Search Results (75)

Background and Objectives: Chronic ankle instability (CAI), a prevalent injury among female volleyball players, can negatively affect functional performance and increase the risk of further injury. The aim of this study was to compare functional movement quality, dynamic balance, vertical jumping performance, hip muscle strength, and risk of injury between adolescent female volleyball players with unilateral CAI and those without CAI. Materials and Methods: This cross-sectional study included 46 adolescent female volleyball players, divided into CAI (n = 23) and control (n = 23) groups based on predefined criteria. Functional movement quality was assessed using the Functional Movement Screen (FMS), and dynamic balance was evaluated with the Y-Balance Test (YBT). Maximal isometric strength of the hip muscles (flexors, extensors, abductors, adductors, and internal and external rotators) was measured using hand-held dynamometry, and vertical jumping performance was assessed using countermovement jump tests. Injury risk was classified based on established cut-off values for the FMS-composite and YBT-anterior reach asymmetry scores. Results: The CAI group demonstrated significantly lower FMS-composite scores (p = 0.007), reduced anterior reach on the YBT (p = 0.004), and decreased strength in the hip flexors (p = 0.007) and hip adductors (p = 0.044), supported by moderate effect sizes. No significant group differences were observed in the other YBT directions, vertical jump tests, or the other hip muscles (p > 0.05). A greater proportion of athletes in the CAI group were classified as high risk for injury based on both FMS-composite (p = 0.022) and YBT-anterior reach asymmetry (p = 0.001) cut-off values, supported by moderate and relatively strong effect sizes, respectively. Conclusions: Adolescent female volleyball players with unilateral CAI showed impaired movement quality, balance deficits, hip muscle weakness, and increased injury risk. These results highlight the importance of targeted interventions and broader investigations into CAI in adolescent athletes. Full article

Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion^®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan^® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy. Full article

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy. Full article

Hallux valgus (HV) is described as a lateral deviation of the great toe at the first metatarsophalangeal joint (MTP), which is a very common foot deformity in the clinic. This deformity extends beyond localized foot mechanics to affect the entire lower extremity kinetic chain, potentially increasing dynamic instability during locomotion. This study aimed to characterize the kinematics of ankle and knee joints during walking in HV patients compared to controls. In total, 23 patients with bilateral HV and matched healthy controls were recruited. The 6-DOF kinematics data of ankles and knees were collected using a joint motion function analysis system while level walking at adaptive speed. HV patients demonstrated significant kinematic alterations in the ankle joint at IC, including decreased varus by 2.87° (p < 0.001), decreased internal rotation by 1.77° (p = 0.035), and decreased plantarflexion by 4.39° (p < 0.001) compared with healthy subjects. Concurrent compensatory changes in the knee joint included increased varus rotation by 1.41° (p = 0.023), reduced anterior translation by 0.84 mm (p < 0.001), and increased lateral translation by 0.26 mm (p = 0.036). HV patients showed increased ankle dorsiflexion of 3.61° (p = 0.06) and decreased ankle internal rotation of 2.69° (p = 0.043), with concurrent increased knee internal rotation of 2.59° (p = 0.009) at SPF. The ripple effect during walking in the HV population may elevate the risk of knee pathologies. These findings may inform both conservative management strategies and post-surgical rehabilitation regimens. Full article

Background: The ankle joint plays a key role in stabilizing the lower limb during interaction with ground reaction forces. Instability can result in pain, weakness, and impaired movement. Although assessing ankle stability is important, few studies examine existing in vivo methodologies for dynamic load assessment, limiting effective injury management. Objective: To identify in vivo techniques using objective measurement tools for assessing ankle stability during dynamic exercise. Methods: A scoping review was performed based on PRISMA-ScR criteria. Five databases—PubMed, PEDro, Embase, SPORTDiscus, and CDSR—were searched from inception to September 2024. Results: Out of 1678 records, 32 studies met the inclusion criteria. A total of 1142 subjects were included: 293 females (25.6%), 819 males (71.7%), and 30 unspecified (2.62%). Six categories of dynamic exercise were identified: analytical, functional, balance, stair climbing, running, and walking. The techniques used included 3D motion capture, force and pressure platforms, dynamometry, electromyography, accelerometers, pressure and speed sensors, instrumented treadmills, and inertial measurement units. Conclusions: The 3D motion capture systems (240 Hz) and the force platforms (1000 Hz) were most frequently used in functional tasks and walking. Combining these with multisegmented foot models appears optimal, though tool selection depends on study goals. This review enhances our understanding of ankle stability assessment. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

