1
|
Maduka GC, Jakusonoka R, Maduka DC, Yusuf N. Conservative Management of Acute Lateral Ligaments of the Ankle Injuries: An Analytical Literature Review. Cureus 2023; 15:e47709. [PMID: 37965420 PMCID: PMC10641652 DOI: 10.7759/cureus.47709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
Injuries to the lateral ligaments of the ankle are among the most frequent sporting injuries. These injuries constitute a significant portion of all sports-related injuries. Nearly all cases involve damage to either the anterior talofibular ligament (ATFL) or the calcaneofibular ligament (CFL). While they are generally considered to be mild injuries, without adequate rehabilitation and treatment, these injuries often result in lingering symptoms for many patients for a period ranging from 6 weeks to 18 months. Subsequently, this analysis seeks to assess the non-surgical, conservative approaches currently employed in managing lateral ligament injuries of the ankle. Therefore, this assessment explores the variations and effectiveness of conservative treatment approaches based on the injury's severity and the mechanisms of trauma. The study conducted an analytical literature review that relied on diverse sources, including orthopedic books, e-books, articles, journals, and internet databases, to accomplish this. The main sources were obtained from reputable databases such as UpToDate, NCBI, and PubMed. Collectively, these sources provide definitions, outlines, evaluations, and discussions related to the topic. As such, they facilitated the formulation of an informed conclusion on the approach to treating lateral ligament injuries of the ankle complex. The reviewed literature shows that early and effective initial treatment involving pain management, prompt resumption of weight-bearing activities, limited immobilisation, and targeted physical therapy yields favorable outcomes for minor-grade sprains and is an effective preventive measure against recurrent injuries. Accordingly, athletes who experience regular ankle sprains should consider prophylactic bracing or taping to lower the risk of re-injury while enhancing their functionality. Notably, the existing functional and conservative management methods demonstrate and yield positive post-treatment outcomes. Nonetheless, the efficiency and effectiveness of these treatments depend on the specific nature of the injury and the unique traits of the individuals who sustain it. Consequently, these factors must be considered for when determining the appropriate treatment approach.
Collapse
Affiliation(s)
- Godsfavour C Maduka
- Trauma and Orthopaedics, Lister Hospital, East & North Herts National Health Service (NHS) Trust, Stevenage, GBR
| | | | - Divinegrace C Maduka
- Major Trauma, Queens Medical Centre-Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, GBR
| | - Naeem Yusuf
- Plastic Surgery, Lister Hospital, East & North Herts National Health Service (NHS) Trust, Stevenage, GBR
| |
Collapse
|
2
|
Tan YY, Nambiar M, Onggo JR, Hickey BA, Babazadeh S, Tay WH, Hsuan J, Bedi H. Tibio-Talar-Calcaneal Nail Fixation for Ankle Fractures: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 61:1325-1333. [PMID: 34802910 DOI: 10.1053/j.jfas.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/17/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
Unstable ankle fractures are traditionally treated with open reduction and internal fixation. An alternative surgical option is primary tibio-talar-calcaneal fusion. Our aims were to determine the indication, complication rates, and functional outcomes, of tibio-talar-calcaneal nailing when used as the primary treatment of ankle fractures. A multidatabase literature search was performed on December 14, 2019 according to PRISMA guidelines. All studies in the English language reporting complications and outcomes involving tibio-talar-calcaneal nailing for primary treatment of ankle fractures were included. Ten studies with 252 ankle fractures were included. Mean age of patients was 75.5 (32-101) years. Mean follow-up duration was 79 weeks (36-104 weeks). Surgical site infection occurred in 11.2% (95% confidence interval [CI] 6.3%-19%) of patients, implant failure occurred in 8.1% (95% CI 5%-12.8%) of patients, and unplanned return to operating room occurred in 10.1% (95% CI 6.1%-16.2%) of patients. There were no cases of wound dehiscence. All-cause mortality rate at the end of follow-up was 26.6% (95% CI 19.7%-34.9%). Average reduction in Olerud-Molander Ankle Score after surgery was 7.9 points (5.0-11.8). Eighty-one point five percent (95% CI: 67.4%-90.4%) of patients were able to return to similar preoperative mobility aid after surgery. Tibio-talar-calcaneal nailing is an alternative procedure for patients who have sustained fractures unsuitable for nonoperative management, but have low functional demands and at increased risks of complications after open reduction and internal fixation. About 81.5% (95% CI 67.4%-90.4%) of patients were able to return to a similar preinjury mobility status after tibio-talar-calcaneal nailing.
Collapse
Affiliation(s)
- Yong Yao Tan
- Medical Student, Department of Orthopaedic Surgery, Maroondah Hospital, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - Mithun Nambiar
- Registrar, Department of Orthopaedic Surgery, Maroondah Hospital, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - James Randolph Onggo
- Resident, Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Benjamin A Hickey
- Consultant Orthopaedic Foot and Ankle Surgeon, Department of Orthopaedic Surgery, Wrexham Maelor Hospital, Wrexham, Wales, United Kingdom
| | - Sina Babazadeh
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Wei Han Tay
- Consultant Orthopaedic Foot and Ankle Surgeon, Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Victoria, Australia, Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Janet Hsuan
- Consultant Orthopaedic Foot and Ankle Surgeon, Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Harvinder Bedi
- Consultant Orthopaedic Foot and Ankle Surgeon, Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| |
Collapse
|
3
|
Foster KS, Greenlee TA, Young JL, Janney CF, Rhon DI. How Common is Subsequent Posterior Tibial Tendon Dysfunction or Tarsal Tunnel Syndrome After Ankle Sprain Injury? J Knee Surg 2022; 35:1181-1191. [PMID: 35944572 DOI: 10.1055/s-0042-1751246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posterior tibial tendon dysfunction (PTTD) and tarsal tunnel syndrome (TTS) are debilitating conditions reported to occur after ankle sprain due to their proximity to the ankle complex. The objective of this study was to investigate the incidence of PTTD and TTS in the 2 years following an ankle sprain and which variables are associated with its onset. In total, 22,966 individuals in the Military Health System diagnosed with ankle sprain between 2010 and 2011 were followed for 2 years. The incidence of PTTD and TTS after ankle sprain was identified. Binary logistic regression was used to identify potential demographic or medical history factors associated with PTTD or TTS. In total, 617 (2.7%) received a PTTD diagnosis and 127 (0.6%) received a TTS diagnosis. Active-duty status (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.70-2.79), increasing age (OR 1.03, 95% CI 1.02-1.04), female sex (OR 1.58, 95% CI 1.28-1.95), and if the sprain location was specified by the diagnosis (versus unspecified location) and did not include a fracture contributed to significantly higher (p < 0.001) risk of developing PTTD. Greater age (OR 1.06, 95% CI 1.03-1.09), female sex (OR 2.73, 95% CI 1.74-4.29), history of metabolic syndrome (OR 1.73, 95% CI 1.03-2.89), and active-duty status (OR 2.28, 95% CI 1.38-3.77) also significantly increased the odds of developing TTS, while sustaining a concurrent ankle fracture with the initial ankle sprain (OR 0.45, 95% CI 0.28-0.70) significantly decreased the odds. PTTD and TTS were not common after ankle sprain. However, they still merit consideration as postinjury sequelae, especially in patients with persistent symptoms. Increasing age, type of sprain, female sex, metabolic syndrome, and active-duty status were all significantly associated with the development of one or both subsequent injuries. This work provides normative data for incidence rates of these subsequent injuries and can help increase awareness of these conditions, leading to improved management of refractory ankle sprain injuries.
Collapse
Affiliation(s)
- Kaitlyn S Foster
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Jodi L Young
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
| | - Cory F Janney
- Naval Medical Center San Diego, San Diego, California
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas.,Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
4
|
Vajapey SP, Harrison RK. Hook Plate Fixation of Medial Malleolar Fractures: A Comparative Study of Clinical Outcomes. J Foot Ankle Surg 2021; 59:969-971. [PMID: 32414648 DOI: 10.1053/j.jfas.2018.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 02/03/2023]
Abstract
Medial malleolar fractures, occurring in isolation or in bi- or trimalleolar fractures, require surgical fixation if there is any displacement. Several techniques have been described in the literature for open reduction and internal fixation of medial malleolar fractures, but no data exist on the functional outcomes after fixation with a hook plate. The objective of this review study was to compare complication and union rates in patients who underwent hook plate fixation of medial malleolar fractures to those who underwent fixation with 2 lag screws. A total of 31 patients were included in the study. They were all followed for a minimum of 6 months from the day of surgery. There was a 18% to 35% complication rate with this technique; however, there was no statistical difference in the complication rate between medial malleolar fracture fixation with hook plate versus 2 lag screws in our study. All patients in this study went on to have a successful union. Hook plate fixation is an acceptable alternative to medial malleolar fracture fixation, especially in patients at high risk for poor bone healing.
Collapse
Affiliation(s)
- Sravya P Vajapey
- Resident Physician, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ryan K Harrison
- Assistant Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
5
|
Jona James J, Al-Dadah O. Ankle injuries in athletes: A review of the literature. World J Meta-Anal 2021; 9:128-138. [DOI: 10.13105/wjma.v9.i2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/26/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
Ankle injuries are commonplace in the athletic population, with lateral ligament sprains accounting for the majority of them. The medial ligament complex, the distal tibiofibular syndesmosis as well as any of the bones that constitute the ankle joint can also be injured. Typical mechanisms of injury include inversion-plantarflexion and external rotation on a supinated, dorsiflexed or pronated foot. Lesions of the ankle present with similar symptoms of pain, swelling and tenderness. Therefore, a thorough history and physical examination must be obtained to make the correct diagnosis. This is especially critical for athletes as certain injuries can lead to termination of their career if not treated accurately on time. Imaging may be useful in some cases to confirm or rule out differential diagnoses. Most injuries can be managed conservatively using the Protection, Rest, Ice, Compression and Elevation protocol followed by a comprehensive rehabilitation programme. Surgery is reserved for grade III ligament tears that are refractory to initial non-operative treatment and displaced fractures that are unlikely to unite without surgical intervention. The objective of this review is to discuss the common ankle injuries encountered in the athletic population and the approaches to their diagnosis and management.
Collapse
Affiliation(s)
- Jenita Jona James
- The Medical School, Newcastle University, Newcastle-upon-Tyne NE2 4HH, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2 4HH, United Kingdom
| |
Collapse
|
6
|
Borra V, Berry DC, Zideman D, Singletary E, De Buck E. Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review. J Athl Train 2021; 55:789-800. [PMID: 32688372 DOI: 10.4085/1062-6050-0093.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Current prehospital recommendations for an acute closed extremity joint injury (ACEJI) are to apply compression in some manner. However, the effectiveness of compression is unclear. We performed a systematic review to summarize and synthesize the evidence for the use of a compression bandage for ACEJI in the prehospital setting. DATA SOURCES Cochrane Library, PubMed, and Embase were searched for relevant literature in November 2019. STUDY SELECTION Controlled trials involving adults in the prehospital setting with a recent ACEJI were included when compressive, nonimmobilizing interventions, feasible in a first aid setting, were applied and compared with no compression or any noncompressive intervention, such as braces, splints, or noncompressive stockings. Articles in all languages were included if an English abstract was available. DATA EXTRACTION Data on study design, study population, intervention, outcome measures, and methodologic quality were extracted from each included article. DATA SYNTHESIS Eight studies out of 1193 possibly relevant articles were included. All authors examined compression in the treatment of acute ankle sprains; no studies involved compression for the treatment of other ACEJIs. No difference in the major outcomes of pain reduction or swelling, ankle-joint function, or range of motion could be demonstrated. For the outcome of recovery time, no benefit was shown when comparing compression with no compression. Evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low certainty. CONCLUSIONS The evidence for the use of a compression wrap was limited to patients with closed ankle injuries. In this systematic review, we could not demonstrate either a beneficial or harmful effect from the application of a compression or elastic bandage compared with no compression or a noncompressive stocking, splint, or brace as a first aid treatment in the prehospital environment.
Collapse
Affiliation(s)
- Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium
| | - David C Berry
- Department of Kinesiology, College of Health and Human Services, Saginaw Valley State University, University Center, MI
| | | | - Eunice Singletary
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium.,Department of Public Health and Primary Care, KU Leuven, Belgium
| |
Collapse
|
7
|
Dangor S, Jayaraman-Pillay P, Maddocks S, Chetty V. Pre-operative physiotherapy following unilateral ankle fractures at a tertiary hospital in South Africa: Perceptions of patients and nurses. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1501. [PMID: 33604479 PMCID: PMC7876942 DOI: 10.4102/sajp.v77i1.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ankle fractures are a common injury because of an increase in levels of physical activity, as well as senescence worldwide. Ankle fractures often require surgical management for optimal stabilisation. Pre-operative physiotherapy is necessary to prepare patients for early mobilisation and home discharge. There is a lack of information on the influence of pre-operative physiotherapy on post-operative rehabilitation success, as well as timeous discharge, in patients with ankle fractures. OBJECTIVES To explore the perceptions of patients receiving pre-operative physiotherapy care following a unilateral ankle fracture and the perceptions of nursing staff managing these patients at a tertiary hospital in South Africa. METHOD A descriptive qualitative design, using semi-structured interviews, including both patients with unilateral ankle fractures and nurses caring for these patients, was adopted. Interviews were recorded and verbatim transcriptions were analysed utilising thematic analysis. RESULTS Four overarching themes emerged: the perceived benefits of pre-operative physiotherapy; inhibitors to physiotherapy rehabilitation; hidden enablers to pre-operative physiotherapy and future initiatives for rehabilitation. CONCLUSION The perceived benefits included improved functional independence and safety of patients, as well as reduced burden of care for nurses. Patients also believed that pain and fear were two inhibitors to physiotherapy. Furthermore, nurses identified that organisational limitations, such as short-staffing and inadequately trained staff, inhibited pre-operative physiotherapy and continuity of care. Early post-operative discharge was a crucial hidden enabler to the pre-operative physiotherapy protocol. Recommendations included improved health education; the potential role of nursing staff as facilitators in pre-operative rehabilitation and regular, pre-operative in-patient monitoring of physiotherapy intervention. CLINICAL IMPLICATIONS Health education was perceived to have improved patient safety and compliance which subsequently reduced patient safety incidences as well as served as a risk mitigation measure. Furthermore, gait training and muscle strengthening exercises was perceived to have resulted in safe, independent mobility to ensure prompt discharge home. Consequently, a reduced post-operative length of in hospital stay results in major cost savings per patient as well as improved access and bed availability. Future studies may need to explore the effects of pre-operative physiotherapy on post-operative success and return to pre-injury activity.
