Ankle Sprain

A literature review examining conventional proprioceptive interventions (i.e. unstable surface training) and novel proprioceptive interventions (i.e. tactile and vibratory stimulation) of the ankle and foot on measures of proprioception (i.e. joint position sense, joint movement perception threshold) and balance/postural sway (i.e. center-of-pressure) in young healthy adults and those with FAI or acute ankle injury. Directives for ankle/foot rehabilitation protocols and propositions for future research are included.

Background: Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS: Methods: Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed.

OBJECTIVE: Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity. DESIGN: A randomized clinical trial with two arms. METHODS: Patients were recruited by word of mouth and via social network as well as posters, and analyzed in the neuro musculoskeletal laboratory of the "Université Catholique de Louvain-la-Neuve", Brussels, Belgium. PARTICIPANTS: 67 men (aged 18-40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM. INTERVENTIONS: Two modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients. MAIN OUTCOME MEASURES: Comprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann's device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well. RESULTS: A two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p = 0.37), viscous-stiffness (p = 0.83), total-stiffness (p = 0.58). For WBADF-ROM: toe-wall distance (p = 0.58) and angular ROM (p = 0.68). Small effect sizes between groups were determined with Co-hen's d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d = 0.003-0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the effect of each intervention on the sample categorized according to injury history status, and demonstrated a significant interaction between groups and time only for viscous stiffness (p = 0.04, d = −0.55). CONCLUSION: A single session of MWM and OM targeting the talocrural joint failed to immediately improve all measures in Galley Proof 18/04/2018; 14:11 File: bmr-1-bmr170963.tex; BOKCTP/ljl p. 2 2 B. Hidalgo et al. / The immediate effects of two manual therapy techniques on ankle MAS and dorsiflexion ROM subjects with chronic ankle dorsiflexion stiffness. Despite this, there was an increase in viscous stiffness in people with history of ankle injury following both manual techniques, the value of which remains unclear even if it might help to prevent future abnormal ankle joint movements.

Background: Musculoskeletal disorders of the lower extremities are commonly affected by chronicity and disability. One of the most commonly affected areas is the ankle. Epidemiological information is limited for chronic musculoskeletal ankle disorders in the general community, particularly in the developing world. This study aimed to determine the prevalence and impact of chronic musculoskeletal ankle disorders in the Sri Lankan community. Methods: A cross-sectional stratified random sample of people (n = 1000) aged 18 to 85 years in Sri Lanka was undertaken by questionnaire in the general community setting. Of those questionnaires, 827 participants provided data. Point prevalence for no history of ankle injury or ankle disorders, history of ankle injuries without chronic ankle disorders, and chronic ankle disorders were obtained. Point prevalence of chronic musculoskeletal disorders and causes for chronicity was evaluated. Results: There were 448 (54.2%) participants with no ankle disorders, 164 (19.8%) with a history of ankle injury but no chronic disorders, and 215 (26.0%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n = 113, 13.7% of the total sample), most of which were due to ankle injury (n = 80, 9.7% of the total). Sprains were responsible for 17.7% of the total ankle injuries. Arthritis was the other main cause for chronicity of ankle disorders with 4% of total participants (n = 33).

