J Orthop Sports Phys Ther. 2007;37(6):303-311, Epub 16 April 2007. doi:10.2519/jospt.2007.2322

KEY WORDS: ankle sprain, balance, Foot and Ankle Disability Index, star excursion balance test 

Objective:Assess range of motion, posterior talar glide, and residual joint laxity following ankle sprain in a population of athletes who have returned to unrestricted activity.

Background: Lateral ankle sprains occur frequently in athletic populations and the reinjury rate may be as high as 80%. In an effort to better understand risk factors for reinjury, the sequelae to injury in a sample of college athletes were assessed.

Methods and Measures: Twelve athletes with a history of lateral ankle sprain within the last 6 months and who had returned to sport participation were tested. Only athletes who reported never injuring the contralateral ankle were included. The injured and uninjured ankles of subjects were compared for measures of joint laxity, ankle dorsiflexion range of motion, and posterior talar glide. Friedman’s test of rank order was used to analyze the laxity measures and a MANOVA was used to assess the dorsiflexion and posterior talar glide measures.

Results: Laxity was significantly greater at the talocrural and subtalar joints of the injured ankles. There were no significant differences in any of the ankle dorsiflexion measurements between injured and uninjured ankles, but posterior talar glide was significantly reduced in injured ankles as compared to uninjured ankles.

Conclusion: In our sample of subjects, residual ligamentous laxity was commonly found following lateral ankle sprain. Dorsiflexion range of motion was restored in the population studied despite evidence of restricted posterior glide of the talocrural joint. Although restoration of physiological range of motion was achieved, residual joint dysfunction persisted. Further research is warranted to elucidate the role of altered arthrokinematics after lateral ankle sprain.

J Orthop Sports Phys Ther. 2002; 32(4):166-173.

Key Words: arthrokinematic motion, inversion ankle sprain, ligamentous laxity

]]> http://www.jospt.org/issues/articleID.160/article_detail.asp http://www.jospt.org/issues/articleID.527/article_detail.asp Jay Hertel, Thomas W. Kaminski

The Second International Ankle Symposium was a multidisciplinary conference focused on topics related to ankle instability and associated pathologies and was held on the campus of the University of Delaware in October 2004. The first symposium was held in Ulm, Germany in 2000 and its success served as the catalyst for the second symposium. The most recent symposium brought together over 75 clinicians and scientists from disciplines such as physical therapy, athletic training, orthopedics, podiatry, and biomechanics. Participants represented many countries, including Australia, Belgium, Germany, Ireland, Japan, Sweden, and the United States. A call for abstracts was initially distributed in the fall of 2003. Members of the organizing committee reviewed all submitted abstracts for scientific merit. Thirty-two abstracts were accepted and presented at the symposium. The educational program consisted of several invited plenary lectures from internationally recognized experts and 19 podium and 13 poster presentations of original research. The symposium also provided for considerable scholarly interaction among the attendees. The meeting culminated with the formation of the International Ankle Consortium, a multidisciplinary group aiming to further the scientific understanding and to improve the clinical care of ankle instability and related pathologies. This group will work to develop standards for ankle instability research, such as guidelines for inclusion and exclusion criteria in ankle instability studies and development of a standardized clinical outcomes tool for use in ankle instability studies. Plans have already commenced for the third International Ankle Symposium to be held at University College Dublin, Dublin, Ireland, September 1-3, 2006. This special supplement to the Journal of Orthopaedic & Sports Physical Therapy includes a summary statement, synopses of 5 plenary lectures, and the abstracts of the original research presentations from the second International Ankle Symposium.

J Orthop Sports Phys Ther. 2005; 35(5):A1-A28.  doi:10.2519/jospt.2005.0301

Key Words: ankle instability, outcomes tool, clinical care

Study Design: Case control study. Objectives: The purpose of this study was to assess the position of the distal fibula in individuals with chronic ankle instability (CAI). Background: Recent literature has suggested that a positional fault of the fibula on the tibia may contribute to CAI; however, there is a lack of objective scientific evidence to support this claim. Methods and Measures: Thirty subjects with unilateral CAI (mean ± SD age, 20.3 ± 1.3 years) and 30 subjects with no previous history of ankle injury (mean ± SD age, 21.3 ± 3.8 years) participated in this study. Subjects completed a pair of subjective functional scales and fluoroscopic lateral images of both the right and left ankles were recorded. The distance from the anterior margin of the distal tibia to the anterior margin of the distal fibula was measured in millimeters. Nonparametric statistics were used to assess the relationship between fibular position and CAI status. Results: There were significant differences between the CAI and control group ankles (P = .045) and within the involved and uninvolved sides of the CAI group (P = .006). Those with CAI had a significantly more anterior fibular position on their involved ankle in relation to their uninvolved limb, and the ankles of the control group. Conclusions: The fibula was positioned significantly more anterior in relation to the tibia in subjects with unilateral CAI. It is unclear if repetitive bouts of ankle instability caused the anterior fibular position or if the more anterior position was a predisposing factor to injury.

J Orthop Sports Phys Ther. 2006;36(1):3-9. doi:10.2519/jospt.2006.2153

Key Words: ankle sprain, fibula, fluoroscopy, tibiofibular joint

Study Design: Case control study. Objectives: The objectives of this study are: (1) to perform factor analyses on data from the 8 components of the star excursion balance test (SEBT) in subjects with and without chronic ankle instability (CAI) in an effort to reduce the number of components of the SEBT, (2) to assess the relationships between performance of the different reach directions using correlation analyses, and (3) to determine which components of the SEBT are most affected by CAI. Background: The SEBT is a series of 8 lower-extremity–reaching tasks purported to be useful in identifying lower extremity functional deficits. Methods and Measures: Forty-eight young adults with unilateral CAI (22 males, 26 females; mean ± SD age, 20.9 ± 3.2 years; mean ± SD height, 173.6 ± 11.1 cm; mean ± SD mass, 80.1 ± 22.1 kg) and 39 controls (23 males, 16 females; mean ± SD age, 20.7 ± 2.4 years; mean ± SD height, 174.1 ± 12.9 cm; mean ± SD mass, 75.1 ± 18.6 kg) performed 3 trials of the 8 tasks with each of their limbs. Separate exploratory factor analyses were performed on data for involved limbs of the CAI group, uninvolved limbs of the CAI and control groups, and both limbs of the CAI and control groups. Pearson product moment correlations were calculated to identify the relationships between the different reach directions. A series of eight 2 × 2 analyses of variance were calculated to determine the influence of group (CAI, control) and side (involved, uninvolved) on performance of the 8 tasks. Results: For all 3 factor analyses, only 1 factor in each analysis produced an eigenvalue greater than 1 and the posteromedial reach score was the most strongly correlated task with the computed factor (α>.90), although all 8 tasks produced alpha scores greater than .67. Bivariate correlations between specific reach directions ranged from .40 to .91. Subjects with CAI reached significantly less on the anteromedial, medial, and posteromedial directions when balancing on their involved limbs compared to their uninvolved limbs and the side-matched limbs of controls. Conclusions: The posteromedial component of the SEBT is highly representative of the performance of all 8 components of the test in limbs with and without CAI. There is considerable redundancy in the 8 tasks. The anteromedial, medial, and posteromedial reach tasks may be used clinically to test for functional deficits related to CAI in lieu of testing all 8 tasks. There is a need for a hypothesis-driven study to confirm the results of this exploratory study.

J Orthop Sports Phys Ther. 2006;36(3):131-137. doi:10.2519/jospt.2006.2103 

Key Words: dynamic postural control, functional testing, lower extremity