Collapse
Affiliation(s)
- Sabeeha Dangor
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prithi Jayaraman-Pillay
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Stacy Maddocks
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Verusia Chetty
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
Gulbrandsen M, Hartigan DE, Patel KA, Makovicka JL, Tummala SV, Chhabra A. Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players. J Athl Train 2019; 54:881-888. [PMID: 31390272 DOI: 10.4085/1062-6050-144-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. OBJECTIVE To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. DESIGN Descriptive epidemiology study. SETTING Online injury surveillance. MAIN OUTCOME MEASURE(S) The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. RESULTS When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). CONCLUSIONS Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.
Collapse
|
9
|
MANAGEMENT OF ACUTE GRADE II LATERAL ANKLE SPRAINS WITH AN EMPHASIS ON LIGAMENT PROTECTION: A DESCRIPTIVE CASE SERIES. Int J Sports Phys Ther 2019; 14:445-458. [PMID: 31681503 DOI: 10.26603/ijspt20190445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose Lateral ankle sprain the most common injury in physically active populations. Individuals who sustain an acute lateral ankle sprain may not receive timely formal rehabilitation and are at an increased risk to have subsequent sprains which can lead to chronic pain and instability. Attention to essential factors for ligament protection and healing while preserving ankle movement, may result in a more stable yet mobile ankle offering improved outcomes. The purpose of this case series was to describe the methods and observe the outcomes associated with a comprehensive strategy for managing acute first episode grade II lateral ankle sprains. Study design Prospective case series. Case Descriptions and Interventions Ten patients (mean age 26.7 years, range 16-51 years, mean 2.3 days from injury) with acute grade II lateral ankle sprain were treated with an approach to protect the injured ligament, prevent impairments to movement, restore strength and proprioception, and progress to full function. Patient outcomes were assessed at four, eight and 12 weeks. Follow-up interviews at six and 12 months assessed injury recurrence. Outcomes Patients were treated for an average of eight sessions over a mean of seven weeks. Rapid change in self-reported function, ankle ROM, and pain were observed in the first four weeks of care. Clinically meaningful improvements in function and ankle ROM were also noted at eight weeks and maintained at 12-week follow-ups. All patients returned to desired physical activity with only a single re-sprain event within one year after injury. Conclusion The results of this prospective case series suggest that a treatment approach designed to protect the injured ligament, maintain and restore normal ankle motion, and provide a tailored functional pathway to return to run and sport demonstrated resolution of symptoms and improvement in reported functional outcomes in a group of patients following grade II acute primary ankle sprain. Level of Evidence Level IV, Case Series.
Collapse
|
10
|
Mohd Salim NS, Umar MA, Shaharudin S. Effects of the standard physiotherapy programme on pain and isokinetic ankle strength in individuals with grade I ankle sprain. J Taibah Univ Med Sci 2018; 13:576-581. [PMID: 31435381 PMCID: PMC6694912 DOI: 10.1016/j.jtumed.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The isokinetic evaluation of the ankle joint is important in determining the effectiveness of the rehabilitation programme for the management of ankle sprains. This study aimed to determine the effects of physiotherapy programme on isokinetic variables in individuals with grade I ankle sprains. Methods Seven patients with acute grade 1 ankle sprain (15 days of ankle sprain) were recruited. They were provided with 7 days of protection, optimal loading, ice, compression, and elevation (POLICE) treatment, and the standard physiotherapy programme consisted of towel stretching and balancing exercises on one leg. Pain scale score was recorded daily during the physiotherapy programme. The isokinetic ankle strengths of the patient's injured and uninjured legs were compared before and after the physiotherapy programme. Isokinetic tests were conducted in painless range of motion for the injured leg. Results Pain was significantly reduced after the patients underwent the standard physiotherapy programme. No significant differences were observed in terms of the ankle peak torque, time to peak torque, and ankle plantar flexion-to-dorsiflexion ratio of the injured and uninjured legs. The injured leg showed significant improvement in terms of ankle eversion-to-inversion ratio (E:I) after 7 days of performing the standard physiotherapy programme. Conclusion Performing the standard physiotherapy programme for 1 week reduces pain and improves the ankle E:I in patients with grade 1 ankle sprain.
Collapse
Affiliation(s)
- Nor S Mohd Salim
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Muhammad A Umar
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Shazlin Shaharudin
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| |
Collapse
|
11
|
Simon JE, Wikstrom EA, Grooms DR, Docherty CL, Dompier TP, Kerr ZY. Athletic Training Service Characteristics for Patients With Ankle Sprains Sustained During High School Athletics. J Athl Train 2018; 54:676-683. [PMID: 29373057 DOI: 10.4085/1062-6050-449-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Limited information exists on the amount and type of care provided by athletic trainers (ATs) treating athletes who sustained ankle sprains in the high school setting. OBJECTIVE To describe AT services provided for patients with ankle sprains injured in high school athletics. DESIGN Descriptive epidemiology study. SETTING Athletic training facility (ATF) visits and AT services collected from 147 high schools in 26 states. PATIENTS OR OTHER PARTICIPANTS High school student-athletes participating in 13 boys' and 14 girls' sports who sustained a diagnosed ankle sprain during the 2011-2012 through 2013-2014 academic years. The ATs documented 3213 ankle sprains. MAIN OUTCOME MEASURE(S) Number of ATF visits and individual AT services and mean ATF visits (per injury) and AT services (per injury) were calculated by sport and for time-loss injuries (participation-restriction time of at least 24 hours) and non-time-loss injuries (participation-restriction time <24 hours). RESULTS During the 3-year period, 19 925 ATF visits were reported, with an average of 6 (interquartile range = 1-7) ATF visits per ankle sprain. Most ATF visits were for non-time-loss injuries (65.1%). Football accounted for the largest proportions of ankle sprains (27.3%) and ATF visits (35.0%). In total, 71 404 AT services were provided for ankle sprains. Therapeutic activities or exercise were the most common AT services (47.4%), followed by neuromuscular reeducation (16.6%), strapping (14.2%), and modalities (11.5%). An average of 22 (interquartile range = 4-28) AT services were reported per ankle sprain. The average number of AT services per injury was higher among patients with time-loss than non-time-loss injuries (35 versus 19; P < .001). CONCLUSIONS The ATs provided a variety of services to treat high school athletes who had sustained ankle sprains, including therapeutic exercises and neuromuscular reeducation, which were supported by research. However, ATs should consider using manual therapy (use supported by grade B evidence) and therapeutic exercise more (use supported by grade A evidence).
Collapse
|
12
|
Wang CW, Muheremu A, Bai JP. Use of three-dimensional finite element models of the lateral ankle ligaments to evaluate three surgical techniques. J Int Med Res 2017; 46:699-709. [PMID: 29239256 PMCID: PMC5971510 DOI: 10.1177/0300060517727941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare three surgical techniques for lateral ankle ligament reconstruction using finite element (FE) models. Methods A three-dimensional FE model of the left foot of a healthy volunteer and lateral collateral ligament injury models were developed. Three tendons [one-half of the autologous peroneus longus tendon (PLT), one-half of the peroneus brevis tendon (PBT), and an allogeneic tendon] were used for lateral collateral ligament reconstruction. The ankle varus stress and anterior drawer tests were performed to compare the three surgical techniques. Results The ankle varus stress test showed that the equivalent stresses of the anterior talofibular ligament (ATFL) (84.00 MPa) and calcaneofibular ligament (CFL) (27.01 MPa) were lower in allogeneic tendon reconstruction than in the other two techniques but similar to those of normal individuals (138.48 and 25.90 MPa, respectively). The anterior drawer test showed that the equivalent stresses of the ATFL and CFL in autologous PLT reconstruction (31.31 and 28.60 MPa, respectively) and PBT reconstruction (31.47 and 29.07 MPa, respectively) were lower than those in allogeneic tendon reconstruction (57.32 and 52.20 MPa, respectively). Conclusions The allogeneic tendon reconstruction outcome was similar to normal individuals. Allogeneic tendon reconstruction may be superior for lateral ankle ligament reconstruction without considering its complications.