Soft tissue injury screening faces two main diagnostic challenges. one is the perceptual bias of the athlete in terms of referred pain and second injury assessment tools are not only in need of highly specialized personal but they are also financially demanding. Since ankle sprains is one of the leading soft tissue injuries, the current study was set to examine the suitability of functional infrared thermal imaging (fITI) in evaluating physiological alteration on the ankle as a result of exercise or injury. The current study consists of a case report of a patient with an ankle sprain and the behavior of temperature after a series of physiotherapy sessions. Moreover to strengthen the communication of the report, results from a healthy population sample were added to draw a deeper understanding on physiological temperature manifestations on soft tissue. Twenty participants underwent a 30-minute treadmill run with pictures of their ankles being taken during rest and after exercise. In addition the case of a patient is reported that has suffered an ankle sprain followed for a period of over a month. It was observed that the temperature of the ankles of participants that underwent physical exercise rose on average by 2.4 °C after taking into account both the medial and lateral sides of the both ankles. In addition the patient's left ankle appeared to be 2.5 °C above the temperature of the non-affected right ankle. This phenomenon of unilateral hyperthermia of the left injured side seems to start to dissipate by the 21 st day following the injury, completely resolving by the 42 nd day achieving bilateral isothermia in both ankles. Thermal imaging provides a reliable tool for the screening of soft tissue strain and injury. The current study further expands the literature on soft tissue screening with the use of thermal imaging, adding a quantifiable way for assessing the extend of tissue damage. The implemented method of analyses offers a suggested simple way not only in visualizing trauma but also physical strain. Nevertheless further investigations with a variety in the severity of ankle sprains need to be applied in order for thermal imaging to be used as a first line tool for the assessment and recovery of ankle sprains. Over the years with the progress of technology thermal imaging has managed to make leaps on ergonomics capitalizing on the progress of nanotechnology and lens engineering. Functional infrared imaging in now portable and more sensitive on infrared dynamics compared to what it used to be when the technique first begun its journey with the Pyroscan in 1959 in Bath 1. As a result of sensitivity and design infrared thermal imaging has now gained a reasonable exposure over the last 20 years specifically in the potential that it holds in a clinical setting specifically for soft tissue screening 2. Acute injury presents the organism with two types of challenges; prevent a possible infection as well as repair the wound and heal the body. To facilitate the physical needs of the body a population of different cells is recruited such as platelets, endothelial cells, macrophages, lymphocytes neutrophils and fibroblasts 3. Heat, swelling, redness and pain usually accompany inflammation, due to factors such as the release of endothelial nitric oxide (NO) and prostaglandins (PGI 2 and PGE 2), platelet derived growth factor and endothelial growth factor can lead to elevated heat patterns 3. Whereas the former can lead to vasodilation, the later can enhance proliferation and angiogenesis. The change in metabolic and vascular distribution from the "norm" makes tissue thermal changes visible on the infrared spectrum 4. Asymmetries in the circulation of focal body heat above <1 °C are an indication of an abnormality. Inflammation in its majority is measured on subjective scales that rate pain, redness, gross functional measures (movement/resistance) and volumetric changes such as swelling 5. All of these subjective

Objective Some individuals with Chronic Ankle Instability (CAI) termed as functional ankle instability (FAI) suffer from repetitive ankle giving way and feeling of ankle joint instability during dynamic activities like walking. Walking, as a postural task, requires some central attention to integrate sensory inputs, estimate , and plan and produce proper motor outputs. Attention demanding cognitive task has the ability to influence walking control and may increase the risk of giving way and ankle sprain. The purpose of this study was to investigate the effect of dual-tasking on dynamic balance in people with FAI. Materials & Methods Twelve physically active with clinically diagnosed FAI and 12 matched controls completed trials of normal walking in isolation or with a concurrent cognitive task, which is repeatedly subtracting seven from a randomly selected number (between 200 and 250) and the same cognitive task while sitting. Spatiotemporal parameters (measured by a seven-camera motion capture system) were calculated by visual3D during gait cycles. Gait velocity, step time, step length, stance time, and swing time were calculated. Independent t-test was used to compare the data for FAI and control groups, and comparisons between the single and dual task conditions were made using the paired t-test. Step time variability was calculated using Intraclass Correlation (ICC). Results The results indicated that step velocity was decreased and that stance, swing, and step time were increased significantly during dual task walking in FAI people (P<0.05). FAI people demonstrated greater step time variability during single and dual tasks compared to the control group. Conclusion The athletes with FAI demonstrated different movement strategies during the dual-task condition compared to control group. Cognitive load may increase the risk of ankle instability in individuals with FAI.