The purpose of this study was to assess whether a simple and reproducible battery of jump tests can distinguish between patients affected by chronic ankle instability (CAI) and control subjects. The hypothesis was that patients with CAI would demonstrate lower performance compared to healthy subjects during jumping tasks. Twenty-one young, active adults aged 18 to 45 years affected by CAI were matched for sex, age, and body mass index (BMI) to a control group of 21 healthy subjects without history of lower limb pathology. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery, including mono- and bipodalic vertical squat jumps, countermovement jumps (CMJs), a drop jump (DJ), and a side-hop test. Patients with CAI had significantly worse monopodalic CMJ, DJ, and side-hop test scores in their involved limb compared to the non-dominant limb of healthy individuals. Pathological limbs of CAI patients reported inferior results compared to non-dominant limbs of healthy individuals while performing monopodalic CMJs, DJs, and side-hop tests (p < 0.05). No statistically significant differences were found between the two groups in the limb symmetry index (LSI) while performing monopodalic CMJs and DJs (p = 0.072 and p = 0.071, respectively), while a difference was found between the two groups, in favor of healthy subjects, while performing monopodalic side-hop tests (p < 0.01). A reproducible battery of jump tests performed with a simple and low-cost instrument can be applied in the clinical setting allowing for reliable measurements of functional ability of subjects with CAI. Our findings support the idea that side-hop tests could be more accurate than vertical jump tests for detecting functional deficits in patients suffering from CAI. Full article

Alterations in static plantar pressure distribution serve as important indicators of gait and balance impairments in individuals with Multiple Sclerosis (MS). In addition, the identification of altered patterns of plantar load distribution, along with restricted ankle dorsiflexion, may serve as early markers of postural instability and gait dysfunction in women with MS. Objectives: To assess differences in static plantar pressure, load distribution, and ankle dorsiflexion range of motion between women diagnosed with MS and women without the condition. Methods: A cross-sectional observational study was conducted between April and December 2024. Women with MS were recruited from patient associations in the provinces of Alicante and Murcia, as well as from the neurology outpatient clinic at the Doctor Balmis University Hospital (Alicante, Spain). Static postural assessment was performed using the Neo-Plate^® pressure platform, which measured maximum and mean plantar pressure (kPa), load distribution (%), contact surface area (cm²), and anterior–posterior weight distribution between the forefoot and rearfoot. The ankle dorsiflexion range of motion was assessed with a universal two-arm goniometer. All parameters were compared with those of a group of women without a diagnosis of MS. Results: Compared to women without MS, participants with MS showed a significantly greater load on the right forefoot (25.75% vs. 23.41%, p = 0.021), and reduced load on the right (23.09% vs. 26.01%, p = 0.004) and left rearfoot (26.60% vs. 30.85%, p = 0.033). Total forefoot loading was significantly higher (52.33% vs. 46.40%, p < 0.001), and rearfoot loading was lower (47.64% vs. 52.42%, p = 0.006) in the MS group. Ankle dorsiflexion range of motion was also significantly reduced in women with MS, both with the knee flexed (5.95° ± 4.50 and 6.76° ± 4.69 vs. 15.45° ± 5.04 and 14.90° ± 5.43) and extended (2.69° ± 3.69 and 3.12° ± 3.83 vs. 8.17° ± 3.41 and 8.60° ± 3.31), with all differences reaching statistical significance (p < 0.001). Conclusions: Women with MS present significant alterations in static plantar load distribution, with increased forefoot and decreased rearfoot loading, as well as markedly reduced ankle dorsiflexion, in comparison to women without the disease. These findings suggest the presence of postural imbalances associated with MS, potentially affecting functional stability and mobility. Full article

The prevalence of ankle pain in adults is 9–15%, with up to 45% of sports-related injuries attributed to ankle pain and injuries. If ankle pain is not controlled in a timely manner, it can lead to ankle instability, resulting in further damage, recurrence of pain, and secondary injuries. The present study aimed to assess the therapeutic potential and safety profile of bee venom acupuncture (BVA) in the management of ankle pain. Ten electronic databases were searched for articles published up to March 2025. We included clinical studies that utilized BVA for the treatment of ankle pain and studies that included pain- and function-related assessment tools. The safety of bee venom acupuncture (BVA) was assessed by extracting adverse events from the included studies and categorizing them according to the Common Terminology Criteria for Adverse Events (CTCAE). A total of 14 clinical studies were selected, of which 9 were case reports, 2 were case-controlled clinical trials (CCTs), and 3 were randomized controlled trials (RCTs). The conditions causing ankle pain were mostly traumatic (42.9%), followed by inflammatory (21.4%) and neuropathic disorders (14.3%). BVA was applied at concentrations ranging from 0.05 to 0.5 mg/mL, with a per-session volume ranging from 0.04 to 2.5 mL. In most studies, BVA was reported to improve both ankle pain and function simultaneously. Among the 14 studies, four participants reported adverse events following BVA treatment, all of which were classified as grade 1 or grade 2, indicating mild to moderate severity. This review suggests that BVA may be recommended for controlling ankle pain based on clinical evidence. However, the number of high-quality RCTs is limited, and half of the studies did not report side effects, indicating the need for further clinical research to verify its safety and efficacy. Full article

This study examined the impact of different breath-holding conditions on iliopsoas and other hip flexor muscle activity in individuals with chronic ankle instability (CAI). It has been hypothesised that impaired diaphragmatic function influences iliopsoas activation, potentially contributing to motor control deficits in patients with CAI. Eleven adults with a history of chronic ankle sprain participated in this study. Maximal isometric hip flexion was assessed under three breath-holding conditions: end-expiration, end-inspiration, and the intermediate state. Surface electromyography was used to record the muscle activity of the iliopsoas, rectus femoris, sartorius, and tensor fasciae latae, while the peak hip flexion torque was measured using an isokinetic dynamometer. Under the end-inspiration condition, iliopsoas activity on the affected side was significantly lower than that on the control side (p < 0.05). However, no significant differences were observed between the affected and control sides in the activity of the other hip flexor muscles or the peak hip flexion torque across breath-holding conditions. This study highlights the association between reduced iliopsoas activity during end-inspiration and compromised diaphragmatic function in patients with CAI. Future research should explore dynamic movement tasks and larger sample sizes to elucidate neuromuscular mechanisms further and refine rehabilitation strategies. Full article

Background/Objectives: Adolescent female basketball players are frequently affected by lateral ankle sprains that may progress to chronic ankle instability (CAI) if not adequately managed. This double-blind, prospective, cluster-randomized controlled trial aimed to compare the effects of hop-stabilization training (hop training) and those of traditional balance training on ankle instability and functional performance of this population. Methods: Thirty-two adolescent female basketball players with CAI were cluster-randomized into the hop training group (HG; n = 16) or balance training group (BG; n = 16). Participants completed three 20 min sessions per week for 6 weeks. The hop training protocol comprised multiplanar hopping exercises with progressive increases in the landing volume and an emphasis on controlled landing mechanics. The balance training protocol included single-leg stance and basketball-specific dynamic activities with gradually increasing difficulty. Primary outcomes were self-reported ankle stability (Cumberland ankle instability tool [CAIT] score) and performance test results (t-test, lateral hop test, figure-8 hop test results). Secondary outcomes included static and dynamic balance and isometric ankle strength (dorsiflexion [DF], plantar flexion, inversion, eversion [EV]). Assessments were conducted at baseline and after interventions. Results: The HG and BG exhibited significant improvements in CAIT scores and balance. However, the HG demonstrated significantly greater enhancements in dynamic performance test results and notable improvements in DF and EV strength compared to those of the BG. Conclusions: Hop training comprising the close replication of the multidirectional and dynamic demands of basketball was more effective than traditional balance training for enhancing functional performance and ankle strength. Full article

Background/Objectives: The ankle joint is among the most frequently injured joints in daily life, with approximately 25% of young adults reporting chronic ankle instability (CAI). This study investigated the effects of transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation (NIBS) technique, combined with joint mobilization and active joint mobilization on CAI. Methods: A total of 36 participants (mean age: 20.81 years; 63.89% female; mean body mass index: 21.68) were randomly divided into three groups: (1) tDCS with joint mobilization (n = 12); (2) active joint mobilization (n = 12); and (3) tDCS with active joint mobilization (n = 12). Dynamic balance, range of motion (ROM), static balance, and ankle instability (Cumberland Ankle Instability Tool, CAIT) were evaluated at multiple time points. Interventions were conducted three times per week, for 15 min per session, over four weeks (12 sessions total). Results: All three groups showed significant improvements over time in dynamic balance, ankle instability, ROM, and static balance (p < 0.05). However, no significant interaction effects were observed between time and group (p > 0.05). The tDCS with active joint mobilization group demonstrated the largest effect sizes across most outcome measures, particularly for ankle instability, ROM, and static balance, in both immediate and post-intervention assessments. Conclusions: tDCS combined with active joint mobilization appears to be particularly effective in improving CAI. This approach, targeting both top-down mechanisms through non-invasive brain stimulation and local joint function, offers a promising alternative to traditional interventions that focus solely on the ankle joint. This study was registered with the Clinical Research Information Service (CRIS) under the identifier KCT0009566. Full article

