The first group (NVOEG, n = 30) was included in the Neuro-Vestibular-ocular exercise training program, while the myofascial release was applied to the second group (MRHOG, n = 30). Both protocols were applied for eight weeks. The participants' Cumberland Ankle Instability Tool (CAIT) scores were assessed before and after the intervention. Proprioception was evaluated by using the joint position sense test. Additionally, kick speed (KS), 30-m sprint, zig-zag agility test (ZAT) and Landing error score system (LESS) tests were applied to evaluate their performance. RESULTS: Post-rehabilitation scores showed significant differences in proprioception and performance parameters compared to pre-scores in both groups. (p<0.05). Significant differences were observed between the NVOEG and MRHOG in the post-test scores, including CAIT for unstable and stable ankle, proprioception for unstable ankle, LESS, ZAT with ball performance, and 30-meter sprint test. CONCLUSIONS: The neuro-vulvular-ocular exercise training protocol had superior results in terms of proprioception and performance parameters in chronic ankle instability management for football players. [ABSTRACT FROM AUTHOR]

Background: The Cumberland Ankle Instability Tool (CAIT) is used to screen patients with chronic ankle instability (CAI) and to quantify the severity of ankle instability. Neuromuscular deficits are common in CAI, including proprioception, strength, and balance issues. The relationship between CAIT scores and neuromuscular factors is unclear. The purpose of this study was to investigate the correlation between ankle instability and ankle muscle strength, proprioception, and dynamic balance. Methods: Thirty-four individuals with chronic ankle instability were included in this study. The participants' CAIT scores, muscle strength (isokinetic) and proprioception in plantarflexion (PF), dorsiflexion (DF), inversion (IV), and eversion (EV), and dynamic balance (Star Excursion Balance Test in anterior, posteromedial, and posterolateral directions) were assessed. Bivariate correlations were used to determine the relationship between CAIT scores and ankle muscle strength, proprioception, and dynamic balance. Results: In terms of muscle strength, ankle PF (r = 0.378, 95%CI: 0.046–0.635, P = 0.027) and IV (r = 0.527, 95%CI: 0.233–0.736, P = 0.001) strength were positively correlated with CAIT Score, whereas ankle DF and EV strength had no significant correlation with CAIT Score. In terms of proprioception, ankle IV proprioception (r = -0.340, 95%CI: -0.608–0.002, P = 0.027) was negatively correlated with CAIT Score, while ankle PF, DF, and EV proprioception had no significant correlation with CAIT Score. In terms of dynamic balance, the SEBT posteromedial (r = 0.444, 95%CI: 0.124–0.680, P = 0.001) was positively correlated with CAIT Score. The SEBT anterior and posterolateral were not significantly correlated with the CAIT Score. Conclusion: This study found that increasing ankle plantarflexion and inversion muscle strength, improving dynamic balance in the posteromedial direction, and decreasing ankle inversion proprioceptive thresholds may help improve the subjective stability of CAI. This provides data support for targeted ankle neuromuscular function rehabilitation training for patients. Trial registration: Chinese Clinical Trial Registry ChiCTR2100044089. Registered on 10 March 2021. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Clinically, chronic ankle instability has symptoms such as muscle weakness, loss of control and repeated sprains. These symptoms can be effectively improved by means of exercise intervention. Here, we conducted a comprehensive quantitative evaluation of the effects of exercise intervention on chronic ankle instability at home and abroad through Meta-analysis, and examined the moderating effects of different exercise interventions on chronic ankle instability in terms of effect size and exercise dose. METHODS: CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched and screened for relevant literature regarding randomized controlled trials of an exercise intervention program against chronic ankle instability. Included literature was analyzed by using Review Manager 5.3 and Stata-SE 15. RESULTS: A total of 52 documents were included with 1 880 patients with chronic ankle instability. Meta-analysis showed that exercise intervention could improve the functional score of patients with chronic ankle instability to a large amount. Neuromuscular control training, a 12-week intervention cycle, and two weekly interventions of > 60 minutes are the best protocol for improving instability symptoms in patients with chronic ankle instability. Exercise intervention could improve the dynamic balance of patients with chronic ankle instability to reach the medium equivalent stress. The best exercise program to improve the dynamic balance ability is a combination of neuromuscular control training and hip strength training, with an exercise dose of 30-60 minutes, two or three times per week, for 8 weeks in total. CONCLUSION: Different exercise forms have a good effect on improving the unstable symptoms and dynamic balance ability of patients with chronic ankle instability, among which neuromuscular control training has a more comprehensive effect on improving chronic ankle instability. It is recommended that a multifunctional combination of training forms be used as a means of rehabilitation rather than a single form of exercise. [ABSTRACT FROM AUTHOR]

The level of dynamic mechanical instability between the bony parts of the ankle joint provides important information on biomechanical function. However, the dynamics of the distance between the talus and lateral malleolus during gait remain unclear. This study aimed to compare the distance between the talus and lateral malleolus and the ankle joint angles during the stance phase of gait between individuals with chronic ankle instability (CAI) and healthy adults. The comparison was conducted using a synchronized ultrasound (US) imaging with a three-dimensional motion analysis (MA) system. This cross-sectional study included 12 participants (5 males, 7 females; age, 20.5 ± 1.8 years; height, 166.6 ± 9.4 cm; body weight, 60.2 ± 5.3 kg; body mass index, 21.7 ± 2.0 kg/m2; 16 feet) with CAI and 10 healthy controls (4 males, 6 females; age, 21.2 ± 1.6 years; height, 164.6 ± 10.5 cm; body weight, 56.8 ± 11.3 kg; body mass index, 20.8 ± 2.6 kg/m2; 20 feet). The distance between the talus and lateral malleolus during gait was significantly increased in the CAI group compared with that in the control group throughout the stance phase. The ankle dorsiflexion angle was smaller in the CAI group during the middle and terminal stance phases. Additionally, the ankle inversion angle was greater in the CAI group than in the control group. Our findings show the application of the synchronized US and MA system in the assessment of mechanical instability in CAI group, which may be used to determine treatment efficacy. [ABSTRACT FROM AUTHOR]

