Effects of soft and semi-rigid ankle orthoses on postural sway in people with and without functional ankle instability

Gait and muscle activity measures after biomechanical device therapy in subjects with ankle instability: A systematic review

INTRODUCTION

Health specialists suggest a conservative approach comprising non-pharmacological interventions as the initial course of action for individuals with repetitive ankle sprain due to ankle instability. This systematic review aimed to assess the effectiveness of biomechanical devices (Foot Orthoses, Ankle Orthoses, and Taping) on gait and muscle activity in individuals with ankle instability.

METHODS

A systematic search was performed on electronic databases, including PubMed, EMBASE, Clinical Trials.gov, Web of Science, and Scopus. The PEDro scoring system was used to evaluate the quality of the included studies. We extracted data from population, intervention, and outcome measures.

RESULTS

In the initial search, we found 247 articles. After following the steps of the PRISMA flowchart, only 22 reports met the inclusion criteria of this study. The results show that biomechanical device therapy may increase swing time, stance time, and step. Additionally, studies suggest that these devices can reduce plantar flexion, inversion, and motion variability during gait. Biomechanical devices have the potential to optimize the subtalar valgus moment, push-off, and braking forces exerted during walking, as well as enhance the activity of specific muscles including the peroneus longus, peroneus brevis, tibialis anterior, gluteus medius, lateral gastrocnemius, rectus femoris, and soleus.

CONCLUSION

Biomechanical devices affect gait (spatiotemporal, kinetic, and kinematic variables) and lower limb muscle activity (root mean square, reaction time, amplitude, reflex, and wave) in subjects with ankle instability.

Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis

BACKGROUND

Chronic ankle instability (CAI) is manifested by sensorimotor impairments in the sprained ankle, including deficits in sensation, motor function, and central integration or processing. These impairments have a significant impact on physical activities and daily life. Recently, some studies have suggested that bilateral deficits were observed in unilateral CAI, but contradictory evidence disputes this finding. Therefore, the objective of this study was to investigate whether bilateral sensorimotor deficits presented in individuals with unilateral CAI.

METHODS

Without language restriction, the following databases were retrieved from database inception up until 3 November 2023, including PubMed, WOS, EMBASE, Cochrane, SPORTDiscus and CINAHL. Case-control and cross-sectional studies that investigated bilateral sensorimotor functions in individuals with unilateral CAI were included. Sensorimotor functions contained static and dynamic balance, functional performance, muscle strength and activation, as well as sensation. Outcome measures contained centre-of-pressure parameters, normalised reach distance, activation time and magnitude of muscle, sensory errors and threshold. The risk of bias and quality assessment of included studies were evaluated using a standardised tool recommended by the Cochrane Collaboration and the Epidemiological Appraisal Instrument, respectively. To explore the potential bilateral deficits associated with unilateral CAI, a comprehensive meta-analysis was conducted using Review Manager version 5.4. The analysis compared the injured limb of unilateral CAI with healthy controls and the uninjured limb with healthy controls. The main focus of this study was to investigate the differences between the uninjured limb and healthy controls. A random-effects model was employed and effect sizes were estimated using the standardised mean difference (SMD) with 95% confidence intervals (CIs). Effect sizes were deemed as weak (0.2-0.5), moderate (0.5-0.8), or large (> 0.8).

RESULTS

A total of 11,442 studies were found; 30 studies were contained in the systematic review and 20 studies were included in the meta-analysis. Compared with healthy controls, those with unilateral CAI presented weak to moderate impairments in their uninjured limbs in static balance with eyes open (SMD = 0.32, 95% CI: 0.08 to 0.56), functional performance (SMD = 0.37; 95% CI: 0.08 to 0.67), kinesthesia (SMD = 0.52; 95% CI: 0.09 to 0.95) and tibialis anterior activation (SMD = 0.60, 95% CI: 0.19 to 1.01). There were no significant differences in other comparisons between the uninjured limb and healthy controls.

CONCLUSIONS

Patients with unilateral CAI may present bilateral deficits in static balance with eyes open, functional performance and kinaesthesia. However, further evidence is required to confirm this point due to limited studies included in some analyses and small effect size.

REGISTRATION

The protocol was registered in the International Prospective Register of Systematic Reviews platform (CRD: 42,022,375,855).

Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis

CONTEXT

Postural control deficits arising from injured ankles are central to chronic ankle instability (CAI) and its persistent symptoms. This is usually measured by recording the center of pressure (CoP) trajectory during static single-leg stance using a stable force plate. However, existing studies have produced conflicting results on whether this mode of measurement adequately reveals the postural deficits in CAI.