Collapse
Affiliation(s)
- Cheng-Wei Wang
- 1 Department of Orthopedics, Tumor Hospital Affiliated to Xinjiang Medical University, Xinshi, Urumqi, Xinjiang, PR China.,2 Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Aikeremujiang Muheremu
- 2 Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Jing-Ping Bai
- 1 Department of Orthopedics, Tumor Hospital Affiliated to Xinjiang Medical University, Xinshi, Urumqi, Xinjiang, PR China
| |
Collapse
|
13
|
Abstract
OBJECTIVE To characterize trends in the acute management (within 30 days) after lateral ankle sprain (LAS) in the United States. DESIGN Descriptive epidemiology study. PATIENTS Of note, 825 718 ankle sprain patients were identified; 96.2% were patients with LAS. Seven percent had an associated fracture and were excluded from the remaining analysis. SETTING Primary and tertiary care settings. INTERVENTIONS We queried a database of national health insurance records for 2007 to 2011 by ICD-9 codes for patients with LAS while excluding medial and syndesmotic sprains and any LAS with an associated foot or ankle fracture. MAIN OUTCOME MEASURES The percentage of patients to receive specific diagnostic imaging, orthopedic devices, or physical therapy treatments within 30 days of the LAS diagnosis and the associated costs. RESULTS Over two-thirds of patients with LAS without an associated fracture received radiographs, 9% received an ankle brace, 8.1% received a walking boot, 6.5% were splinted, and 4.8% were prescribed crutches. Only 6.8% received physical therapy within 30 days of their LAS diagnosis, 94.1% of which performed therapeutic exercise, 52.3% received manual therapy, and 50.2% received modalities. The annual cost associated with physician visits, diagnostic imaging, orthopedic devices, and physical therapy was 152 million USD, 81.5% was from physician evaluations, 7.9% from physical therapy, 7.2% from diagnostic imaging, and 3.4% from orthopedic devices. CONCLUSIONS Most patients with LAS do not receive supervised rehabilitation. The small proportion of patients with LAS to receive physical therapy get rehabilitation prescribed in accordance with clinical practice guidelines. The majority (>80%) of the LAS financial burden is associated with physician evaluations.
Collapse
|
14
|
Fatoye F, Haigh C. The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. J Clin Nurs 2016; 25:1435-43. [DOI: 10.1111/jocn.13255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Francis Fatoye
- Department of Health Professions; Manchester Metropolitan University; Manchester UK
| | - Carol Haigh
- Department of Nursing; Manchester Metropolitan University; Manchester UK
| |
Collapse
|
15
|
Di Trani Lobacz A, Glutting J, Kaminski TW. Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries. J Athl Train 2016; 51:162-74. [PMID: 26942659 DOI: 10.4085/1062-6050-51.3.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Hamstrings strain injuries (HSIs) are among the most commonly occurring injuries in sport and are top causes of missed playing time. Lingering symptoms, prolonged recovery, and a high reinjury rate (12%-34%) make HSI management a frustrating and challenging process for the athletic trainer (AT). The clinical practice patterns and opinions of ATs regarding HSI treatment and rehabilitation are unknown. OBJECTIVE To examine the frequency of method use and opinions about current HSI management among ATs. DESIGN Cross-sectional study. SETTING Survey administered to registrants at the 2013 National Athletic Trainers' Association Clinical Symposia and AT Expo. PATIENTS OR OTHER PARTICIPANTS A total of 1356 certified ATs (691 men, 665 women; age = 35.4 ± 10.5 years, time certified = 11.92 ± 9.75 years). DATA COLLECTION AND ANALYSIS A survey was distributed electronically to 7272 registrants and on paper to another 700 attendees. Validity and reliability were established before distribution. Participants reported demographic information and rated their frequency of treatment and rehabilitation method use and agreement with questions assessing confidence, satisfaction, and desire for better clinical practice guidelines. Exploratory factor analysis and principal axis factor analysis were used. We also calculated descriptive statistics and χ(2) tests to assess practice patterns. RESULTS The response rate was 17% (n = 1356). A 2-factor solution was accepted for factor analysis (r = 0.76, r = 0.70), indicating that ATs follow either a contemporary or traditional management style. Various practice patterns were evident across employment settings and years of clinical experience. Satisfaction with the current HSI management plan was high (73.6%), whereas confidence in returning an athlete to play was lower (62.0%). Rates of use were associated with belief in effectiveness for all methods assessed (P < .001). Higher confidence levels were associated with high use of several methods; we observed increased satisfaction (χ(2)2 = 22.5, P = .002) but not increased confidence levels in more experienced ATs. CONCLUSIONS Our study demonstrated the lack of consensus in HSI treatment and rehabilitation and the ATs' desire for better clinical practice guidelines. Future research in which multimodal strategies, including both traditional and contemporary methods, are studied is warranted for effective management of HSI.
Collapse
|
16
|
The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial. J Orthop Sports Phys Ther 2016; 46:157-67. [PMID: 26813753 DOI: 10.2519/jospt.2016.6212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized 3-treatment, 3-period crossover trial. BACKGROUND There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery. OBJECTIVE To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery. METHODS Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100). RESULTS Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; P<.001) wider in the walker boot than in Tubigrip. Self-reported pain was lower in the walker boot (5/100) and in the stirrup brace (13/100) compared to the Tubigrip (18/100, P = .03). No significant differences were found in the effects of the supports on step-length asymmetry between the walker boot or stirrup brace and Tubigrip. CONCLUSION At 6 weeks after surgical internal fixation for ankle fracture, pain and single-limb support time asymmetry over a short distance and for a short-term walk were immediately reduced with the use of a walker boot use and, to a lesser extent, a stirrup-brace compared to Tubigrip. Step width also widened in a walker boot, which may confer some additional gait stability. These results apply to immediate effects, so studies with longer-term follow-up are now indicated. The trial was registered at http://www.isrctn.com/ (ISRCTN84536917). Level of Evidence Therapy, level 2b.
Collapse
|
17
|
Keene DJ, Williams MA, Segar AH, Byrne C, Lamb SE. Immobilisation versus early ankle movement for treating acute lateral ankle ligament injuries in adults. Hippokratia 2016. [DOI: 10.1002/14651858.cd012101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- David J Keene
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); Kadoorie Centre John Radcliffe Hospital, Headley Way Oxford UK OX3 9DU
| | - Mark A Williams
- Oxford Brookes University; Department of Sport and Health Sciences; Jack Straws Lane Oxford Oxon UK OX3 0FL
| | - Anand H Segar
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); Kadoorie Centre John Radcliffe Hospital, Headley Way Oxford UK OX3 9DU
| | - Christopher Byrne
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); Kadoorie Centre John Radcliffe Hospital, Headley Way Oxford UK OX3 9DU
| | - Sarah E Lamb
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); Kadoorie Centre John Radcliffe Hospital, Headley Way Oxford UK OX3 9DU
| |
Collapse
|
18
|
Bilgic S, Durusu M, Aliyev B, Akpancar S, Ersen O, Yasar SM, Ardic S. Comparison of two main treatment modalities for acute ankle sprain. Pak J Med Sci 2016; 31:1496-9. [PMID: 26870123 PMCID: PMC4744308 DOI: 10.12669/pjms.316.8210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: Acute ankle sprains are one of the most common injuries in emergency departments. Immobilization is widely accepted as the basic treatment modality for acute ankle sprains; however, immobilization method remains controversial. In this study, we aimed to compare two treatment modalities: splint and elastic bandage for the management of acute ankle sprains. Methods: This prospective study was conducted in the emergency department. Fifty-one consecutive patients who were admitted to the emergency department owing to the complaint of ankle sprain and who were treated with an elastic bandage or a splint were included in the study. After bone injury was ruled out, treatment choice was left to the on-shift physicians’ discretion. The extent of edema was evaluated before and after the treatment by using a small, graduated container filled with warm water. Volume differences were calculated by immersing both lower extremities in a container filled to a constant level. Pain was evaluated using the visual analogue scale. Results: There were 25 patients in the elastic bandage group and 26 patients in the splint group. VAS scores of these groups before and after the treatment were similar. Although edema size before and after the treatment were similar between the groups, edema size reduction was significantly more in the elastic bandage group [p=0,025]. Conclusions: This study showed that treatment of acute ankle sprains with an elastic bandage was more effective than splint in reducing edema. Therefore, an elastic bandage could be preferred over a splint for the treatment of acute ankle sprains.