Background: In sports dance events, athletes often face the risk of ankle injury and instability, which may have a negative impact on their training and athletic performance, and even hinder their rehabilitation process and increase the likelihood of re-injury. Objective: This study aims to observe the effects of exercise intervention (low-load ankle muscle strength training with blood flow restriction training (BFRT) equipment and balance training with blood flow restriction training equipment) combined with instrumentation therapy (Instrument-assisted soft tissue mobilization, IASTM) on ankle function, joint range of motion, and strength in sports dancers with chronic ankle instability (CAI). This study aims to provide an evidence-based approach to rehabilitation for athletes by comparing the effects of combination therapy approaches to traditional ankle strength and stability training. Methods: Forty-two subjects with ankle instability, restriction, or discomfort were selected as observation objects and randomly divided into three groups: the combined group (n = 14, blood flow restriction training combined with IASTM), the simple blood flow restriction training group (n = 15), and the conventional ankle strength and stability training group (n = 13). The intervention lasted for 6 weeks, once a week. The three groups were assessed with the Cumberland ankle instability assessment, Foot and Ankle Ability Measure (FAAM) ankle function assessment score, and ankle range of motion measurement before intervention, after the first intervention, and after 6 weeks of intervention. The ankle strength test was compared and analyzed only before and after intervention. Result: There was no significant difference in the participant characteristics of the three intervention groups. In terms of Cumberland Ankle Instability Tool (CAIT) scores, within-group comparisons showed that the scores after the first intervention and at the 6-week mark were significantly higher than before the intervention (P < 0.05). Between-group comparisons revealed that the combined intervention group had higher CAIT scores than the other two groups after the 6-week intervention. Regarding the FAAM functional scores, all three interventions significantly improved ankle joint function in patients with chronic ankle instability (P < 0.05), with the BFRT group showing significantly higher FAAM - Activities of Daily Living scale (FAAM-ADL) scores than the control group (P < 0.05). Both the combined and BFRT groups also had significantly higher FAAM-SPORT scores after the first intervention compared to the control (P < 0.05). In terms of ankle range of motion improvement, the combined intervention group showed a significant increase in ankle joint motion after the intervention (P < 0.05), particularly in the improvement of dorsiflexion ability (P < 0.05). As for ankle strength enhancement, all three intervention groups experienced an increase in ankle strength after the intervention (P < 0.05), with the combined intervention group showing a significant improvement in both dorsiflexion and inversion strength compared to the control group (P < 0.05). Conclusion: BFRT combined with IASTM, isolated BFRT, and conventional ankle strength and stability training significantly improve stability, functionality, and strength in CAI patients. The combined intervention demonstrates superior efficacy in improving ankle range of motion compared to isolated BFRT and conventional approaches. [ABSTRACT FROM AUTHOR]

Researchers have shown that patients with chronic ankle instability (CAI) have deficits in memory and attention allocation. This functional deficit affects lower extremity performance. Motor-cognitive dual-task training may improve lower limb dysfunction caused by central nervous system injury. Further study is needed to determine whether dual-task training is more favorable than single-task training for improving neuromuscular control in patients with CAI. To compare the effects of balance-cognition dual-task training and balance single-task training on lower limb function and electroencephalography changes during static postural control in patients with CAI. Randomized clinical trial (Chinese Clinical Trial Registry: ChiCTR2300073875). Rehabilitation training room. A total of 24 patients with CAI (age = 22.33 ± 2.43 years, height = 175.62 ± 7.7 cm, mass = 70.63 ± 14.59 kg) were block randomized into 2 groups. Protocols were performed 3 times per week for 6 weeks. The single-task group underwent 1-legged static balance training with eyes open and closed and hopping balance training. The dual-task group underwent balance and cognitive training (backward-counting task). Cortical activity, proprioception, muscle onset time (difference between the muscle activation time and touchdown time), and dynamic balance were assessed before and after the interventions. We performed multivariate analyses of variance to identify main effects and interactions across groups and time. A post hoc Bonferroni test was performed for pairwise comparisons when interactions were present. All participants successfully completed the 6-week interventions. Proprioception, peroneus longus (PL) muscle onset time, and dynamic postural control improved after the interventions in both groups (P <.05). Dual-task training was superior to single-task training in improving joint position sense in plantar flexion, shortening PL muscle onset time, and altering cortical activity (P <.05). A 6-week program of balance training or balance combined with cognitive training could improve the functional deficits associated with CAI. The dual-task training could also improve joint position sense in plantar flexion, PL muscle onset time, and cortical activity. [ABSTRACT FROM AUTHOR]

Objective: To identify the effects of chronic pain levels on static and dynamic postural (DP) control in individuals with chronic ankle instability (CAI). Design: Cross-sectional study. Setting: Controlled laboratory. Participants: Sixty participants were divided into the following 3 groups: 20 high pain individuals with CAI (high pain), 20 low pain individuals with CAI (low pain), and 20 healthy controls (control). Independent Variables: Groups (CAI with high pain, CAI with low pain, and control) and visual conditions (eyes open and closed) for single-leg stance. Main OutcomeMeasures: Participants performed single-leg stance with eyes open and closed, the star excursion balance test, and single-leg hop to stabilization. Results: The high pain group experienced worse self-reported outcomes, including Foot and Ankle Ability Measure activities of daily living and sports, than the low pain and control groups. Regardless of visual condition, both the high and low pain groups exhibited decreased static postural control in mediolateral (ML) compared with the control group. Specifically, the high pain group showed decreased static postural control in ML under closed eyes compared with the low pain and the control groups. The high pain group showed less reach distance than the control group and increased DP control in vertical and overall DP stability index compared with the low and control groups. Conclusions: Chronic pain can significantly affect both static and DP control in individuals with CAI. Therefore, clinicians should consider chronic pain as one of the factors affecting postural control in individuals with CAI. [ABSTRACT FROM AUTHOR]

In quantitative ankle stress sonography, different examiners use different techniques, which may cause measurement variability. This study aimed to clarify whether standardizing stress sonography techniques reduces variability in the quantitative measurement of anterior talofibular ligament length change. Fourteen examiners with a mean ultrasound experience of 8.7 years participated in this study. Each examiner performed stress ultrasonography of the ankle using their preferred method on one patient with an intact anterior talofibular ligament (Patient 1) and on two patients with chronic ankle instability (Patient 2 and 3). Changes in the ligament length between the resting and stressed positions were determined. A consensus meeting was then conducted to standardize the sonographic technique, which was used by the examiners during a repeat stress sonography on the same patients. The variance and measured values were compared between the preferred and standardized techniques using F-tests and paired t-tests, respectively. At a consensus meeting, a sonographic technique in which the examiner pushed the lower leg posteriorly against the fixed foot was adopted as the standardized technique. In Patient 1, the change in the anterior talofibular ligament length was 0.4 (range, −2.3–1.3) mm and 0.6 (−0.6–1.7) mm using the preferred and standardized techniques, respectively, with no significant difference in the variance (P = 0.51) or the measured value (P = 0.52). The length changes in Patient 2 were 2.0 (0.3–4.4) mm and 1.7 (−0.9–3.8) mm using the preferred and standardized techniques, respectively. In Patient 3, the length changes were 1.4 (−2.7–7.1) mm and 0.7 (−2.0–2.3) mm. There were no significant differences between the techniques in either patient group. Variability in the quantitative measurement of ankle stress sonography was not reduced despite the standardization of the technique among examiners. Hence, comparing the measured values between different examiners should be avoided. [ABSTRACT FROM AUTHOR]

In the treatment of chronic lateral ankle instability (CLAI), the repair of the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) is still being discussed, possibly due to the difficulty in assessing CFL injuries. In particular, it is challenging to evaluate the extent of CFL deficiency quantitively. We hypothesized that CFL tension change would alter morphology of the CFL on magnetic resonance imaging (MRI) and that measuring this morphological change allows assessing CFL injury quantitatively. Thus, this study aimed to analyze the feasibility of quantitatively assessing CFL injuries using MRI. Sixty-four ankles with CLAI were included and divided into two groups: with (ATFL and CFL group, 31 ankles) or without CFL repair (ATFL group, 33 ankles) in addition to arthroscopic ATFL repair. The angle between the CFL and calcaneal axis (CFLCA) and the bending angles of the CFL was defined as the flexed CFL angle (FCA) were measured on the oblique CFL view of preoperative MRI. The diagnostic abilities of these angles for CFL injury and correlations between these angles and stress radiographs were analyzed. The sensitivity and specificity of CFLCA were 86.7 % and 88.7 %, and those of FCA were 63.3 % and 77.4 %, respectively. The combination of CFLCA and FCA improved the sensitivity to 93.3 %. The cutoff points of CFLCA and FCA were 3.8° and 121.2°, respectively. There were significant moderate and weak correlations between the talar tilting angle and CFLCA or FCA (rs = −0.533, and rs = −0.402, respectively). The CFLCA and FCA were significantly smaller in the ATFL and CFL group than those in the other groups. Measurement of CFLCA and FCA in oblique CFL view on MRI could be useful for the quantitative evaluation of CFL injury in patients with CLAI． Level IV. case-control study. [ABSTRACT FROM AUTHOR]

• Our findings added to the evidence of balance control, position sense, and force sense deficits in athletes with chronic ankle instability (CAI). • Athletes with CAI showed diminished ankle proprioception, including joint position sense and force sense, and demonstrated impaired balance control. • Deficit in force sense was deemed as a moderate predictor of one-leg standing balance control deficits in athletes with dominant-side injury CAI. To compare balance control and ankle proprioception between athletes with and without chronic ankle instability (CAI). A further objective was to explore the relationship between balance control performance and ankle proprioception in athletes with CAI. Cross-sectional study. Sports Rehabilitation Laboratory. Eighty-eight recreational athletes (47 CAI and 41 healthy control) were recruited. No applicable. Balance control performance was assessed using the sway velocity of the center of the pressure during the one-leg standing tasks. Ankle proprioception, including joint position sense and force sense, were tested using absolute error (AE) associated with joint position reproduction and force reproduction tasks in 4 directions, that is, plantarflexion, dorsiflexion, inversion, and eversion. Athletes with CAI performed significantly worse than those without CAI in balance control tasks. In addition, CAI athletes showed significantly worse joint position sense and force sense in all 3 movement directions tested (plantarflexion, inversion, and eversion). Correlation analysis showed that the AE of the plantarflexion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open and closed conditions (r =.372-.403, P =.006-.012), and the AE of inversion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open (r =.345, P =.018) in athletes with CAI, but the joint position sense measures were not (all P >0.05). Athletes with CAI showed significantly impaired balance control performance and diminished ankle proprioception. Deficit in force sense was deemed as a moderate predictor of one-leg standing balance control deficits in athletes with dominant-side injury CAI, whereas ankle position sense may be a small predictor. [ABSTRACT FROM AUTHOR]

Emerging evidence has suggested that gluteus medius (GM) muscle activity may be critical for functional performance in individuals with chronic ankle instability (CAI). This study aimed to systematically review the literature to determine whether there are differences in GM muscle activity between individuals with and without CAI. A comprehensive search in PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro databases was undertaken from the year of inception to 10 June 2024. Studies that investigated GM muscle activity during physical activities in healthy controls or copers and individuals with CAI were included. The quality assessment was conducted using the Newcastle-Ottawa Quality scale (NOS). After review, forty studies (1840 participants) were included; NOS scoring for the included studies ranged from 5/9 to 9/9 stars. GM activity was reported for seven activities: walking (14 studies), stance-transition (four studies), jump-landing (13 studies), perturbation (six studies), balance (four studies), cutting (three studies), and other functional exercises (seven studies). The outcome measures selected to examine each task varied across studies, and electromyography (EMG) results were inconsistent. Overall, although the quality of the available studies was generally high, there were substantial methodological differences, and the activity of GM muscles in CAI participants compared to controls was equivocal. A consensus on standardization of GM muscle activity assessment reporting should be established to guide future studies. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI. Objective: The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI. Methods: A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period. Results: After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment. Conclusion: Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions The functional connectivity (FC) has emerged as a valuable tool for comprehending the cerebral operational mechanism. Understanding the FC changes in patients with chronic ankle instability (CAI) helps reveal the underlying central nervous system mechanisms of the disease and provides clues for developing personalized treatment plans.To explore differences between low‐ and high‐order FC in patients with CAI and healthy controls, as well as the correlation among the feature connections and clinical data.In our study, we recruited 40 patients with CAI and 42 healthy individuals who had not experienced ankle injuries. All participants underwent clinical assessments of ankle joints, collected the number of ankle sprains within the past 6 months, and performed resting‐state functional magnetic resonance imaging (rs‐fMRI) scans. Pearson correlation and matrix variate normal distribution (MVND) were used to construct low‐order and high‐order FC networks, respectively. Feature selections between groups were performed by two‐sample t‐tests, and a multi‐kernel support vector machine (MK‐SVM) was subsequently applied to combine the multiple connection patterns for the classification. Using leave‐one‐out cross‐validation (LOOCV) to assess classification performance and identify the consensus connections contributing most to classification.FC was reduced in certain brain regions of CAI patients. More consensus connections were recognized in low‐order FC network than in high‐order FC network. The highest classification accuracy of 91.30% was achieved by combining three connection patterns. The most discriminating functional connections were primarily centered on the default mode network and spanned the visual network, sensorimotor network, ventral attention network, and central executive network. In addition, FC strength in the left cingulate and paracingulate gyrus (DCG.L) and right superior temporal gyrus (STG.R) was negatively correlated with the number of ankle sprains in the past 6 months in all FC networks (p < 0.05).Abnormalities in connectivity in patients with CAI were observed in both low‐ and high‐order FC networks. The adaptive changes in the brain related to CAI may extend beyond the sensorimotor networks, primarily involving higher‐level default mode networks associated with attention. Moreover, the FC strength between DCG.L and STG.R may predict the risk of ankle re‐sprains and help clinicians develop personalized treatment plans. [ABSTRACT FROM AUTHOR]

Background: Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied. Purpose: The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control. Methods: A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy. Results: The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly. Conclusions: The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI. [ABSTRACT FROM AUTHOR]

Poor postural control during jump landing may increase ankle sprain incidences among people with chronic ankle instability (CAI). The effects of anticipation on it and its relationship with proprioception need further examination. Fifteen participants with CAI and 15 healthy controls were recruited to perform single-leg jump landings when knowing the landing side before (planned) or after (unplanned) take-off respectively, along with a step-down proprioception test differentiating four inclination platforms (inverted 12°, 14°, 16° and 18°). Ground reaction force data (peak force, loading rate and time of stabilisation) during landings and proprioception scores were collected and analysed. The CAI group exhibited a higher loading rate (59.6 ± 7.6 vs 49.4 ± 6.7 N/kg*seconds, p = 0.011) and longer medial-lateral time to stabilisation (4.82 ± 0.69 vs 4.11 ± 0.47 seconds, p = 0.023) compared to the control group during an unplanned landing. Furthermore, the above variables were negatively correlated with the step-down proprioception score only in the unplanned condition but not in the planned condition. CAI participants had inferior medial-lateral time-to-stabilisation and loading attenuation during unplanned jump landing than healthy controls, which were associated with decreased proprioception, highlighting the importance of addressing proprioception to improve balance control during unpredictable landing situations. [ABSTRACT FROM AUTHOR]

Objectives: To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI). Methods: 3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle). Results: In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively. Conclusion: We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI. Critical relevance statement: High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients. Key Points: Spatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements. The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs. 3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionComparisons of talar cartilage and the anterior talofibular ligament (ATFL) profiles in individuals with different levels of chronic ankle instability (CAI) provide insight into early adaptation of tissue morphology.This study compared morphologic response and recovery of the talar cartilage and ATFL before and after 30-min of self-paced treadmill running between individuals with CAI, coper (full recovery from a first-time ankle sprain), and healthy controls.Sixty young males (24.8 years, 176.9 cm, 75.7 kg) were allocated into the CAI, coper, and healthy control group by their number of ankle sprains and scores on the self-reported ankle instability questionnaires (Cumberland Ankle Instability Tool, and Foot and Ankle Ability Measure-Activities of Daily Living). Ultrasonographic images in the cross-sectional area (CSA; overall, lateral, and medial) and ATFL length (unstressed and stressed and position) before and after treadmill running were recorded and analyzed.There were no group by time interactions in the talar cartilage CSA (F14,399 <1.09, p > .36 for all tests) and ATFL length (F14,399< .69, p > .79 for all tests). Regardless of time, CAIs had the largest overall (F2,399 = 42.68, p < .001), lateral (F2,399 = 37.16, p < .001), and medial (F2,399 = 36.57, p < .001) CSA of talar cartilage and the longest stressed-ATFL length (F2,399 = 54.42, p < .001), followed by copers and healthy controls.Morphologic features of the talar cartilage and ATFL appear to depend on the level of ankle instability (e.g. a history of recurrent ankle sprain). [ABSTRACT FROM AUTHOR]

Background: In sports dance events, athletes often face the risk of ankle injury and instability, which may have a negative impact on their training and athletic performance, and even hinder their rehabilitation process and increase the likelihood of re-injury. Objective: This study aims to observe the effects of exercise intervention (lowload ankle muscle strength training with blood flow restriction training (BFRT) equipment and balance training with blood flow restriction training equipment) combined with instrumentation therapy (Instrument-assisted soft tissue mobilization, IASTM) on ankle function, joint range of motion, and strength in sports dancers with chronic ankle instability (CAI). This study aims to provide an evidence-based approach to rehabilitation for athletes by comparing the effects of combination therapy approaches to traditional ankle strength and stability training. Methods: Forty-two subjects with ankle instability, restriction, or discomfort were selected as observation objects and randomly divided into three groups: the combined group (n = 14, blood flow restriction training combined with IASTM), the simple blood flow restriction training group (n = 15), and the conventional ankle strength and stability training group (n = 13). The intervention lasted for 6 weeks, once a week. The three groups were assessed with the Cumberland ankle instability assessment, Foot and Ankle Ability Measure (FAAM) ankle function assessment score, and ankle range of motion measurement before intervention, after the first intervention, and after 6 weeks of intervention. The ankle strength test was compared and analyzed only before and after intervention. Result: There was no significant difference in the participant characteristics of the three intervention groups. In terms of Cumberland Ankle Instability Tool (CAIT) scores, within-group comparisons showed that the scores after the first intervention and at the 6-week mark were significantly higher than before the intervention (P < 0.05). Between-group comparisons revealed that the combined intervention group had higher CAIT scores than the other two groups after the 6-week intervention. Regarding the FAAM functional scores, all three interventions significantly improved ankle joint function in patients with chronic ankle instability (P < 0.05), with the BFRT group showing significantly higher FAAM - Activities of Daily Living scale (FAAM-ADL) scores than the control group (P < 0.05). Both the combined and BFRT groups also had significantly higher FAAM-SPORT scores after the first intervention compared to the control (P < 0.05). In terms of ankle range of motion improvement, the combined intervention group showed a significant increase in ankle joint motion after the intervention (P < 0.05), particularly in the improvement of dorsiflexion ability (P < 0.05). As for ankle strength enhancement, all three intervention groups experienced an increase in ankle strength after the intervention (P < 0.05), with the combined intervention group showing a significant improvement in both dorsiflexion and inversion strength compared to the control group (P < 0.05). Conclusion: BFRT combined with IASTM, isolated BFRT, and conventional ankle strength and stability training significantly improve stability, functionality, and strength in CAI patients. The combined intervention demonstrates superior efficacy in improving ankle range of motion compared to isolated BFRT and conventional approaches. [ABSTRACT FROM AUTHOR]

Athletes who have successfully regained high sports performance despite prior inversion injuries, and who do not have persistent symptoms, are referred to as "copers" in the literature. The aim of the study was to assess dynamic stability under fatigue in patients with chronic ankle instability in comparison to healthy controls. We conducted a case - controlled study on a group of 60 young, physically active individuals aged 29.8 ± 4.6. They were divided into 3 groups: I - unilateral ankle instability n = 14, II - bilateral ankle instability n = 15, III - no ankle instability, n = 31. All participants filled out questionnaires on the health, the FADI and FADI-S. The study protocol consisted of a dynamic stability measurements by Biodex Balance System, followed by a fatigue test, followed by the series of the same measurements. General stability index value before and value after fatigue test did not differ significantly. The differences between groups in measurements taken before fatigue test (F (2.49) = 1.59; p = 0.214; ηp2 = 0.06) and after fatigue test also proved insignificant (F (2.49) = 1.28; p = 0.286; ηp2 = 0.05). The incidence of structural ankle instability did not affect functional stability. "Copers" had efficient neural-muscular control in dynamic stabilography tests. [ABSTRACT FROM AUTHOR]

Chronic Ankle Instability (CAI) significantly affects athletic performance and increases the risk of recurrent ankle sprains. Stroboscopic Glasses (SG) may enhance proprioceptive feedback and postural control. We aimed to evaluate the augmented effects of Proprioceptive Feedback Training (PFT) combined with SG in athletes with CAI. We conducted a single-blinded randomized controlled trial with participants assigned to the PFT+SG or PFT alone groups. The interventions were administered over an eight-week period. Improvements in the Foot and Ankle Ability Measure Sport subscale (FAAM-S), Identification of Functional Ankle Instability questionnaire (IdFAI), Joint Position Sense (JPS) error value, postural stability via the Balance Velocity Test (BVT), Functional Performance Tests (FPTs), and giving-way episodes were assessed pre- and post-intervention. Substantial improvements in FAAM-S and IdFAI scores were observed in the PFT+SG group compared to those in the PFT group. JPS and BVT were significantly higher in the PFT+SG group than in the PFT group. FPTs and giving-way episodes were significantly higher in the PFT+SG group than in the PFT group. The inclusion of SG in PFT significantly enhanced rehabilitation outcomes in athletes with CAI. SG combined with PFT may address proprioceptive deficits and improve functional performance in patients with CAI. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the effect of task constraints on the neurobiological systems while maintaining postural control under various sensory feedback manipulations in individuals with and without Chronic Ankle Instability (CAI). Forty-two physically active individuals, with and without CAI, were enrolled in a case-control study conducted at a biomechanics research laboratory. All participants underwent the Sensory Organization Test (SOT), which assesses individuals' ability to integrate somatosensory, visual, and vestibular feedback to maintain postural control in double-, uninjured-, and injured-limb stances under six different conditions in which variations in the sway-referenced support surface (platform) and visual surroundings, with and without vision, are manipulated to affect somatosensory and visual feedback. Center-of-Pressure (COP) path length was computed from raw data collected during trials of each SOT condition. Sample Entropy (SampEN) values were extracted from the COP path length time series to examine neurobiological systems complexity, with lower SampEN values indicating more predictable and periodic (rigid) neurobiological systems, while higher SampEN values indicate more unpredictable and random systems. The results show that specific task constraints affect the neurobiological systems. Specifically, individuals with CAI demonstrated reduced complexity (decreased SampEN values) in the neurobiological systems during the uninjured-limb stance when all sensory feedback was intact and during both uninjured- and injured-limb stances when they were forced to rely on vestibular feedback. These results highlight the interplay between sensory feedback and task constraints in individuals with CAI and suggest potential adaptations in the neurobiological systems involved in postural control. [ABSTRACT FROM AUTHOR]

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. [ABSTRACT FROM AUTHOR]

Background: The evaluation of lateral ankle laxity remains challenging when diagnosing chronic lateral ankle instability (CLAI). Several studies have reported that internal rotation of the talus as an indicator of rotational lateral ankle laxity (RLAL) increases in patients with CLAI. However, there is no established method for detecting and evaluating the RLAL. This study aimed to report a novel method for evaluating the RLAL in the gravity stress position by measuring the talofibular distance (TFD) using ultrasonography (US) and show the normative value of the TFD. Methods: The TFDs in the subjects with healthy ankles were prospectively measured 10 mm distal to the ankle joint in the neutral ankle position and gravity stress position using US. The differences in the TFD between the two ankle positions were evaluated. The differences in the TFD by gender and ankle laterality were also evaluated. Results: A total of 52 healthy ankles of 28 subjects (mean age, 24.0 ± 1.6; male/female, 12/16) were finally included. There was a significant difference in the TFD between the neutral ankle position (6.9 ± 0.9 mm) and gravity stress position (9.0 ± 0.9 mm) (p < 0.001). The mean difference in the TFD between the two ankle positions was 2.1 ± 0.6 mm. There were no significant differences in the TFD by gender and ankle laterality. Conclusions: The present study reported a novel US method for evaluating RLAL by applying gravity stress and the normative value of the TFD. [ABSTRACT FROM AUTHOR]

Purpose: To develop the Sinhala version of the Cumberland Ankle Instability Tool (CAIT-Sin) and evaluate its validity and reliability in native Sinhala speakers. Methods: The CAIT was translated and cross-culturally adapted into Sinhala, using a forward-backward translation method. CAIT-Sin, Karlsson score, and visual analog scale (VAS) were filled out by 156 university athletes and students with and without ankle instabilities, in order to test internal consistency, test-retest reliability, criterion validity, floor and ceiling effect, and discriminative ability of the CAIT-Sin. Furthermore, ROC analysis was used to identify the presence of chronic ankle instability (CAI). Results: The CAIT-Sin was with a high internal consistency (Cronbach's alpha = 0.88) and excellent test-retest reliability (ICC2,1 = 0.95, 95% CI: 0.93–0.96). The CAIT-Sin exhibited strong and positive correlations with the Karlsson score (r = 0.832, p < 0.001) and VAS (r = 0.876, p < 0.001). No ceiling or floor effect was observed in individuals with CAI. A CAIT-Sin score of 26 or lower indicated the presence of CAI. Conclusions: The clinicians and researchers in Sri Lanka can use the CAIT-Sin for assessing and measuring CAI because its validity and reliability are confirmed. Implications for Rehabilitation: Functional ankle instability is an ongoing chronic condition which presents for rehabilitation therapist. Outcome measurements are crucial in the rehabilitation of ankle sprains and it is important to administer these subjective outcome measures in their native language. The CAIT-Sin was found to have high internal consistency and excellent test-retest reliability. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing. Design: This was a randomized, controlled, double-blind trial. Thirtysix individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week0 and week6. A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week6, with the outcome variables at week0 as covariates. Results: Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (−16.05, −78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week6. Conclusions: Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control. [ABSTRACT FROM AUTHOR]

High ankle motion smoothness involves small acceleration or deceleration, which is related to ankle stability. Interventions for ankle motion smoothness are important to reduce the progression of chronic ankle instability (CAI) symptoms and prevent recurrent ankle sprains. Training using whole-body vibration (WBV) may easily and effectively improve ankle motion smoothness; however, its effects have not yet been investigated. We aimed to clarify the acute effects of WBV training on ankle motion smoothness in patients with CAI. Randomized controlled trials. Overall, 31 university students from a basketball team with CAI were included. Training was performed using a WBV device in both groups. The WBV group was administered with WBV using the device, whereas the NWBV group was not administered with WBV. Only one training session was performed in each group immediately after the premeasurements. The main outcome measure was the mean angular jerk cost of the ankle joint in plantar/dorsal flexion and in inversion/eversion during the star excursion balance test (SEBT), which were measured using accelerometers. Results/findings: No significant group × time interaction was noted for the mean angular jerk cost of the ankle joint in any direction (anterior, posterolateral, or posteromedial) during ankle inversion/eversion or plantar/dorsal flexion. Pre and postintervention comparisons of each group showed no significant differences in any of the SEBT directions in both ankle inversion/eversion and plantar/dorsal flexion in the NWBV and WBV groups. Using WBV training on individuals with chronic ankle instability did not acutely improve ankle motion smoothness. [ABSTRACT FROM AUTHOR]

Interpreting ankle stress radiographs is subjective and time-consuming. We aimed to train an AI model that efficiently screens negative cases, assess the agreement with expert with and without AI-assistance, and compare the workload reduction. We collected anterior draw test (ADT) and talar tilt test (TTT) ankle stress radiographs from Seoul St. Mary's Hospital and St. Vincent's Hospital. Patients with prior surgery, severe joint fusion, or incomplete images were excluded. Expert measurements of tibio-talar distance (TTD) and tibio-talar angle (TTA) served as reference, defining positive labels as TTD ≥ 8.3 mm or TTA ≥ 6.2°. We trained a VGG16 model on data from hospital A and tested it on three separate test sets (testset1, 2 from St. Mary's Hospital, and testset3 from St. Vincent's Hospital). Three readers (expert, reader2, and the collective reading reports) evaluated the test sets, with and without AI-assistance (focusing only on AI-predicted positive cases). We measured agreement with the expert using Cohen's weighted Kappa and assessed the hypothetical workload reduction. AI-assistance did not significantly affect agreement with the expert for any reader in all test sets. Reader2 showed moderate-substantial agreement for all test sets, while collective reports reached fair agreement. The AI alone demonstrated fair to moderate agreement with the expert. AI-assistance reduced the hypothetical workload by 68.8–89.2% for ADT and 58.3–70.4% for TTT. We successfully trained an AI model for ankle stress radiography, achieving an average of 70% workload reduction while maintaining agreement with expert radiologists. [ABSTRACT FROM AUTHOR]

Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions. [ABSTRACT FROM AUTHOR]

Background: Anterior ankle bony impingement, which can cause pain and dysfunction of the ankle, is commonly seen in sports injuries. Its primary cause is repeated injury due to chronic ankle instability. An excellent clinical result has been reported by surgically removing osteophytes and ankle stabilization. However, reports of complex anterior impingement combined with lateral ankle instability are rare, which remains challenging in clinical practice. Purpose/Hypothesis: The purpose of this study was to evaluate the clinical outcomes of anterior ankle bony impingement combined with lateral ankle instability with surgical dissection of osteophytes and stabilization. It was hypothesized that complex ankle osteophytes with instability would achieve optimal clinical outcomes through surgical management. Study Design: Case series; Level of evidence, 4. Methods: A total of 57 patients with complex ankle bony impingement combined with lateral instability treated with surgical dissection of complex osteophytes between September 2013 and January 2019 were enrolled in the study. The clinical outcomes were evaluated by visual analog scale (VAS) for pain score, American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and radiographic examination with a mean follow-up time of 39.6 months. Postoperative ankle function and complications were compared using the t test and post hoc Tukey significant difference test. Results: The mean AOFAS score significantly increased at the 3-month, 1-year, and 2-year follow-ups compared with the preoperative condition (t = 10.57, P =.0001). The mean Karlsson score after surgery also significantly improved at each follow-up time compared with the preoperative score (t = 12.93, P =.0001). The preoperative VAS score significantly decreased at 3 months, 1 year, and 2 years postoperatively (t = 8.73, P =.001). A significant improvement of mean dorsiflexion difference was observed at 3 months and 1 year compared with the preoperative condition, but it seemed to have regressed at the 2-year follow-up (t = 2.11, P =.01). Tibial side recurrence was found in 9 cases, including 7 Scranton type 1 and 2 Scranton type 2. Talar side recurrence was also found in 3 of those cases. Conclusion: Our retrospective study demonstrated that complex ankle bony impingement combined with lateral instability can yield good clinical results when treated surgically with both ankle stabilization and osteophyte removal. [ABSTRACT FROM AUTHOR]

Abstract Background The Cumberland Ankle Instability Tool (CAIT) is used to screen patients with chronic ankle instability (CAI) and to quantify the severity of ankle instability. Neuromuscular deficits are common in CAI, including proprioception, strength, and balance issues. The relationship between CAIT scores and neuromuscular factors is unclear. The purpose of this study was to investigate the correlation between ankle instability and ankle muscle strength, proprioception, and dynamic balance. Methods Thirty-four individuals with chronic ankle instability were included in this study. The participants’ CAIT scores, muscle strength (isokinetic) and proprioception in plantarflexion (PF), dorsiflexion (DF), inversion (IV), and eversion (EV), and dynamic balance (Star Excursion Balance Test in anterior, posteromedial, and posterolateral directions) were assessed. Bivariate correlations were used to determine the relationship between CAIT scores and ankle muscle strength, proprioception, and dynamic balance. Results In terms of muscle strength, ankle PF (r = 0.378, 95%CI: 0.046–0.635, P = 0.027) and IV (r = 0.527, 95%CI: 0.233–0.736, P = 0.001) strength were positively correlated with CAIT Score, whereas ankle DF and EV strength had no significant correlation with CAIT Score. In terms of proprioception, ankle IV proprioception (r = -0.340, 95%CI: -0.608–0.002, P = 0.027) was negatively correlated with CAIT Score, while ankle PF, DF, and EV proprioception had no significant correlation with CAIT Score. In terms of dynamic balance, the SEBT posteromedial (r = 0.444, 95%CI: 0.124–0.680, P = 0.001) was positively correlated with CAIT Score. The SEBT anterior and posterolateral were not significantly correlated with the CAIT Score. Conclusion This study found that increasing ankle plantarflexion and inversion muscle strength, improving dynamic balance in the posteromedial direction, and decreasing ankle inversion proprioceptive thresholds may help improve the subjective stability of CAI. This provides data support for targeted ankle neuromuscular function rehabilitation training for patients. Trial registration Chinese Clinical Trial Registry ChiCTR2100044089. Registered on 10 March 2021.

Abstract Background The anatomical location for lateral ligament reconstruction remains a significant challenge. With the development of arthroscopic technology, arthroscopic-assisted lateral ligament reconstruction can significantly facilitate the correct localization of anatomical points. However, there is limited evidence on the clinical efficacy of arthroscopic ligament reconstruction compared with percutaneous ligament reconstruction. Methods This study included 72 patients who underwent lateral ligament reconstruction for chronic lateral ankle instability from 2018 to 2022. The follow-up duration in the percutaneous(n = 35) and the arthroscopic(n = 37) groups was 6–30 months. The patients were evaluated before the operation, at 6 months after surgery, and at the final follow-up. The American Orthopaedic Foot and Ankle Society score (AOFAS), Karlsson-Peterson score, and Visual Analog Scale (VAS) were evaluated at each time point. The complications and the time required to return to sports were documented during the follow-up. Results All clinical evaluations significantly improved after surgery in both groups. There was no significant difference between the two groups in the AOFAS score, VAS score, and complications. The Karlsson-Peterson score (85.4 vs 83.6, p = 0.044), surgical duration (50.4 min vs 60.2 min, p

Abstract Background Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI. Objective The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI. Methods A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period. Results After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment. Conclusion Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability.

Abstract Background Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied. Purpose The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control. Methods A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy. Results The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly. Conclusions The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.

Abstract Objectives To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI). Methods 3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle). Results In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively. Conclusion We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI. Critical relevance statement High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients. Key Points Spatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements. The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs. 3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability. Graphical Abstract

Abstract Athletes who have successfully regained high sports performance despite prior inversion injuries, and who do not have persistent symptoms, are referred to as “copers” in the literature. The aim of the study was to assess dynamic stability under fatigue in patients with chronic ankle instability in comparison to healthy controls. We conducted a case - controlled study on a group of 60 young, physically active individuals aged 29.8 ± 4.6. They were divided into 3 groups: I - unilateral ankle instability n = 14, II - bilateral ankle instability n = 15, III - no ankle instability, n = 31. All participants filled out questionnaires on the health, the FADI and FADI-S. The study protocol consisted of a dynamic stability measurements by Biodex Balance System, followed by a fatigue test, followed by the series of the same measurements. General stability index value before and value after fatigue test did not differ significantly. The differences between groups in measurements taken before fatigue test (F (2.49) = 1.59; p = 0.214; ηp 2 = 0.06) and after fatigue test also proved insignificant (F (2.49) = 1.28; p = 0.286; ηp 2 = 0.05). The incidence of structural ankle instability did not affect functional stability. “Copers” had efficient neural-muscular control in dynamic stabilography tests.

OBJECTIVE: The optimal non-surgical therapy for chronic ankle instability remains unclear due to the continuous introduction of novel treatment methods despite the availability of several non-surgical options for improving foot and ankle function and dynamic balance in chronic ankle instability patients. This study aims to investigate the most effective non-surgical therapy options to improve foot and ankle function and dynamic balance for patients with chronic ankle instability using a network meta-analysis. METHODS: Using “CAI, exercise, and randomized controlled trial” as search terms, a literature search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted through a computer network to collect information from the databases from their inception to March 2024 on non-surgical therapies for the treatment of chronic ankle instability randomized controlled trials on foot and ankle function or dynamic balance in patients. EndNote software was utilized for literature management. RevMan 5.4 software and Cochrane Risk of Bias Assessment Tool were used to evaluate the risk of bias of the included literature. Paired meta-analysis and network meta-analysis of the outcomes such as the Foot and Ankle Ability Measure in daily living subscale score, Foot and Ankle Ability Measure in sports activities subscale score, Star Excursion Balance Test – Anterior score, Star Excursion Balance Test – Posteromedial score, Star Excursion Balance Test – Posterolateral score and Cumberland ankle instability tool score were performed using the network commands of Stata 14.0 software. The strength of evidence rating of the outcome metrics was evaluated according to the GRADE Level of Evidence and Strength of Recommendation Grading Criteria. RESULTS: Of the 22 randomized controlled trials that met the inclusion criteria, 1 study was rated as low risk, 8 studies were rated as medium risk, and 13 studies were rated as high risk, enrolling a total of 952 patients and 25 treatments. (1) Network meta-analysis showed that compared with the control group, Isokinetic Strength Training, Balance Training, Balance+Stroboscopic Glasses Training, Strength Training, Joint Mobilizations Training, CrossFit Training, CrossFit Training+Self-Mobilization, Wobble Board Training, National Academy of Sport Medicine corrective exercise program, Trigger Point Dry Needling, and Neuromuscular Training had different significant enhancement effects on improving foot and ankle function and dynamic balance in patients with chronic ankle instability (P < 0.05). (2) Cumulative probability ranking results showed that the three treatments with the highest ranked Cumberland ankle instability tool score were Joint Mobilizations Training (88.6%) > Visual Feedback Balance Training (83.1%) > CrossFit Training+Self-Mobilization (74.8%); the three treatments with the highest ranked Star Excursion Balance Test - Anterior score were Joint Mobilizations Training (88.4%) > Isokinetic Strength Training (86.9%) > National Academy of Sport Medicine corrective exercise program (65.0%); the three treatments with the highest ranked Star Excursion Balance Test - Posteromedial score were Balance+Stroboscopic Glasses Training (87.4%) > Neuromuscular Training (74.6%) > Strength Training (68.9%); the three treatments with the highest ranked Star Excursion Balance Test - Posterolateral score were CrossFit Training+Self-Mobilization (74.6%) > Balance+Stroboscopic Glasses Training (70.0%) > Neuromuscular Training (63.7%); the three treatments with the highest ranked Foot and Ankle Ability Measure in daily living subscale score were National Academy of Sport Medicine corrective exercise program (91.9%) > Balance+Stroboscopic Glasses Training (85.6%) > Wobble Board Training (82.2%); the three treatments with the highest ranked Foot and Ankle Ability Measure in sports activities subscale score were Balance+Stroboscopic Glasses Training (93.5%) > Balance Training (86.7%) > National Academy of Sport Medicine corrective exercise program (86.4%). CONCLUSION: Non-surgical therapies can significantly improve foot and ankle function and dynamic balance in patients with chronic ankle instability. National Academy of Sport Medicine corrective exercise program had the best efficacy in improving foot and ankle daily activity function in chronic ankle instability patients; Balance+Stroboscopic Glasses Training had the best efficacy in improving foot and ankle sports function and posterior medial dynamic balance; Joint Mobilizations Training had the best efficacy in improving anterolateral dynamic balance and ankle instability condition; and CrossFit Training+SelfMobilization had the best efficacy in improving posterior lateral dynamic balance. The strength of evidence for each outcome was low, influenced by the risk of methodological bias and risk of publication bias of the included studies. Therefore, the above conclusions need to be validated by more high-quality pilot studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with chronic ankle instability are prone to inversion ankle sprains during landing. Moderately increasing the foot toe-out angle during landing may reduce the occurrence of inversion ankle sprains, but no studies have directly demonstrated this effect. OBJECTIVE: To explore the effect of increased toe-out angle during landing on the peak inversion angle, peak angular velocity, and the time to peak inversion among individuals with and without chronic ankle instability. METHODS: A total of 60 participants were recruited for this study, including 30 individuals with chronic ankle instability and 30 without chronic ankle instability. The study utilized a simulated sprain apparatus for drop-landing tests, featuring a platform that could tilt forward by 24° and inward by 15°, thus simulating the foot position during an ankle inversion sprain. Participants were required to perform drop-landing tests under two landing conditions: natural landing and toe-out landing, with the latter involving a greater foot toe-out angle, over 150% more than the former. Kinematic data of participants were recorded using a 12-camera three-dimensional motion capture system. Data analysis was conducted using two-way repeated measures analysis of variance and Spearman correlation analysis. RESULTS AND CONCLUSION: (1) Significant main effects of condition were found for peak inversion angle during drop-landing (P < 0.001, η² p=0.270), peak inversion velocity (P=0.015, η² p=0.098), and peak inversion time (P < 0.001, η² p=0.260); a significant main effect of group was found for peak inversion velocity (P=0.029, η² p=0.080). (2) There were significant negative correlations between the foot toe-out angle at landing and the peak ankle inversion angle (P=0.021, r=-0.310; P=0.042, r=-0.278) as well as the peak inversion time (P=0.018, r=-0.312; P=0.021, r=-0.309) in both chronic ankle instability and non-chronic ankle instability groups. Moreover, a significant negative correlation was also found between the foot toe-out angle and peak inversion velocity in the chronic ankle instability group (P=0.021, r=-0.312). (3) It is indicated that increasing the foot toe-out angle at landing can reduce the peak inversion angle, peak inversion velocity, and the peak inversion time during landing in patients with chronic ankle instability and non-chronic ankle instability, thereby decreasing the risk of ankle inversion sprains. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stroboscopic visual training can force sensory reweighting to restore the original weights by increasing sensitivity to proprioceptive information, which may be an effective method to improve proprioception. OBJECTIVE: To determine the effects of balance training in three conditions, low frequency, high frequency and normal vision, on ankle proprioception in patients with chronic ankle instability. METHODS: Thirty-six patients with chronic ankle instability recruited from the students of Southwest Medical University were randomly assigned to a low- frequency vision training group, a high-frequency vision training group, and a normal vision training group, with 12 subjects in each group. Subjects in the three groups underwent progressive hop stabilization and balance training, in which the low-frequency vision training group and the high-frequency vision training group wore stroboscopic spectacles during the training, with a stroboscopic frequency of 1.75 and 5 Hz, respectively. The training in each group was performed three times a week for 4 consecutive weeks. Assessments, including ankle proprioception, ankle stability self-assessment and dynamic postural stability, were performed before training and within 1 week after the completion of training. RESULTS AND CONCLUSION: There was a significant main effect of time factor in ankle proprioception (P < 0.05). Compared with the pre-training period, subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvement in ankle proprioception after 4 weeks of training (P < 0.05); and subjects in the low-frequency vision training group showed a significant improvement in ankle proprioception compared with that of the normal vision training group after 4 weeks of training (P < 0.05). There were significant main effects of time factor and group × time interaction in ankle proprioception (P < 0.05). Compared with the pre-training period, the ankle stability self-assessment in all three groups was improved after 4 weeks of training (P < 0.05). And the ankle stability self-assessment in high-frequency visual training group was higher than that in normal vision training group after 4 weeks of training (P < 0.05). Compared with the pre-training period, subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvements in forward dynamic postural stability, posteromedial dynamic postural stability, and posterolateral dynamic postural stability after 4 weeks of training (P < 0.05), while in the normal vision training group, forward dynamic postural stability and posterolateral dynamic postural stability were significantly improved after 4 weeks of training (P ≤ 0.05). To conclude, balance training under stroboscopic visual conditioning improves proprioception, ankle stability self-assessment, and dynamic postural stability in patients with chronic ankle instability regardless of frequency. [ABSTRACT FROM AUTHOR]

Introduction: Ankle sprains remain one of the most commonly reported injuries in athletes. These injuries occur as a result of forced plantar flexion and inversion causing failure of the anterior talofibular ligament followed by the calcaneofibular ligament. Acute ankle sprains are generally treated conservatively. Nevertheless, 20%–40% of patients with an acute ankle sprain might develop chronic ankle instability (CAI). Surgical treatment is advocated for active young patients who develop CAI. MATERIALS AND METHODS: This study is a case series of 10 cases of CAI treated by the modified open Brostrom-Gould procedure from 2014 to 2021. The AOFAS ankle-hindfoot score and visual analog scores were used to evaluate the patient preoperatively and at regular intervals postoperatively. Results: All the patients had good-to-excellent results. There was a significant improvement in the mean AOFAS ankle-hindfoot scores from a preoperative 59.9 to a postoperative value of 91.3. The mean visual analog scores significantly dropped from a preoperative value of 5.9 to a postoperative value of 1.2. The minimum follow-up duration is around 1 year, while the maximum is around 8 years. Conclusion: The open modified Brostrom-Gould lateral ligament repair provides excellent results for chronic lateral ankle instability in active young individuals.