OBJECTIVE

To determine whether postural control during static single-leg stance is impaired in CAI patients when compared with uninjured healthy controls.

DATA SOURCES

Literature databases, PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus, were searched from inception to April 1, 2022, using ankle-, injury-, and posture-related terms.

STUDY SELECTION

Two authors independently performed the step-by-step screening of article titles, abstracts, and full texts to select peer-reviewed studies investigating CoP trajectory during static single-leg stance using a stable force plate in CAI patients and healthy controls. A total of 13,637 studies were reviewed, and 38 studies (0.003%) met the selection criteria.

STUDY DESIGN

Meta-analyses of descriptive epidemiological study.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

CoP parameters, sway directions, visual condition, and numerical data (means and standard deviations) were extracted.

RESULTS

The injured ankles of CAI patients had higher standard deviations of sway amplitude in both anterior-posterior and medial-lateral directions (standardized mean difference [SMD] = 0.36 and 0.31, respectively) under conditions of open eyes than controls. Higher mean sway velocity in anterior-posterior, medial-lateral, and total directions (SMD = 0.41, 0.37, and 0.45, respectively) with closed eyes was also found.

CONCLUSION

CAI patients had deficits of postural control during static single-leg stance, and these deficits were identified by the CoP trajectory. Further methodological explorations of CoP parameters and corresponding test conditions are required to enhance the sensitivity and reliability of postural deficit assessments in CAI using force plates.

Effects of Ankle Orthoses, Taping, and Insoles on Postural Stability of Individuals with Chronic Ankle Instability: A Systematic Review

Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and diminished function. Foot and ankle external supports are commonly used in clinical practice and research for treating CAI. This systematic review aimed to assess the effects of foot and ankle external supports on the postural stability of individuals with CAI to guide clinical practice and inform future research. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases from 1 January 2012 to 1 November 2022. Eighteen studies involving individuals with CAI were chosen in this systematic review. The quality of the included studies and risk of bias were assessed using Cochrane Collaboration's tool for randomized controlled trials, the Newcastle-Ottawa Scale for case-control studies, and the DELPHl-list for crossover trial studies. The external supports included in this review were ankle orthoses (elastic, semi-rigid, and active orthoses), taping (kinesiotaping and fibular reposition taping), and insoles (textured and supportive insoles). The outcome measures included static and dynamic postural stability tests, such as the single-leg stance test, star excursion balance test, Y-balance test, single-leg landing test, lateral jump test, walking test, and running test. The results showed that elastic orthoses, Kinesiotaping, and textured insoles demonstrated potential benefits in improving postural stability in individuals with CAI. Elastic orthoses decreased ankle joint motion variability, kinesiotaping facilitated cutaneous receptors and proprioceptive feedback, while textured insoles increased tactile stimulation and foot position awareness. However, the effects of semi-rigid orthoses, fibular reposition taping, and arch support insoles were inconsistent across studies. Future research should explore the long-term effects of these external supports, analyze the effects of different characteristics and combinations of supports, and employ standardized outcome measures and testing protocols for assessing postural stability.

In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report

We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.

Effects of Kinesiotape vs Soft and Semirigid Ankle Orthoses on Balance in Patients With Chronic Ankle Instability: A Randomized Controlled Trial

BACKGROUND

Chronic ankle instability (CAI) is a frequent complication of ankle sprain that may be associated with long-term consequences. Although taping and bracing are common interventions that are widely used by clinicians and athletic trainers for patients with CAI, no studies have compared the effects of kinesiotaping and bracing on balance performance in these patients. The present study aimed to compare the effects of ankle kinesiotaping, a soft ankle orthosis, and a semirigid ankle orthosis on balance performance in patients with CAI.

METHODS

Sixty patients with CAI were randomly assigned to 4 groups that received kinesiotaping, a soft orthosis, a semirigid orthosis, or no treatment (control group). Dynamic and static balance were measured with the modified Star Excursion Balance Test, single leg hop test, and single leg stance test before and after a 4-week intervention period.

RESULTS

Significant between-group differences were seen in all evaluated outcomes (P ≤ .003). The lowest reach distances in all directions in the modified Star Excursion Balance Test were found in the control group, and these patients also had a significantly shorter measured distance in the single leg hop test, and more errors in the single leg stance test compared with the 3 intervention groups. No significant differences were found among the 3 intervention groups.