Collapse
Affiliation(s)
- Serkan Bilgic
- Serkan Bilgic, Department of Orthopaedics, Haydarpasa Military Training Hospital, Istanbul, Turkey
| | - Murat Durusu
- Murat Durusu, Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara Turkey
| | - Bahtiyar Aliyev
- Bahtiyar Aliyev, Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara Turkey
| | - Serkan Akpancar
- Serkan Akpancar, Department of Orthopaedics, Gulhane Military Medical Academy, Ankara Turkey
| | - Omer Ersen
- Omer Ersen, Department of Orthopaedics, Maresal Cakmak Military Hospital, Erzurum, Turkey
| | - S Mehmet Yasar
- S.Mehmet Yasar, Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara Turkey
| | - Sukru Ardic
- Sukru Ardic, Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara Turkey
| |
Collapse
|
19
|
Singh V, Elamvazuthi I, Jeoti V, George J, Swain A, Kumar D. Impacting clinical evaluation of anterior talofibular ligament injuries through analysis of ultrasound images. Biomed Eng Online 2016; 15:13. [PMID: 26838596 PMCID: PMC4736278 DOI: 10.1186/s12938-016-0129-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 01/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background Anterior talofibular ligament (ATFL) is considered as the weakest ankle ligament that is most prone to injuries. Ultrasound imaging with its portable, non-invasive and non-ionizing radiation nature is increasingly being used for ATFL diagnosis. However, diagnosis of ATFL injuries requires its segmentation from ultrasound images that is a challenging task due to the existence of homogeneous intensity regions, homogeneous textures and low contrast regions in ultrasound images. To address these issues, this research has developed an efficient ATFL segmentation framework that would contribute to accurate and efficient diagnosis of ATFL injuries for clinical evaluation. Methods The developed framework comprises of five computational steps to segment the ATFL ligament region. Initially, region of interest is selected from the original image, which is followed by the adaptive histogram equalization to enhance the contrast level of the ultrasound image. The enhanced contrast image is further optimized by the particle swarm optimization algorithm. Thereafter, the optimized image is processed by the Chan–Vese method to extract the ATFL region through curve evolution; then the resultant image smoothed by morphological operation. The algorithm is tested on 25 subjects’ datasets and the corresponding performance metrics are evaluated to demonstrate its clinical applicability. Results The performance of the developed framework is evaluated based on various measurement metrics. It was found that estimated computational performance of the developed framework is 12 times faster than existing Chan–Vese method. Furthermore, the developed framework yielded the average sensitivity of 98.3 %, specificity of 96.6 % and accuracy of 96.8 % as compared to the manual segmentation. In addition, the obtained distance using Hausdorff is 14.2 pixels and similarity index by Jaccard is 91 %, which are indicating the enhanced performance whilst segmented area of ATFL region obtained from five normal (average Pixels—16,345.09), five tear (average Pixels—14,940.96) and five thickened (average Pixels—12,179.20) subjects’ datasets show good performance of developed framework to be used in clinical practices. Conclusions On the basis of obtained results, the developed framework is computationally more efficient and more accurate with lowest rate of coefficient of variation (less than 5 %) that indicates the highest clinical significance of this research in the assessment of ATFL injuries.
Collapse
Affiliation(s)
- Vedpal Singh
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - Irraivan Elamvazuthi
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - Varun Jeoti
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - John George
- Research Imaging Centre, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Akshya Swain
- Department of Electrical and Computer Engineering, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Dileep Kumar
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| |
Collapse
|
20
|
Keene DJ, Willett K, Lamb SE. The effects of ankle supports on gait in adults: A randomized cross-over study. J Electromyogr Kinesiol 2015; 25:973-81. [PMID: 26337720 DOI: 10.1016/j.jelekin.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022] Open
Abstract
We aimed to compare the effects of different ankle supports used after ankle injury/surgery on temporo-spatial gait characteristics. We conducted a randomized cross-over study including adult participants with no previous lower limb or neurological pathology, who underwent gait analysis on an electronic walkway in three different ankle supports, Tubigrip(®), a stirrup brace and a walker boot. The 18 participants were an average age of 42 (SD 13, range 24-62) years and 14 (88%) were female. Compared to Tubigrip(®), gait in the walker boot was slower (-0.19 m/s, 95%CI -0.23 to -0.16, P < 0.001), step length asymmetry was 10% (95%CI 9-12, P < 0.001) worse, single support time asymmetry was 5% (95%CI 3-7, P < 0.001) worse and participants also adopted a wider step width (4.1 cm, 95%CI 3.7-4.5, P < 0.001). There were no important differences in gait between the Tubigrip(®) and stirrup brace. The findings of this study suggest that there is a limit to the degree of normal walking characteristics in a walker boot in the absence of lower limb impairment. Further research is required to directly compare the effects of these ankle supports in clinical populations.
Collapse
Affiliation(s)
- David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| |
Collapse
|
21
|
Muniz TB, Moraes R, Guirro RRJ. Lower limb ice application alters ground reaction force during gait initiation. Braz J Phys Ther 2015; 19:114-21. [PMID: 25993625 PMCID: PMC4481831 DOI: 10.1590/bjpt-rbf.2014.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Cryotherapy is a widely used technique in physical therapy clinics and sports.
However, the effects of cryotherapy on dynamic neuromuscular control are
incompletely explained. OBJECTIVES: To evaluate the effects of cryotherapy applied to the calf, ankle and sole of the
foot in healthy young adults on ground reaction forces during gait initiation.
METHOD: This study evaluated the gait initiation forces, maximum propulsion, braking
forces and impulses of 21 women volunteers through a force platform, which
provided maximum and minimum ground reaction force values. To assess the effects
of cooling, the task - gait initiation - was performed before ice application,
immediately after and 30 minutes after removal of the ice pack. Ice was randomly
applied on separate days to the calf, ankle and sole of the foot of the
participants. RESULTS: It was demonstrated that ice application for 30 minutes to the sole of the foot
and calf resulted in significant changes in the vertical force variables, which
returned to their pre-application values 30 minutes after the removal of the ice
pack. Ice application to the ankle only reduced propulsion impulse. CONCLUSIONS: These results suggest that although caution is necessary when performing
activities that require good gait control, the application of ice to the ankle,
sole of the foot or calf in 30-minute intervals may be safe even preceding such
activities.
