Rehabilitation of ligamentous ankle injuries: a review of recent studies

Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study

Background

Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence.

Objective

We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains.

Methods

We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction.

Results

In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability.

Conclusions

Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions.

Trial Registration

ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022

Return to Play After a Lateral Ligament Ankle Sprain

Purpose of Review

The purpose of this review is to describe the current evidence on the most common sports-related ankle injuries. Joint anatomy, epidemiology, clinical findings, diagnostic approach, and treatment are presented with a specific focus on the available evidence towards return to play.

Recent Findings

Recent findings show that ankle sprain is the most common injury in the world of sports. Bony fractures, cartilage defects, and syndesmotic lesions are frequently seen in association with the more severe type of ankle sprains.

Summary

In summary, the majority of the athletes’ ankle sprains are managed conservatively with excellent outcomes and full return to their pre-injury level of play. However, it is essential to differentiate the single ligament sprain from a more complex injury to the ankle joint. The evidence-based treatment and rehabilitation programmes are associated with a better prognosis and a faster time to return to sport participation.

Shape Memory Ankle-Foot Orthoses

Electrically actuated ankle-foot orthoses (AFOs) were designed and prototyped using shape memory textile composites. Acrylic copolymers were synthesized as the matrix to demonstrate shape memory effects, whereas electrothermal fabrics were embedded to generate uniform heat as a trigger. Superior to conventional polymeric orthoses, shape memory AFOs (SM-AFOs) could be repeatedly programmed at least 20 times with stable shape fixity and recovery. Evidenced by clinical practice, SM-AFOs were effectively actuated at 10 V, allowing the correction of ankle angles with 10° plantarflexion. Ultimately, we envision a smart orthopedic system that can advance progressive rehabilitation with manipulation under safe and convenient conditions.

Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial

OBJECTIVE

 To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains.

DESIGN

 A randomised controlled trial of 503 participants followed for six months.

SETTING

 Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada.

PARTICIPANTS

 The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol.

INTERVENTION

 Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy.

MAIN OUTCOME MEASURES

 The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months.

RESULTS

 The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score.

CONCLUSIONS

 In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BACKGROUND

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports.

OBJECTIVE

To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI.

DESIGN

Overview of intervention systematic reviews.

PARTICIPANTS

Individuals with acute ankle sprain/CAI.

MAIN OUTCOME MEASUREMENTS

The primary outcomes were injury/reinjury incidence and function.

RESULTS

46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains.

CONCLUSIONS

For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.

ANKLE JOINT CONTROL DURING SINGLE-LEGGED BALANCE USING COMMON BALANCE TRAINING DEVICES - IMPLICATIONS FOR REHABILITATION STRATEGIES

BACKGROUND

A lateral ankle sprain is the most prevalent musculoskeletal injury in sports. Exercises that aim to improve balance are a standard part of the ankle rehabilitation process. In an optimal progression model for ankle rehabilitation and prevention of future ankle sprains, it is important to characterize different balance exercises based on level of difficulty and sensori-motor training stimulus.

PURPOSE

The purpose of this study was to investigate frontal-plane ankle kinematics and associated peroneal muscle activity during single-legged balance on stable surface (floor) and three commonly used balance devices (Airex®, BOSU® Ball and wobble board).

DESIGN

Descriptive exploratory laboratory study.

METHODS

Nineteen healthy subjects performed single-legged balance with eyes open on an Airex® mat, BOSU® Ball, wobble board, and floor (reference condition). Ankle kinematics were measured using reflective markers and 3-dimensional recordings and expressed as inversion-eversion range of motion variability, peak velocity of inversion and number of inversion-eversion direction changes. Peroneus longus EMG activity was averaged and normalized to maximal activity during maximum voluntary contraction (MVC), and in addition amplitude probability distribution function (APDF) between 90 and 10% was calculated as a measure of muscle activation variability.

RESULTS

Balancing on BOSU® Ball and wobble board generally resulted in increased ankle kinematic and muscle activity variables, compared to the other surfaces. BOSU® Ball was the most challenging in terms of inversion-eversion variability while wobble board was associated with a higher number of inversion-eversion direction changes. No differences in average muscle activation level were found between these two surfaces, but the BOSU® Ball did show a more variable activation pattern in terms of APDF.

CONCLUSION

The results showed large kinematic variability among different balance training devices and these differences are also reflected in muscle activation variability. The two most challenging devices were BOSU® Ball and Wobble board compared to Airex® and floor. This study can serve as guidance for clinicians who wish to implement a gradual progression of ankle rehabilitation and prevention exercises by taking the related ankle kinematics and muscle activity into account.

LEVEL OF EVIDENCE

Level 3.

Utilization of mobilization with movement for an apparent sprain of the posterior talofibular ligament: a case report

Ankle sprains are a common injury. According to the National Electronic Injury Surveillance System (NEISS), an estimated 630,891 ankle sprains occurred in 2009 (CPSC, 2011). The anterior talofibular ligament (AFTL) is frequently sprained as a result of a plantarflexion-inversion injury. Sometimes the calcaneofibular ligament or posterior talofibular ligament (PTFL) is also sprained (Komenda and Ferkel, 1999). The patient in this study presented with lateral ankle pain reproducible by passive plantarflexion and eversion, complaining of pain during exercise and playing sports. These findings are consistent with a sprain of the PTFL. Positional faults have also been shown to occur at tibiofibular joint, mimicking the symptoms of an ankle sprain. Brian Mulligan first hypothesized the occurrence of positional faults at the ankle. He developed a Mobilization with Movement (MWM) technique to treat these positional faults. Mulligan also hypothesized that a similar positional fault could occur in a posterior direction mimicking a sprain of the PTFL (Mulligan, 2010, p. 71, 96-97). The purpose of this case study is to present a patient with an apparent posterior talofibular ligament sprain who responded to an anterior glide MWM of the fibula. The two measurements used to assess function and pain were the Foot and Ankle Ability Measure (FAAM) and a 10-point numeric pain scale. Each measure was conducted prior to treatment, after treatment was discontinued, 6 months post treatment and 12 months post treatment. A positive response was achieved, as her symptoms were reduced and she was able return to her prior level of function.

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician.

Anatomical review of the lateral collateral ligaments of the ankle: a cadaveric study

Arrangements of the lateral collateral ligaments of the ankle are complex. Injuries to these ligaments can occur in the inverted planter flexed position of the ankle. Traditionally, the anterior talofibular ligament (ATFL) is the first ligament involved in such ankle injuries. We reviewed the anatomical arrangements of the lateral ankle. Twenty ankles from ten Caucasian cadavers were carefully dissected. Length and width of each ligament were measured in neutral, dorsiflexion and plantar flexion. The angle between the ATFL and other ligaments was also recorded. ATFL was present in 95% of ankles dissected. Five ankles showed two slip configuration of the ATFL. One ATFL was noted as being significantly thicker and another one was significantly narrow. Mean length of the ATFL in neutral was 15.5 mm (range 10-21 mm), which increased in plantar flexion to 18 mm (range 11-25 mm) and decreased slightly in dorsiflexion to 14.5 mm (range 10-19 mm). The calcaneofibular ligament was present in all dissections and had a mean measurement of 18.5 mm in neutral (range 14-23 mm) decreasing to 17 mm in planter flexion and 15.5 mm in dorsiflexion. Treating ligamentous ankle injuries can be very costly, thus creating a large economic burden to both patients and health institutions. Understanding the anatomical characteristics of the lateral collateral ligament complex of the ankle provides the basic foundation for understanding injuries and helps to clinically manage such injuries appropriately.

Distinctive pain course during first year after total ankle arthroplasty: a prospective, observational study

BACKGROUND

Patients and health care professionals alike are often surprised by the course of pain after total ankle arthroplasty (TAA). The current study aimed to determine the baseline patterns of postoperative symptoms during the first year following uncomplicated TAA.

MATERIALS AND METHODS

In a prospective observational study 28 patients with unilateral posttraumatic osteoarthritis were tested for pain with a visual analogue scale, swelling (min grade, 0; max grade, 4), ankle range of motion, and AOFAS ankle score. Assessments were performed preoperatively and 6 weeks, 3, 6, 9, and 12 months after TAA.

RESULTS

At 6 weeks all variables had improved significantly. However, at 3 months a relapse with deterioration of mean variables was found. These improved asymptotically during assessments at 6, 9, and 12 months.

CONCLUSION

Our data suggest patients undergoing uncomplicated TAA have to overpass what we believe is an adaptive inflammatory phase with increased periarticular pain and swelling about 3 months after surgery. This distinctive course may influence patient education and increase confidence of healthcare professionals involved in the rehabilitation of TAA patients.

Effect of a plaster containing DHEP and heparin in acute ankle sprains with oedema: a randomized, double-blind, placebo-controlled, clinical study

OBJECTIVE

Ankle sprains are the most frequent injuries in sport and daily life, and are usually treated with anti-inflammatory drugs or compounds that have an effect on microcirculation. The efficacy and tolerability of a novel plaster containing both diclofenac epolamine (DHEP) and heparin in the treatment of acute painful ankle sprains with oedema was investigated in a randomized, double-blind, placebo-controlled study.

RESEARCH DESIGN AND METHODS

This study, carried out in 32 French medical centres, enrolled 233 patients (148 male and 86 female, aged 18-65 years) with an ankle sprain that had occurred within the previous 48 hours. Patients were treated once daily with DHEP heparin or placebo plaster for 7 days.

MAIN OUTCOME MEASURES

Reduction in ankle joint swelling measured by submalleolar circumference was the primary efficacy endpoint; secondary endpoints were pain (at rest, in active mobilization, by passive stretch and by pressure), functional disability and global judgement of efficacy and tolerability.

RESULTS

DHEP heparin-treated patients experienced a significantly greater reduction in joint swelling compared with placebo (p = 0.005). The reduction in pain was also in favour of DHEP heparin patients, with significantly lower pain in DHEP heparin-treated than placebo-treated patients within 3 hours of the first application (p < 0.05). Only two patients in the DHEP heparin plaster group and six in the placebo group experienced minor adverse events, all of which resolved spontaneously. By design, the study was limited to a placebo-controlled comparison, and there was no test for possible selection bias (subsequently ruled out by choice of efficacy parameters and measures) that may have resulted in a baseline imbalance between patient groups.

CONCLUSIONS

Results confirm the efficacy of DHEP heparin plaster compared with placebo for the treatment of painful ankle sprain with oedema. Prompt control of pain and oedema may shorten the time to initiation of a rehabilitation programme, thus reducing the risk of ankle disability recurrence and the development of chronic injury.

Plyometric training versus resistive exercises after acute lateral ankle sprain

BACKGROUND

Plyometric training is a widely used method to improve performance in healthy athletes. It is highly recommended in the late stage of rehabilitation of many lower limb injuries. However, its effects on muscle strength and function in management of lateral ankle sprain have not been reported. Therefore, the objective of the current study was to determine the effects of plyometric training versus resistive exercises on muscle strength and function following acute lateral ankle sprain.

MATERIALS AND METHODS

Twenty-two athletes (aged from 20 to 35 years) of both sexes with grade I or II unilateral inversion ankle sprain participated in the study (at least 3 weeks after acute injury). They were randomly assigned to two groups. The first group received plyometric training, whereas the second one received resistive training for 6 weeks. Isokinetic peak torque/body weight for invertors and evertors at 30 degrees/s and 120 degrees/s and functional tests were assessed before and after training.

RESULTS

Both plyometric and resistive training improve isokinetic evertor and invertor peak torques and functional performance of athletes p < 0.05. There were no significant differences between groups concerning peak torque/body weight for invertors and evertors at both speeds measured p > 0.05. The functional test measures of the plyometric group were significantly higher than that of resistive group.

CONCLUSION

Plyometrics were more effective than resistive exercises in improving functional performance of athletes after lateral ankle sprain.

Orthopaedic sport biomechanics - a new paradigm

This article proposes a new paradigm, "Orthopaedic sport biomechanics", for the understanding of the role of biomechanics in preventing and managing sports injury. Biomechanics has three main roles in this paradigm: (1) injury prevention, (2) immediate evaluation of treatment, and (3) long-term outcome evaluation. Related previous studies showing the approach in preventing and managing anterior cruciate ligament rupture and anterior talofibular ligament tear are highlighted. Orthopaedics and biomechanics specialists are encouraged to understand what they could contribute to the current and future practice of sports medicine.

Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review

QUESTIONS

Which intervention(s) best augment early mobilisation and external support after an acute ankle sprain? What is the most appropriate method of preventing re-injury?

DESIGN

A systematic review of randomised controlled trials published from 1993 to April 2005.

PARTICIPANTS

People with an acute ankle sprain.

INTERVENTION

Any pharmacological, physiotherapeutic, complementary or electrotherapeutic intervention added to controlled mobilisation with external support. Immobilisation, surgical intervention, and use of external ankle supports in isolation were excluded.

OUTCOMES

Pain, function, swelling, re-injury, and global improvement; assessed at short, intermediate, and long-term follow-up.

RESULTS

23 trials were included with a mean PEDro score of 6/10. There was strong evidence that non-steroidal anti-inflammatory drugs can reduce pain and improve short-term ankle function. There was moderate evidence that neuromuscular training decreases functional instability and minimises re-injury; and that comfrey root ointment decreases pain and improves function. There was also moderate evidence that manual therapy techniques improve ankle dorsiflexion. There was no evidence to support the use of electrophysical agents or hyperbaric oxygen therapy. Very few long-term follow-ups were undertaken, and few studies focused on preventing long-term morbidity.

CONCLUSIONS

Non-steroidal anti-inflammatory drugs, comfrey root ointment, and manual therapy can significantly improve short-term symptoms after ankle sprain, and neuromuscular training may prevent re-injury. More high quality studies are needed to develop evidence-based guidelines on ankle rehabilitation beyond the acute phases of injury management.

The role of fibular tape in the prevention of ankle injury in basketball: A pilot study

STUDY DESIGN

Prospective nonrandomized controlled trial.

OBJECTIVES

To determine the effect of fibular repositioning tape (FRT) on incidence and severity of ankle injury.

BACKGROUND

Pain and functional disability is common following ankle sprain and a major problem in sport. A novel method of taping, FRT, which has been described to prevent ankle sprain, requires less tape than traditional methods and is easier to apply. The objective of this study was to determine the effect of FRT on the incidence and severity of ankle injury in basketball.

METHODS AND MEASURES

One hundred twenty-five male basketball players were assigned at time of play to either the control (209 exposures) or FRT (224 exposures) condition in a manner of convenience. Control participants had the choice on the use and type of prophylaxis, excluding FRT. FRT participants were taped using the method described by Mulligan. Ankle injury data were collected after each exposure. Injury severity was determined by functional limitation, pain levels, and days to return to play.

RESULTS

Four hundred forty-three measured basketball exposures resulted in 11 ankle injuries. All injuries occurred in subjects with a history of previous ankle sprain. Significantly less ankle injuries were sustained by members of the FRT condition (n = 2), compared to members of the control condition (n = 9) (Fisher exact test, P = .03). The odds ratio of sustaining an ankle injury was 0.20 (P = .04; 95% confidence interval [CI]: 0.04, 0.93) when taped with FRT and the number needed to treat was 22 (95% CI, 12-312).

CONCLUSIONS

This study provides preliminary data regarding the prophylactic effects of FRT on ankle injury in male basketball players.

Management of acute ligament injuries of the ankle

Ligament injuries of the ankle are common and troublesome. Management may seem easy, but residual symptoms ae common. Grade III injuries still generate controversy in terms of the best management available, and more studies are needed when it comes to early mobilization, cast immobilization, or surgery. Even the three Cohrane reviews published to date are not conclusive.

Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review

This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.

Measurement and Evaluation of Dynamic Joint Stability of the Knee and Ankle After Injury

Injuries to the lower extremity, specifically the knee and ankle joints of the human body can occur in any athletic event and are most prevalent in sports requiring cutting and jumping manoeuvres. These joints are forced to rely on the dynamic restraints to maintain joint stability, due to the lack of bony congruence and the inability of the static restraints to handle the forces generated during functional tasks. Numerous variables (proprioception, postural control, electromyography, kinetics/kinematics, dynamic stability protocols) have been measured to better understand how the body maintains joint stability during a wide range of activities from static standing to dynamic cutting or landing from a jump. While the importance of dynamic restraints is not questioned, a recent impetus to conduct more functional or sport-specific testing has emerged and placed a great deal of emphasis on dynamic joint stability and how it is affected by lower extremity injuries. Evidence suggests that surgery and aggressive rehabilitation will not necessarily restore the deficits in dynamic joint stability caused by injury to the anterior cruciate ligament or lateral ankle ligaments. In today's athletic society, there is a major push to return athletes to play as quickly as possible. However, the ramifications of those decisions have not been fully grasped. If an athlete is not fully recovered, a quick return to play could start a vicious cycle of chronic injuries or permanent disability.

Evidence-based treatment of foot and ankle injuries in runners

Foot and ankle injuries are common in runners. Treatment is becoming more evidence-based for the most common of these conditions; however, further research is needed to determine the best treatments for injuries that are encountered less commonly.

Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains

BACKGROUND

Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear.

HYPOTHESIS

Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions.

RESULTS

A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05).

CONCLUSIONS

Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables.

CLINICAL RELEVANCE

Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.

Ankle and Foot Injuries in Pediatric and Adult Athletes

Foot and ankle injuries are among the most common in athletes.Differential diagnosis, imaging decisions, and treatment plan should be influenced by the age of the athlete. A thorough history and physical examination, with an understanding of the anatomy of the foot and ankle anatomy and the mechanism of injury, will give the best opportunity to make the correct diagnosis. For most athletes, the prognosis for returning to play after a foot or ankle injury is very good. The recipe for keeping our athletes healthy includes early intervention, undergoing proper rehabilitation, applying braces or orthotics when indicated, and preventing injuries when appropriate.