CONCLUSION

Use of kinesiotaping and a soft or a semirigid ankle brace for 4 weeks were all beneficial in improving static and dynamic balance in individuals with CAI. None of the interventions was superior to the other 2.

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

Effects of Different Ankle Supports on the Single-Leg Lateral Drop Landing Following Muscle Fatigue in Athletes with Functional Ankle Instability

Background: Ankle support has been utilized for athletes with functional ankle instability (FAI), however, its effect on the landing performance during muscle fatigue is not well understood. This study aimed to examine the effects of ankle supports (ankle brace vs. Kinesio tape) on athletes with FAI following fatigued single-leg landing. Methods: Thirty-three young FAI athletes (CAIT scores < 24) were randomly allocated to control (Cn), ankle brace (AB) and Kinesio tape (KT) groups. All athletes performed single-leg lateral drop landings following ankle fatigue protocol. The fatigue-induced changes in kinetic parameters were measured among three groups. Results: A significant increase in peak vertical ground reaction force (vGRF) was found in the AB group (0.12% body weight (BW)) compared to that of the KT (0.02% BW) and Cn (median = 0.01% BW) groups. Significant decrease in both COP medial-lateral (ML) and anterior-posterior (AP) ranges were also found in the KT group (median = −0.15% foot width (FW) & median = −0.28% foot length (FL)) than those of the Cn group (median = 0.67% FW& median = 0.88% FL). Conclusions: Ankle braces might hamper the ability to absorb the impact force during landing. On the other hand, Kinesio tape might be beneficial for the postural control during landing.

Comparison of the Effect of the Combined Mechanism Ankle Support on Static and Dynamic Postural Control of Chronic Ankle Instability Patients

BACKGROUND

Chronic ankle instability (CAI) is associated with postural control impairment. Orthotic devices are routinely used to improve postural control of CAI patients and prevent recurrence of ankle sprain. This study aimed to evaluate and compare the effect of combined mechanism ankle support (CMAS) with soft ankle support (SAS) and custom-molded foot orthosis (CFO) on static and dynamic postural control in patients with CAI.

METHODS

Twenty-two patients with CAI and 22 matched healthy subjects were recruited. The participants were evaluated in four orthotic conditions (without orthosis and with the CMAS, SAS, and CFO). Static balance was investigated in single-limb stance on the force platform, and dynamic balance was assessed using the Star Excursion Balance Test (SEBT).

RESULTS

Statistically significant differences were found for the main effects of the groups in all center of pressure (COP) parameters and reach distances in medial (M), anteromedial (AM), and posteromedial (PM) directions of the SEBT ( P < .05). The main effect of the orthotics for all evaluated parameters, except reach distance in the PM direction, was statistically different. All COP parameters were significantly lower with the CMAS compared with other orthotic conditions in CAI patients. Also, the higher reach distances with the CMAS were obtained in the AM and M directions of the SEBT.

CONCLUSION

The CMAS improved impaired postural control in static and dynamic stability tests, but no similar effect was found for SAS and CFO. This result may have implications for the best bracing for CAI.

LEVEL OF EVIDENCE

Level II, comparative study.

The influence of wearing ski-boots with different rigidity characteristics on postural control

External supports that reduce ankle joint mobility such as ski-boots can impair postural control of healthy participants. Although this disruptive effect has been attributed to the rigidity of the external supports, the results remained controversial and no study has been conducted in order to evaluate the influence of ski-boots rigidity. Hence, the question about the influence of ankle support rigidity on postural control remains open. This study was therefore undertaken in order to investigate the effect of ski-boots rigidity on postural control. Ten healthy active participants were recruited. The wearing of soft and rigid ski-boots was compared to barefoot while standing on a seesaw generating mediolateral and anteroposterior instability. Centre of pressure displacements were sampled with a force platform. The surface electromyographic activity of the main muscles from the leg, thigh and trunk was recorded. A motion analysis system was also used to calculate the ankle, knee and hip angles. The results did not reveal any negative influence of ski-boot rigidity on postural control but rather suggest a less active postural control with the rigid ski-boots which offered a higher mechanical contribution.

Does the lower extremity alignment affect the risk of falling?

Objectives

This study aims to investigate the effects of knee and foot alignments on the risk of falling.

Patients and methods

Between April 2016 and December 2016, a total of 74 individuals (24 males, 50 females; mean age 32.2±4.9 years; range 18 to 65 years) were included in the study. The knee Q angle and Chippaux-Smirak Index (CSI), Arch Index, and foot progression angle (FPA) evaluated by pedobarography were used for the assessment of the lower extremity alignment. The fall risk was evaluated by the Fall Index, Fourier 56 Index (F56), and Stability Index.