Collapse
Affiliation(s)
- Thiago B Muniz
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato Moraes
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rinaldo R J Guirro
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, FMRP, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| |
Collapse
|
22
|
Wiebking U, Pacha TO, Jagodzinski M. An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations. Foot Ankle Surg 2015; 21:42-8. [PMID: 25682406 DOI: 10.1016/j.fas.2014.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/27/2014] [Accepted: 09/13/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle sprain injuries, often due to lateral ligamentous injury, are the most common sports traumatology conditions. Correct diagnoses require an understanding of the assessment tools with a high degree of diagnostic accuracy. Obviously, there are still no clear consensuses or standard methods to differentiate between a ligament tear and an ankle sprain. In addition to clinical assessments, stress sonography, arthrometer and other methods are often performed simultaneously. These methods are often costly, however, and their accuracy is controversial. The aim of this study was to investigate three different measurement tools that can be used after a lateral ligament lesion of the ankle with injury of the anterior talofibular ligament to determine their diagnostic accuracy. METHODS Thirty patients were recruited for this study. The mean patient age was 35±14 years. There were 15 patients with a ligamentous rupture and 15 patients with an ankle sprain. We quantified two devices and one clinical assessment by which we calculated the sensitivity and specifity: Stress sonography according to Hoffmann, an arthrometer to investigate the 100N talar drawer and maximum manual testing and the clinical assessment of the anterior drawer test. A high resolution sonography was used as the gold standard. RESULTS The ultrasound-assisted gadgetry according to Hoffmann, with a 3mm cut-off value, displayed a sensitivity of 0.27 and a specificity of 0.87. Using a 3.95mm cut-off value, the arthrometer displayed a sensitivity of 0.8 and a specificity of 0.4. The clinical investigation sensitivities and specificities were 0.93 and 0.67, respectively. CONCLUSIONS Different assessment methods for ankle rupture diagnoses are suggested in the literature; however, these methods lack reliable data to set investigation standards. Clinical examination under adequate analgesia seems to remains the most reliable tool to investigate ligamentous ankle lesions. Further clinical studies with higher case numbers are necessary, however, to evaluate these findings and to measure the reliability.
Collapse
Affiliation(s)
- Ulrich Wiebking
- Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Tarek Omar Pacha
- Department of Trauma and Orthopaedic Surgery, Klinikum Neustadt am Rübenberge, Lindenstr. 75, 31535 Neustadt am Rübenberge, Germany
| | - Michael Jagodzinski
- Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| |
Collapse
|
23
|
Grindstaff TL, Hanish MJ, Wheeler TJ, Basnett CR, Miriovsky DJ, Danielson EL, Barr JB, Joseph Threlkeld A. Fibular taping does not alter lower extremity spinal reflex excitability in individuals with chronic ankle instability. J Electromyogr Kinesiol 2015; 25:253-9. [PMID: 25727519 DOI: 10.1016/j.jelekin.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine changes in spinal reflex excitability of the soleus and fibularis longus muscles before and after fibular taping intervention. METHODS Twenty-one individuals (age = 23.4 ± 2.7 y, height = 171.0 ± 12.8 cm, mass = 69.7 ± 11.8 kg) with chronic ankle instability (CAI) and at least 5° ankle dorsiflexion asymmetry volunteered for this randomised crossover design study. Each participant received a fibular taping with tension or fibular taping without tension during separate sessions. Spinal reflex excitability of the soleus and fibularis longus was determined by obtaining maximum values for H-reflex (Hoffmann reflex) and maximum compound muscle action potential (Mmax), which was expressed as a ratio (H/M ratio). Measures were obtained immediately before and after a fibular taping intervention. RESULTS The application of tape to the fibula, regardless of tension, did not produce a change in spinal reflex excitability for the soleus (F1,39 = .01, P = .91) or fibularis longus (F1,39 = .001, P = .99). CONCLUSIONS Fibular taping with and without tension did not result in an immediate change in spinal reflex excitability of the soleus or fibularis longus in individuals with CAI. Although fibular taping has been shown to reduce recurrent ankle sprains in individuals with CAI, the mechanism of effectiveness may not involve an immediate increase in spinal reflex excitability.
Collapse
Affiliation(s)
- Terry L Grindstaff
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States.
| | - Michael J Hanish
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - Todd J Wheeler
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - Curtis R Basnett
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - Daniel J Miriovsky
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - Erin L Danielson
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - J B Barr
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| | - A Joseph Threlkeld
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE, United States
| |
Collapse
|
24
|
Barbanera M, Mazuchi FDAES, Batista JPB, Ultremare JDM, Iwashita JDS, Ervilha UF. Semi-rigid brace and taping decrease variability of the ankle joint position sense. MOTRIZ: REVISTA DE EDUCACAO FISICA 2014. [DOI: 10.1590/s1980-65742014000400012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The present study investigated the effect of taping and the semi-rigid ankle brace on ankle joint position sense. Sixteen healthy women (20.8 ± 2.3 years old) actively placed the ankle in a target position. The experimental conditions were: 1) wearing no orthosis device, 2) using semi-rigid brace, and 3) wearing ankle taping. Absolute error (AE) and variable error (VE) were calculated to obtain the joint position sense. We found an interaction effect between condition and target angle at 15o of plantar flexion for the variable VE, which showed smaller errors during the use of taping and semi-rigid brace. In conclusion, the use of ankle joint orthoses, whether taping or semi-rigid brace, decrease the variability of the position sense at 15o of plantar flexion, potentially decreasing ankle sprains occurrence.
Collapse
|
25
|
|
26
|
Feger MA, Donovan L, Hart JM, Hertel J. Effect of ankle braces on lower extremity muscle activation during functional exercises in participants with chronic ankle instability. Int J Sports Phys Ther 2014; 9:476-487. [PMID: 25133076 PMCID: PMC4127510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Ankle bracing and rehabilitation are common methods to reduce the rate of recurrent ankle sprain in participants with chronic ankle instability (CAI). CAI participants utilize less muscle activity when performing functional exercises compared to healthy controls. The effect of ankle braces on muscle activity during functional exercises in participants with CAI has not been previously studied. PURPOSE To determine the effect of bracing on motor output as demonstrated by surface EMG amplitudes in participants with CAI during single limb, eyes closed balance, star excursion balance, forward lunge, and lateral hop exercises. METHODS A descriptive laboratory study was performed. Fifteen young adults with CAI performed functional exercises with and without ankle braces while surface EMG signals were recorded from the tibialis anterior, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius. The main outcome measures were normalized surface EMG amplitudes (root mean square area) for each muscle, muscles of the shank (distal three muscles), muscles of the thigh (proximal three muscles), and total muscle activity (all six muscles) of the lower extremity. A paired t-test was performed for each dependent variable to compare conditions. The level of significance was set a priori at p ≤ 0.05 for all analyses. RESULTS During the forward lunge, bracing significantly reduced muscle activity pre-initial contact in the lateral gastrocnemius and post-initial contact in the peroneus longus. During the star excursion balance anterior reach the peroneus longus, lateral gastrocnemius, rectus femoris, and gluteus medius had significantly less muscle activity during braced trials. Bracing significantly reduced thigh and total muscle activity during the anterior reach and gluteus medius activity during the posterolateral reach. There were no differences between braced and unbraced conditions during the single limb eyes closed balance, star excursion balance posteromedial reach, or during lateral hop exercises. CONCLUSIONS Clinicians should be aware of the decreased muscle activity that occurs during common rehabilitation exercises when patients with CAI complete those activities while wearing ankle braces. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Mark A Feger
- University of Virginia, Charlottesville, VA, USA
| | - Luke Donovan
- University of Virginia, Charlottesville, VA, USA
| | - Joe M Hart
- University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
27
|
Keene D, James G, Lamb SE, Walton J, Gray B, Coleman D, Handley R, Handa A, Willett K. Factors associated with mobility outcomes in older people post-ankle fracture: an observational cohort study focussing on peripheral vessel function. Injury 2013; 44:987-93. [PMID: 23022083 DOI: 10.1016/j.injury.2012.08.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/23/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are increasing numbers of older persons sustaining ankle fractures. This injury often results in a degree of functional limitation, particularly in older patients. There is currently limited research into factors associated with mobility outcomes. DESIGN Observational cohort study. SETTING Hospital Trauma Department, UK. PARTICIPANTS Persons aged 60 years or over who sustained an unstable ankle fracture with no established peripheral arterial disease pre-injury. METHODS This study investigated the association between ankle-brachial pressure index (ABPI) and extended timed 'up and go' (TUG) measures. Associations between TUG outcomes and age, pre-morbid functional mobility (Olerud-Molander Ankle Score) and fracture severity (number of malleoli injured) were also explored. ANALYSIS Complete cases (n=76; 84% of cohort) were entered into univariate and multivariate linear regression. RESULTS No association was found between ABPI and TUG at 6 months in unadjusted and adjusted analyses. Pre-morbid functional mobility (B=-0.34, 95% confidence interval (CI) -0.45 to -0.23, p<0.001) and age (B=0.46, 95% CI 0.25-0.66, p<0.001) were associated with extended TUG values (r2=0.53, p<0.001). Fracture severity was not a significant independent predictor variable. CONCLUSIONS Peripheral vessel function and fracture severity may have a limited independent influence on mobility outcome after ankle fracture in those patients who do not have established pre-injury peripheral arterial disease. Age and pre-morbid mobility gave an indication of mobility outcome, but a substantial amount of variance remains unexplained. Limitations of this study, including missing data and potential residual confounding, indicate the need for caution in generalising these results. The study provides a basis on which to plan larger studies of the factors associated with mobility outcome after ankle fracture in older populations.