Postural control arises from the complex interplay of stability, adaptability, and dynamic adjustments, which are disrupted post-stroke, emphasizing the importance of examining these mechanisms during functional tasks. This study aimed to analyze the complexity and variability of postural control in post-stroke individuals during the feedforward phase of gait initiation. A cross-sectional study analyzed 17 post-stroke individuals and 16 matched controls. Participants had a unilateral ischemic stroke in the chronic phase and could walk independently. Exclusions included cognitive impairments, recent surgery, and neurological/orthopedic conditions. Kinematic and kinetic data were collected during 10 self-initiated gait trials to analyze centre of pressure (CoP) dynamics and joint angles (−600 ms to +50 ms). A 12-camera motion capture system (Qualisys, Gothenburg, Sweden) recorded full-body kinematics using 72 reflective markers placed on anatomical landmarks of the lower limbs, pelvis, trunk, and upper limbs. Ground reaction forces were measured via force plates (Bertec, Columbus, OH, USA) to compute CoP variables. Linear (displacement, amplitude, and velocity) and non-linear (Lyapunov exponent—LyE and multiscale entropy—MSE) measures were applied to assess postural control complexity and variability. Mann–Whitney U tests were applied (p < 0.05). The stroke group showed greater CoP displacement (p < 0.05) and reduced velocity (p = 0.021). Non-linear analysis indicated lower LyE values and reduced complexity and adaptability in CoP position and amplitude across scales (p < 0.05). In the sagittal plane, the stroke group had higher displacement and amplitude in the head, trunk, pelvis, and limbs, with reduced LyE and MSE values (p < 0.05). Frontal plane findings showed increased displacement and amplitude in the head, trunk, and ankle, with reduced LyE and MSE (p < 0.05). In the transverse plane, exaggerated rotational patterns were observed with increased displacement and amplitude in the head, trunk, pelvis, and hip, alongside reduced LyE convergence and MSE complexity (p < 0.05). Stroke survivors exhibit increased linear variability, indicating instability, and reduced non-linear complexity, reflecting limited adaptability. These results highlight the need for rehabilitation strategies that address both stability and adaptability across time scales. Full article

Background: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24–50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes. Full article

Background/Objectives: As a representative anatomic ankle ligament repair technique, the Broström procedure continues to be modified to reach better clinical outcomes, superior mechanical stability, early rehabilitation, and minimal risk of recurrent instability. This study aimed to evaluate the intermediate-term clinical outcomes after the modified Broström procedure (MBP) with suture-tape augmentation for chronic lateral ankle instability. Methods: Ninety-four patients with chronic lateral ankle instability were followed for ≥3 years after MBP augmented with suture tape. The patient-reported clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). The changes in mechanical ankle stability were evaluated with physical examination and periodic stress radiography. The changes in static and dynamic postural control ability were assessed with the single-leg stance test and Biodex posturography. Results: FAOS and FAAM scores significantly improved from preoperative means of 52.6 and 54.2 points to 91.8 and 90.5 points at final follow-up, respectively (p < 0.001). Talar tilt angle and anterior talar translation significantly improved from preoperative means of 15.4° and 14.3 mm to 2.7° and 4.5 mm at final follow-up, respectively (p < 0.001). Two patients (2.1%) complained of a recurrence of mechanical and functional instability. One patient (1.1%) showed non-specific inflammation related to a suture tape. Balance retention time significantly improved from a preoperative mean of 3.7 to 6.4 s at final follow-up (p < 0.001), with a non-significant side-to-side difference. The overall stability index significantly improved from a preoperative mean of 3.7 to 1.9 at final follow-up (p < 0.001), with a significant side-to-side difference. Conclusions: The MBP augmented with suture tape appears to be an effective surgical technique for chronic lateral ankle instability. Through anatomic repair of attenuated ankle ligaments and suture-tape augmentation, this modified procedure can provide reliable stability and minimal risk of recurrent instability. In addition, static and dynamic postural control ability may be improved through continuous proprioceptive-oriented rehabilitation following surgery. Full article