Results

The fall index was found to be correlated with the Q angle, CSI, the Arch index, and FPA (p<0.05). Q angle, Arch Index, and FPA which were explained 40% of the variance of the fall index. The Q angle was correlated with F56 and the stability index at the most position (p<0.05). The CSI was correlated with the F56 and the stability index at two and three positions, respectively (p<0.05); however, the Arch Index and FPA were not correlated with the F56 and Stability Index at any of the eight positions (p>0.05). According to the categorical regression analysis, the Q angle was the most effective on the F56 and Stability Index.

Conclusion

Our study results suggest that lower extremity malalignment increases the risk of falling. We believe that the risk of falling can be decreased by the reduction of these malalingments and, thus, mortality and morbidity associated with the fall can be reduced as well.

Effects of different lower-limb sensory stimulation strategies on postural regulation-A systematic review and meta-analysis

Systematic reviews of balance control have tended to only focus on the effects of single lower-limb stimulation strategies, and a current limitation is the lack of comparison between different relevant stimulation strategies. The aim of this systematic review and meta-analysis was to examine evidence of effects of different lower-limb sensory stimulation strategies on postural regulation and stability. Moderate- to high- pooled effect sizes (Unbiased (Hedges’ g) standardized mean differences (SMD) = 0.31–0.66) were observed with the addition of noise in a Stochastic Resonance Stimulation Strategy (SRSS), in three populations (i.e., healthy young adults, older adults, and individuals with lower-limb injuries), and under different task constraints (i.e., unipedal, bipedal, and eyes open). A Textured Material Stimulation Strategy (TMSS) enhanced postural control in the most challenging condition—eyes-closed on a stable surface (SMD = 0.61), and in older adults (SMD = 0.30). The Wearable Garments Stimulation Strategy (WGSS) showed no or adverse effects (SMD = -0.68–0.05) under all task constraints and in all populations, except in individuals with lower-limb injuries (SMD = 0.20). Results of our systematic review and meta-analysis revealed that future research could consider combining two or more stimulation strategies in intervention treatments for postural regulation and balance problems, depending on individual needs.

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability

BACKGROUND

Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients.

OBJECTIVES

The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients.

STUDY DESIGN

Cross-sectional study.

METHODS

An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform.

RESULTS

The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support.

CONCLUSION

The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

A soft ankle brace increases soleus Hoffman reflex amplitude but does not modify presynaptic inhibition during upright standing

External ankle supports, such as ankle braces, may improve postural stability by stimulating cutaneous receptors. It remains unknown whether these supports have an effect on the posture central regulation. The aim of this study was to determine the effect of wearing a soft ankle brace on soleus H-reflex amplitude and presynaptic inhibition during standing. Sixteen subjects stood on a rigid floor with their eyes opened, either barefoot or wearing a soft ankle brace. H-reflex amplitude was measured on the soleus muscle by stimulating the tibial nerve electrically. Modulation of presynaptic inhibition was assessed by conditioning the H-reflex with fibular nerve (D1 inhibition) and femoral nerve (heteronymous facilitation) electrical stimulations. The unconditioned H-reflex amplitude was significantly greater when wearing the ankle brace than barefoot, whereas D1 and HF conditioned soleus H-reflex did not differ significantly between bracing conditions. These results suggest that the ankle brace increased the soleus motoneuron excitability without altering presynaptic mechanisms, potentially because of increased cutaneous mechanoreceptors afferent signals provided by the soft ankle brace.

Extended use of Kinesiology Tape and Balance in Participants with Chronic Ankle Instability

CONTEXT

Participants with chronic ankle instability (CAI) have been shown to have balance deficits related to decreased proprioception and neuromuscular control. Kinesiology tape (KT) has been proposed to have many benefits, including increased proprioception.

OBJECTIVE

To determine if KT can help with balance deficits associated with CAI.

DESIGN

Cohort study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty participants with CAI were recruited for this study.

INTERVENTION(S)

Balance was assessed using the Balance Error Scoring System (BESS). Participants were pretested and then randomly assigned to either the control or KT group. The participants in the KT group had 4 strips applied to the foot and lower leg and were instructed to leave the tape on until they returned for testing. All participants returned 48 hours later for another BESS assessment. The tape was then removed, and all participants returned 72 hours later to complete the final BESS assessment.

MAIN OUTCOME MEASURE(S)

Total BESS errors.