Collapse
Affiliation(s)
- David Keene
- Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Teixeira LM, Pires T, Silva RD, de Resende MA. Immediate Effect of a Single Anteroposterior Talus Mobilization on Dorsiflexion Range of Motion in Participants With Orthopedic Dysfunction of the Ankle and Foot. J Manipulative Physiol Ther 2013; 36:369-75. [DOI: 10.1016/j.jmpt.2013.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 12/26/2022]
|
29
|
Wheeler TJ, Basnett CR, Hanish MJ, Miriovsky DJ, Danielson EL, Barr JB, Threlkeld AJ, Grindstaff TL. Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability. J Sci Med Sport 2013; 16:488-92. [PMID: 23537695 DOI: 10.1016/j.jsams.2013.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/18/2013] [Accepted: 02/26/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the effects of fibular taping on ankle dorsiflexion range of motion (ROM) and dynamic balance in individuals with chronic ankle instability (CAI). DESIGN Single-blind, randomized crossover. METHODS Twenty-three individuals (age=23.4 ± 2.5 years, height=171.6 ± 12.4 cm, mass=71.5±13.1 kg) with CAI were allocated to either a fibular taping intervention or sham taping intervention (tape applied without tension) over the course of two visits. Weight-bearing ankle dorsiflexion ROM and components of the Star Excursion Balance Test (SEBT) were measured before and after intervention. RESULTS There was not a significant change in ankle dorsiflexion ROM when comparing the taping interventions (F1,43=1.03, P=.32), but both interventions resulted in a small increase (F1,43=8.07, P=.007) in dorsiflexion ROM (pre=36.7° ± 6.9°, post=37.7° ± 6.2°). This increase in ROM did not exceed the established minimal detectable change for dorsiflexion ROM. Fibular taping with tension produced an increase (F1,41=5.84, P=.02) (pre=69.0 ± 9.1%, post=70.6±8.6%) in posterolateral reach distance when compared to taping without tension (pre=72.7 ± 11.0%, post=71.4 ± 9.6%), but this increase did not exceed the established minimal detectable change. There was not a significant change in dynamic balance between groups for the anterior (F1,41=2.33, P=.14) and posteromedial (F1,41=.41, P=.53) reach directions. CONCLUSIONS Although small changes in ankle dorsiflexion ROM and posterolateral reach distances were observed, these changes did not exceed established minimal detectable change values for these measures. These results suggest that the benefits of fibular taping are not related to an increase in ankle dorsiflexion ROM or dynamic balance.
Collapse
Affiliation(s)
- Todd J Wheeler
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | | | | | | | | | | | | | | |
Collapse
|
30
|
ZHU Y, QIU ML, DING Y, QIANG Y, QIN BY. Effects of electroacupuncture on the proprioception of athletes with functional ankle instability. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2013. [DOI: 10.1016/s1003-5257(13)60002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Lin CWC, Donkers NAJ, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2012; 11:CD005595. [PMID: 23152232 DOI: 10.1002/14651858.cd005595.pub3] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rehabilitation after ankle fracture can begin soon after the fracture has been treated, either surgically or non-surgically, by the use of different types of immobilisation that allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation, including the use of physical or manual therapies, may start following the period of immobilisation. This is an update of a Cochrane review first published in 2008. OBJECTIVES To assess the effects of rehabilitation interventions following conservative or surgical treatment of ankle fractures in adults. SEARCH METHODS We searched the Specialised Registers of the Cochrane Bone, Joint and Muscle Trauma Group and the Cochrane Rehabilitation and Related Therapies Field, CENTRAL via The Cochrane Library (2011 Issue 7), MEDLINE via PubMed, EMBASE, CINAHL, PEDro, AMED, SPORTDiscus and clinical trials registers up to July 2011. In addition, we searched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation. Secondary outcomes included quality of life, patient satisfaction, impairments and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, assessed risk of bias and extracted data. Risk ratios and 95% confidence intervals (95% CIs) were calculated for dichotomous variables, and mean differences or standardised mean differences and 95% CIs were calculated for continuous variables. End of treatment and end of follow-up data were presented separately. For end of follow-up data, short term follow-up was defined as up to three months after randomisation, and long-term follow-up as greater than six months after randomisation. Meta-analysis was performed where appropriate. MAIN RESULTS Thirty-eight studies with a total of 1896 participants were included. Only one study was judged at low risk of bias. Eight studies were judged at high risk of selection bias because of lack of allocation concealment and over half the of the studies were at high risk of selective reporting bias.Three small studies investigated rehabilitation interventions during the immobilisation period after conservative orthopaedic management. There was limited evidence from two studies (106 participants in total) of short-term benefit of using an air-stirrup versus an orthosis or a walking cast. One study (12 participants) found 12 weeks of hypnosis did not reduce activity or improve other outcomes.Thirty studies investigated rehabilitation interventions during the immobilisation period after surgical fixation. In 10 studies, the use of a removable type of immobilisation combined with exercise was compared with cast immobilisation alone. Using a removable type of immobilisation to enable controlled exercise significantly reduced activity limitation in five of the eight studies reporting this outcome, reduced pain (number of participants with pain at the long term follow-up: 10/35 versus 25/34; risk ratio (RR) 0.39, 95% confidence interval (CI) 0.22 to 0.68; 2 studies) and improved ankle dorsiflexion range of motion. However, it also led to a higher rate of mainly minor adverse events (49/201 versus 20/197; RR 2.30, 95% CI 1.49 to 3.56; 7 studies).During the immobilisation period after surgical fixation, commencing weight-bearing made a small improvement in ankle dorsiflexion range of motion (mean difference in the difference in range of motion compared with the non-fractured side at the long term follow-up 6.17%, 95% CI 0.14 to 12.20; 2 studies). Evidence from one small but potentially biased study (60 participants) showed that neurostimulation, an electrotherapy modality, may be beneficial in the short-term. There was little and inconclusive evidence on what type of support or immobilisation was the best. One study found no immobilisation improved ankle dorsiflexion and plantarflexion range of motion compared with cast immobilisation, but another showed using a backslab improved ankle dorsiflexion range of motion compared with using a bandage.Five studies investigated different rehabilitation interventions following the immobilisation period after either conservative or surgical orthopaedic management. There was no evidence of effect for stretching or manual therapy in addition to exercise, or exercise compared with usual care. One small study (14 participants) at a high risk of bias found reduced ankle swelling after non-thermal compared with thermal pulsed shortwave diathermy. AUTHORS' CONCLUSIONS There is limited evidence supporting early commencement of weight-bearing and the use of a removable type of immobilisation to allow exercise during the immobilisation period after surgical fixation. Because of the potential increased risk of adverse events, the patient's ability to comply with the use of a removable type of immobilisation to enable controlled exercise is essential. There is little evidence for rehabilitation interventions during the immobilisation period after conservative orthopaedic management and no evidence for stretching, manual therapy or exercise compared to usual care following the immobilisation period. Small, single studies showed that some electrotherapy modalities may be beneficial. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.
Collapse
Affiliation(s)
- Chung-Wei Christine Lin
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney,Australia.
| | | | | | | | | | | |
Collapse
|
32
|
Lardenoye S, Theunissen E, Cleffken B, Brink PR, de Bie RA, Poeze M. The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial. BMC Musculoskelet Disord 2012; 13:81. [PMID: 22639864 PMCID: PMC3461430 DOI: 10.1186/1471-2474-13-81] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 05/28/2012] [Indexed: 12/26/2022] Open
Abstract
Background Functional treatment is a widely used and generally accepted treatment for ankle sprain. A meta-analysis comparing the different functional treatment options could not make definitive conclusions regarding the effectiveness, and until now, little was known about patient satisfaction in relation to the outcome. Methods Patients with acute ankle sprain received rest, ice, compression and elevation with an compressive bandage at the emergency department. After 5-7 days, 100 patients with grade II and III sprains were randomized into two groups: one group was treated with tape and the other with a semi-rigid ankle brace, both for 4 weeks. Post-injury physical and proprioceptive training was standardized. As primary outcome parameter patient satisfaction and skin complications were evaluated using a predefined questionnaire and numeric rating scale. As secondary outcome parameter the ankle joint function was assessed using the Karlsson scoring scale and range of motion. Results Patient-reported comfort and satisfaction during treatment with a semi-rigid brace was significantly increased. The rate of skin complication in this group was significantly lower compared to the tape group (14.6% versus 59.1%, P < 0.0001). Functional outcome of the ankle joint was similar between the two treatment groups, as well as reported pain. Conclusion Treatment of acute ankle sprain with semi-rigid brace leads to significantly higher patient comfort and satisfaction, both with similar good outcome.
Collapse
Affiliation(s)
- Sacha Lardenoye
- Department of Surgery, Division of Traumasurgery, Maastricht University Medical Center+, P Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | | | | | | | | | | |
Collapse
|
33
|
Lin CWC, Uegaki K, Coupé VMH, Kerkhoffs GM, van Tulder MW. Economic evaluations of diagnostic tests, treatment and prevention for lateral ankle sprains: a systematic review. Br J Sports Med 2012; 47:1144-9. [DOI: 10.1136/bjsports-2012-090319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
34
|
Barbanera M, Araujo RC, Fernandes TD, Hernandez AJ. Avaliação do torque de resistência passiva em atletas femininas com entorse de tornozelo. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A entorse de tornozelo é uma das lesões mais comuns em atletas. Uma forma de avaliar a frouxidão ligamentar pode ser através da medida da amplitude passiva dos movimentos de inversão e eversão do pé para estimar a resistência passiva das estruturas capsuloligamentares do tornozelo, o qual pode ser chamado de torque de resistência passiva. Existem poucos estudos que utilizam a avaliação do torque passivo do tornozelo para avaliar a resistência da cápsula e dos ligamentos. OBJETIVO: O objetivo deste estudo foi comparar o torque passivo dos movimentos de inversão e eversão do pé em atletas com e sem história de entorse de tornozelo. MÉTODO: Participaram do estudo 32 atletas de basquetebol e voleibol feminino (16,06 ± 0,8 anos, 67,63 ± 8,17kg, 177,8 ± 6,47cm). Seus tornozelos foram divididos em dois grupos: grupo controle (29), composto por tornozelos sem sintomas, e grupo entorse de tornozelo, composto por tornozelos que sofreram lesão (29). O torque dos movimentos passivos do tornozelo foi registrado por um dinamômetro isocinético, e a atividade dos músculos fibular longo e tibial anterior foi medida por um eletromiógrafo. As atletas realizaram duas repetições do movimento de inversão e eversão, nas velocidades de 5, 10 e 20°/s e, em seguida, o mesmo protocolo foi repetido apenas para o movimento de inversão máxima do pé. RESULTADOS: O torque de resistência passiva durante os movimentos de inversão e eversão do pé foi menor no grupo com entorse do tornozelo. Este grupo também mostrou menor torque durante o movimento de inversão máxima do pé. Não foram observadas diferenças entre o movimento de inversão e eversão. CONCLUSÕES: A entorse de tornozelo leva a um menor torque de resistência passiva, indicando redução da resistência dos ligamentos colaterais do tornozelo e uma frouxidão articular mecânica.
Collapse
|
35
|
Rodriguez-Merchan EC. Chronic ankle instability: diagnosis and treatment. Arch Orthop Trauma Surg 2012; 132:211-9. [PMID: 22057817 DOI: 10.1007/s00402-011-1421-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a very common injury but still remains an area of debate. QUESTIONS This review aims to define the current diagnosis and treatment of persons with CAI. METHODS A PubMed (MEDLINE) search of the years 2010 and 2011 (1 January 2010 to 15 July 2011) was performed using three keywords: ankle and chronic and instability. The number of articles in English language that was identified was 57. RESULTS Low reliability has been found in effectively testing CAI in a clinical setting. No single force-plate measure is very effective in predicting if an individual had CAI or not. Availability of a nonradiographic device (ankle arthrometer) to measure ankle instability could improve diagnostic accuracy and facilitate decision making in patients with CAI. The sensitivity of magnetic resonance imaging (MRI) may not be adequate to detect lesions in these patients before surgery. In a symptomatic patient, negative results on MRI must be viewed with caution and an arthroscopy may still be required for a definitive diagnosis and treatment. Conservative treatment (rehabilitation, taping, brace) may reduce the occurrence of recurrent ankle sprains and may be effective in managing CAI. In patients with CAI, strengthening of the muscles around the ankle with well-planned proprioceptive exercises helped the patients return to normal living and sports activities, and prevents unnecessary surgery, especially in cases with functional instability. There is no consensus regarding optimum surgical treatment for CAI, but all of them often have good results. CONCLUSIONS Conservative treatment of patients with CAI must be the first-line therapy. Surgical treatment must be indicated only when conservative treatment fails.
Collapse
Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital, Paseo de Castellana 261, 28046 Madrid, Spain.
| |
Collapse
|