RESULTS

Differences between the groups occurred at 48 hours post-application of the tape (mean difference = 4.7 ± 1.4 errors, P < .01; 95% confidence interval = 2.0, 7.5) and at 72 hours post-removal of the tape (mean difference = 2.3 ± 1.1 errors, P = .04; 95% confidence interval = 0.1, 4.6).

CONCLUSIONS

The KT improved balance after it had been applied for 48 hours when compared with the pretest and with the control group. One of the most clinically important findings is that balance improvements were retained even after the tape had been removed for 72 hours.

Difference in postural control between patients with functional and mechanical ankle instability

BACKGROUND

Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI).

METHODS

Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups.

RESULTS

The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision.

CONCLUSIONS

Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people.

CLINICAL RELEVANCE

As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training should also include the contralateral side after a unilateral ankle ligament injured.

Developing a framework for ankle function: a delphi study

CONTEXT

Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed.

OBJECTIVE

To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques.

DESIGN

Delphi study.

SETTING

Telephone interviews and electronic surveys.

PATIENTS OR OTHER PARTICIPANTS

Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists.

DATA COLLECTION AND ANALYSIS

A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded.

RESULTS

The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon.

CONCLUSIONS

Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its characteristics, or the preferred use of the terms FAI and CAI, our findings provide progress toward establishing consistency in those concepts.

Differences in proprioception, muscle force control and comfort between conventional and new-generation knee and ankle orthoses

The aim of this study was to compare muscle force control and proprioception between conventional and new-generation experimental orthoses. Sixteen healthy subjects participated in a single-blind controlled trial in which two different types of orthosis were applied to the dominant knee or ankle, while the following variables were evaluated: muscle force control (accuracy), joint position sense, kinesthesia, static balance as well as subjective outcomes. The use of experimental orthoses resulted in better force accuracy during isometric knee extensions compared to conventional orthoses (P=0.005). Moreover, the use of experimental orthoses resulted in better force accuracy during concentric (P=0.010) and eccentric (P=0.014) ankle plantar flexions and better knee joint kinesthesia in the flexed position (P=0.004) compared to conventional orthoses. Subjective comfort (P<0.001) and preference scores were higher with experimental orthoses compared to conventional ones. In conclusion, orthosis type affected static and dynamic muscle force control, kinesthesia, and perceived comfort in healthy subjects. New-generation experimental knee and ankle orthoses may thus be recommended for prophylactic joint bracing during physical activity and to improve the compliance for orthosis use, particularly in patients who require long-term bracing.

The effect of lateral or medial wedges on control of postural sway in standing

The objective of this study was to evaluate the effects of lateral and medial wedges on postural sway. Twenty healthy volunteers (mean age range of 28.45±3.34) participated in the study. They stood barefoot with eyes open or closed on each of the three surfaces: 10° lateral wedges, 10° medial wedges, and no wedges. Force platform data were collected and the mean and root mean square (RMS) distance, range, and velocity and the mean frequency of the center of pressure (COP) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Standing on both lateral and medial wedges was associated with improved postural stability seen through the decreased mean and RMS distance of COP displacement in ML direction. The results of this study suggest that standing on either lateral or medial wedges might enhance postural control in standing.

Effects of prefabricated ankle orthoses on postural stability in basketball players with chronic ankle instability

Purpose

Ankle sprain is one of the most common injuries among athletes and instability and injury to this joint is responsible for long time loss of physical and recreational activity. Also, it can impose high costs to sport teams. Prevention of this injury is an important concern of practice and rehabilitation. One way of reducing the possibility of ankle joint injury is using an ankle orthosis. The present study aimed at inspecting the effects of two ankle orthoses on dynamic and semi-dynamic postural stability in athletes with chronic ankle instability (CAI).

Methods

Twenty basketball players with CAI and fifteen non-injured athletes volunteered to participate in this study. Biodex Balance System was used to assess the participants’ postural stability in bilateral position at level 8 and level 2. Repeated measures analysis of variance (ANOVA) was performed in order to examine the effects of ankle orthoses. Statistical significance level was determined at P< 0.05.

Results

Statistical analyses revealed the significant effect of ankle supports on dynamic and semi-dynamic postural stability in the two groups and results indicated there wasn't significant difference between groups.

Conclusions

According to our results the orthoses improved both dynamic and semi-dynamic postural stability. Therefore, orthoses can prevent injury and its reoccurrence.

Effect of ankle-foot orthosis on postural control after stroke: a systematic review

INTRODUCTION

Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke.

DEVELOPMENT

The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance.

CONCLUSIONS

Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution.