Search Results (158)

Background: Chronic ankle instability (CAI) post-sprain leads to persistent functional deficits. This study evaluated CAI’s specific impact on ankle dorsiflexion, heel lift function, stability, broader functional impairments, and quality of life. Methods: A case–control study enrolled 100 CAI patients (post-ankle sprain) and 100 healthy controls. Ankle strength (isokinetic dynamometer), stability (pressure plate), maximum dorsiflexion/plantar flexion ROM (mobility meter), functional limitations (0–10 activity scale), pain (VAS), coordination (Agility T-test, figure-of-eight test), and quality of life (FAOS) were compared. ANOVA and Mann–Whitney U tests were used. Results: Compared to controls, the CAI group showed significantly reduced ankle dorsiflexion strength (114.53 ± 10.47 N vs. 156.34 ± 13.26 N), heel lift strength (78.69 ± 5.44 N vs. 105.45 ± 8.28 N), stability scores (4.73 ± 0.52 vs. 8.65 ± 0.71 points), and ROM (dorsiflexion: 16.49° ± 1.23° vs. 22.35° ± 1.65°; plantar flexion: 27.58° ± 6.51° vs. 43.27° ± 5.45°). CAI patients reported higher activity limitation (6.34 ± 1.25 vs. 2.16 ± 0.55) and pain (5.37 ± 1.02 vs. 0.23 ± 0.01) and prolonged Agility T-test (11.24 ± 1.37 s vs. 7.51 ± 1.16 s) and figure-of-eight (16.35 ± 1.67 s vs. 12.43 ± 1.39 s) times. FAOS subscale scores (symptoms, daily activities, sports, pain) were significantly lower in the CAI group. All p < 0.05. Conclusions: CAI significantly compromises ankle dorsiflexion, heel lift strength, stability, and functional mobility, correlating with increased pain, activity restriction, and diminished quality of life. Rehabilitation should prioritize neuromuscular re-education, strength restoration, and dynamic stability training to improve outcomes. Full article

Talocalcaneal coalition is a frequent cause of painful rigid flatfoot in adolescents and young adults, resulting from congenital failure of segmentation with fibrous, cartilaginous, or osseous bridging of the subtalar joint. Clinical presentation typically coincides with skeletal maturation and includes hindfoot pain, recurrent ankle sprains, progressive stiffness, and characteristic planovalgus deformity. Although prevalence is likely underestimated, advances in imaging have improved recognition and characterization. Diagnosis relies on the integration of clinical findings with imaging, where computed tomography (CT) remains the reference standard, while magnetic resonance imaging (MRI) enables accurate detection of both osseous and non-osseous coalitions and associated soft-tissue changes. This narrative review aims to provide a comprehensive and updated synthesis of current concepts in talocalcaneal coalition, with specific focus on its clinical implications and contemporary management strategies. We critically analyze diagnostic pathways, including emerging modalities such as weight-bearing CT, and discuss evidence-based indications for conservative treatment, coalition resection, and arthrodesis. Particular attention is devoted to patient selection, prognostic factors, and evolving minimally invasive techniques. Current limitations and areas of controversy are highlighted, emphasizing the need for standardized imaging criteria and optimized treatment algorithms to improve long-term functional outcomes. Full article

Background and Objectives: Functional Ankle Instability (FAI) is a sequela of ankle sprains; however, its associated variables in volleyballers have not been studied. This study aimed to determine the prevalence of FAI and the association between FAI and its associated variables in volleyball players. Materials and Methods: An observational study with a sample size of 128 male volleyballers, aged 18 years and older, was conducted using the Arabic-Identification of Functional Ankle Instability (Ar-IdFAI) questionnaire. The prevalence of FAI was analyzed in terms of frequency and percentage. The Mann–Whitney U test, Spearman’s test, and t-test were used to analyze the associations between the demographic variables and the categorical variables, and a logistic regression model was applied to identify the independent associations with FAI. Statistical significance was set at p < 0.05. Results: The prevalence of FAI in the sample was 44.53%. Bivariate analysis and the regression model indicated no significant direct association between FAI and age, Body Mass Index (BMI), playing duration, weekly training hours, or limb dominance in this sample. Conversely, historical injury burden showed strong and statistically significant associations with FAI (Cramér’s V = 0.59–1.00), with “giving way” demonstrating perfect separation. The logistic regression model showed an acceptable fit (p = 0.676) and moderate explanatory power (Nagelkerke R² = 0.540), with excellent discriminatory performance Area Under the Curve (AUC = 0.855) driven primarily by injury-related variables. Conclusions: FAI is highly prevalent among male volleyball players and is linked to injury history rather than demographic or training characteristics. Injury-related characteristics, including previous ankle injury, reinjury, and episodes of ankle “giving way”, demonstrated strong associations with the presence of Functional Ankle Instability, to be interpreted as descriptive associations rather than a causal link due to methodological structure. Full article

Functional ankle instability (FAI) is a common consequence of lateral ankle sprains, characterized by impaired sensorimotor control. While orthoses and localized vibration have shown individual benefits for FAI, their combined application in a wearable device has not been previously investigated. This pilot randomized trial compared the effects of a vibrotactile foot orthosis (VFO) and a vibrotactile ankle orthosis (VAO) on joint position sense (JPS) and postural control in individuals with FAI. Sixteen participants were randomized to receive either a VFO or a VAO, both delivering 30–50 Hz pulsed vibration in 20 min sessions, three times a week, for two weeks. Outcome measures included joint position sense (JPS) error (°), center of pressure (COP) velocity (mm/s), the Star Excursion Balance Test (SEBT), and the Six-Meter Hop Test (SMHT), which were assessed pre-intervention, immediately post-intervention, and after two weeks of use. The analysis showed a statistically significant interaction between time and intervention group for JPS error (p = 0.02, η² = 0.42). Specifically, the VFO group improved JPS significantly more than VAO at two weeks follow-up (MD = −1.75°, p = 0.005, d = −1.68). Both groups significantly reduced in anteroposterior COP velocity after two weeks (VFO: MD = 1, p = 0.003, d = 1.47; VAO: MD = 1.39, p ˂ 0.001, d = 2.05) with no between-group differences. No changes were observed in the SEBT or SMHT. Plantar-based vibrotactile stimulation was more effective than ankle-based stimulation in enhancing proprioceptive acuity in individuals with FAI. Both interventions improved static postural stability, supporting the potential of integrated vibrotactile orthoses in FAI rehabilitation. No major practical issues were reported during the intervention. Two participants experienced minor discomfort related to the electronic housing bulk in the first week, which was resolved by week two. No further complaints regarding device weight or usability were observed. Full article

Background/Objectives: Improper landing mechanics in Taekwondo can lead to non-contact injuries such as ankle sprains and knee ligament tears, highlighting the necessity for objective methods to evaluate landing stability and injury risk. Electromyography (EMG) enables the examination of muscle activation patterns; however, conventional analyses based on simple averages have limited predictive value. Methods: This study analyzed EMG signals recorded during single-leg landings (45 cm height) in 30 elite male Taekwondo athletes. Participants were divided into regular exercise groups (REG, n = 15) and non-exercise groups (NEG, n = 15). Signals were segmented into two phases. Eight features were extracted per muscle per phase. Classification models (Random Forest, XGBoost, Logistic Regression, Voting Classifier) were used to classify between groups, while regression models (Ridge, Random Forest, XGBoost) predicted continuous muscle activation changes as injury risk indicators. Results: The Random Forest Classifier achieved an accuracy of 0.8365 and an F1-score of 0.8547. For regression, Ridge Regression indicated high performance (R² = 0.9974, MAE = 0.2620, RMSE = 0.4284, 5-fold CV MAE: 0.2459 ± 0.0270), demonstrating strong linear correlations between EMG features and outcomes. Conclusions: The AI-enabled EMG analysis can be used as an objective measure of the study of the individual landing stability and risk of injury in Taekwondo athletes, but its clinical application has to be validated in the future by biomechanical injury indicators and prospective cohort studies. Full article

Background/Objectives: Lower extremity injuries represent a major health concern in elite snowsport disciplines, where high mechanical loads, complex movement patterns, and demanding environmental conditions substantially increase injury risk. Understanding injury incidence and burden in this population is essential for developing sport- and sex-specific prevention strategies. This retrospective study determined lower extremity injury incidence and burden among elite snowsport athletes. Methods: Ninety-nine Turkish National Snowsport Teams Training Camp athletes (34 females; 65 males) consented to a review of their medical records for injury incidence. Overall, sex- and sport-specific injury incidence (number/10,000 h) and burden (weeks missing/10,000 h) were calculated. Results: Overall, medial tibial stress syndrome (MTSS) was the highest burden (9.5 ± 38.7), and ankle sprain (1.7 ± 0.4) was the highest-incident injury. However, injury incidence and burden patterns differed by sex and sport. Notably, medial tibial stress syndrome (MTSS) showed comparable incidence in female and male athletes but resulted in a substantial injury burden in both sexes, reflecting prolonged time-loss from training and competition and indicating a meaningful negative impact on athletic performance. Specifically, the highest-burden injury for women was anterior cruciate ligament (ACL) rupture (16.2 ± 64.5), and for men the most common injury was MTSS (9.7 ± 40.7). For cross-country skiers, MTSS had the highest burden and incidence. For all other sports, and across sexes, ankle sprain was the highest incidence injury—women (1.3 ± 3.0), men (2.0 ± 4.5), biathletes (2.3 ± 5.7), Alpine skiers (2.8 ± 4.5), ski jumpers (1.6 ± 3.1), and snowboarders (3.2 ± 4.7)—plus the highest-burden injury for biathletes (6.9 ± 14.3) and ski jumpers (6.0 ± 14.0). The highest burden injury for Alpine skiers was ACL damage (34.3 ± 87.2), and for snowboarders it was knee collateral ligament injury (27.8 ± 78.6). Moreover, patellar tendinitis, hamstring strains, calf strains, Achilles ruptures, anterior tibial pain, meniscus tears, and hip injuries were frequently observed in injury patterns. Conclusions: Ankle sprains were the most frequent lower extremity injury in elite snowsport athletes, whereas medial tibial stress syndrome (MTSS) and anterior cruciate ligament (ACL) injuries accounted for the greatest injury burden. Injury incidence and burden differed by sex and snowsport discipline. Full article

Background: The Identification of Functional Ankle Instability (IdFAI) questionnaire is widely used to screen for functional ankle instability (FAI), but its link to objective landing kinetics in multidirectional sports like netball is not well-understood. This study aimed to (i) compare landing kinetics between idFAI stratified netball players, and (ii) examine associations between IdFAI scores with dynamic postural stability (DPS) indices and peak vertical ground reaction forces (PvGRF) during vertical drop landings. Methods: A cross-sectional exploratory study using a repeated-measures landing protocol was conducted on female university netball players (n = 24), stratified into FAI (n = 12) and non-FAI (n = 12) groups using the IdFAI (≥11 indicating possible FAI). Participants completed 18 unilateral drop jump landings in forward (FW), diagonal (DI), and lateral (LA) directions. Ground reaction forces (GRFs) were recorded to obtain DPS and PvGRF metrics (1000 Hz). Mann–Whitney U tests compared FAI groups, and Spearman correlations assessed associations (p < 0.05). Results: Players with FAI showed greater anteroposterior instability during LA landings (U = 33.5, p = 0.020, ES = 0.65). IdFAI scores correlated moderately with lateral anteroposterior deficits (rs = 0.473, p = 0.020, CI = 0.062–0.746). Conclusions: These findings suggest that players with greater FAI display increased anteroposterior instability during LA landings, with higher IdFAI scores moderately associated with these deficits. Despite the small exploratory, hypothesis-generating sample, the results emphasize the practical relevance of direction-targeted landing-stability training to improve DPS in vertical landings. This may provide insight into ankle-injury risk among FAI netball players, given that LA landings represent a documented ankle sprain mechanism. Full article

Background: Ankle sprains affect approximately 8% of the general population, and recurrence occurs in as many as 80% of patients participating in high-risk sports. The aim of this review was to assess the impact of physiotherapy interventions on chronic ankle stability (CAI), providing evidence for the effectiveness of clinical treatment and care for patients with CAI. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) evaluating the effectiveness of physiotherapy interventions in athletes with CAI following injury were analyzed. PubMed, Embase, PEDro, and Cochrane electronic databases were searched. A modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the included studies, in accordance with the guidelines. Results: The literature search yielded 316 results, of which 13 articles met all required eligibility criteria and were included in the study. The RCTs included 490 athletes with CAI. Interventions included various types of exercises, including balance training (BT), plyometric training, CrossFit, and neuromuscular training. The duration of the intervention was 4–12 weeks. Both subjective and objective measures were used to assess the effectiveness of the therapy in the following seven domains: Dynamic Balance, Static Balance, Patient-Reported Outcomes, Kinematic Outcomes, Proprioception, Body-Composition, and Strength Assessment. Conclusions: The evidence supports the effectiveness of rehabilitation interventions in athletes with CAI. Further large-scale randomized controlled trials, incorporating control groups and long-term follow-up, are needed to better determine the robust impact of conservative management on improving both the physical and psychological health of patients with CAI. Full article

Background: Ankle sprains are one of the most frequent ligament injuries in elite sports. Despite their high incidence, current rehabilitation approaches are often based on time-based criteria and neglect the physiological status of the injured tissues. Infrared thermography (IRT) is a non-invasive tool useful for detecting temperature asymmetries related to inflammation and tissue dysfunction. This study aimed to analyze the temporal evolution of ankle temperature asymmetry during return-to-play (RTP). Methods: A retrospective observational study of 26 ankle injuries analyzed with thermography that met the inclusion criteria. Thermograms were processed with a software to calculate temperature asymmetry in the ankle region of interest (ankleROI). Statistical analyses included paired and one-sample t-tests, as well as linear regression models, to assess temporal changes throughout the RTP process. Results: A significant hyperthermic response was observed immediately after injury (Δ = +0.594 °C; p < 0.001, Cohen’s d = 0.918). The first significant asymmetry reduction occurred between 21.5 and 28.5 days post-injury (Δ = −0.488 °C; p = 0.004), with a consistent weekly decrease of −0.109 °C (95% CI [−0.143, −0.078]). These findings indicate a progressive decrease in decrement on thermal asymmetry over approximately four weeks of RTP. Conclusions: IRT demonstrates potential as a physiological monitoring tool during the RTP process after ankle sprains. The observed pattern of temperature recovery provides objective reference thresholds that could complement existing functional and clinical criteria. Full article

(1) Background: Ankle joint range of motion is recognized as abnormal in individuals with ankle sprains and Chronic ankle instability (CAI), especially in the dorsiflexion movement. This research investigated the test–retest and inter-rater reliability of the Motustech Beyond IMU for dorsiflexion movement following only one hour of rater training and familiarization. (2) Methods: In total, 62 subjects were evaluated for the inter-rater reliability and test–retest with a one-week interval. The intraclass correlation coefficient (ICC), along with the Concordance Correlation Coefficient (CCC), was determined for each test of reliability. Standard error of measurement, coefficients of variation, limits of agreement (LoA) and minimal detectable change (MDC) were used for the measurement error analysis. (3) Results: Test–retest reliability was ranked excellent (ICC = 0.949) and very high (CCC = 0.897) for both ankle dorsiflexion measurements. On the other hand, Inter-Rater reliability was evaluated as good (ICC = 0.881–0.906) and very high (CCC = 0.783–0.811). However, the measurement error analysis showed poor absolute agreement (LoA), indicating that the resulting measurement variability is considered clinically unacceptable for high-precision applications. (4) Conclusions: Beyond Inertial demonstrated excellent test–retest reliability for ankle dorsiflexion movements, although measurement error analysis showed considerable absolute error. Consequently, it may be considered a reliable tool for single-rater monitoring of ankle dorsiflexion ROM in non-clinical settings such as general physical activity and amateur sports. Future research should investigate its potential role in injury prevention contexts. Full article

Background: Motor Imagery (MI) refers to the mental simulation of movement without physical execution and activates brain areas involved in motor control. Its use in sports rehabilitation is growing due to its potential to promote recovery, reduce fear of re-injury, and maintain neuromuscular engagement. However, the relationship between MI vividness and preferred imagery perspective remains underexplored in professional athletes. The purpose of this study was to examine the effects of a structured MI intervention on imagery vividness—across internal visual (IVI), external visual (EVI), and kinesthetic (KVI) perspectives—during rehabilitation in professional football players. Methods: Fifty-eight professional football players (aged 18–35) recovering from lateral ankle sprains were randomly assigned to an MI group (guided imagery audio) or a Relaxation comparison group (relaxation instructions). Both followed a standardized 4-week physiotherapy program. MI vividness was assessed over six sessions using the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2). Results: A mixed ANOVA revealed a significant main effect of time, with both groups showing improved imagery vividness across sessions (reduced VMIQ-2 scores). No significant time × group interaction was observed, indicating similar improvement patterns. Among the three perspectives, IVI showed the most pronounced improvement. Conclusions: Repeated engagement with cognitive protocols, even without explicit MI instruction, appears to enhance imagery vividness during rehabilitation. The findings highlight the relevance of internal visual imagery for professional athletes recovering from injury and support the integration of MI-based techniques in physiotherapy programs. Full article

Background: Investigating the kinematics of copers, who are individuals with no recurrent ankle sprains, is necessary to prevent the development of chronic ankle instability (CAI). Because the “giving way” of the ankle joint (episodes of excessive inversion of the rearfoot that do not result in an acute lateral ankle sprain) usually occurs during walking, investigating the intrafoot coordination during walking is necessary. This study aimed to identify intrafoot coordination and its variability in copers while walking. Methods: The study included 12 copers, 13 patients with CAI, and ten control patients. The participants were required to walk on a treadmill at a fixed speed of 1.3 m/sec. Using the modified vector coding technique, the coupling angle between the intrafoot joints, representing interjoint coordination, was calculated and categorized into four coordination patterns. The coupling angle standard deviation represented the coordination variability during the stance phase. Results: The coordination between the rearfoot and midfoot in the frontal plane showed a significantly lower proportion of antiphase with proximal dominance in the coper group than in the CAI and control groups during midstance (P < .05). Regarding coordination between the midfoot and forefoot in the sagittal plane, the coper group also showed a significantly lower proportion of in-phase coordination with distal dominance than the CAI group during midstance (P < .05). For coordination between the midfoot and forefoot in the frontal plane, the coper group also showed a significantly lower proportion of antiphase with distal dominance than the CAI group during late stance (P < .05).The coordination variability between the sagittal midfoot and forefoot in the coper group was significantly lower than that in the CAI group and similar to that in the control group during midstance (P < .05). Conclusions: These differences may explain why copers do not experience ankle sprain recurrence. (J Am Podiatr Med Assoc 115(6), 2025; doi:10.7547/23-203) Full article

(1) Background: Chronic ankle instability (CAI), a common outcome of ankle sprains, involves recurrent sprains, balance deficits, and gait impairments linked to both peripheral and central neuromuscular dysfunction. Dual-task (DT) demands further aggravate postural control, especially during stair descent, a major source of fall-related injuries. Yet the biomechanical mechanisms of stair-to-ground transition in CAI under dual-task conditions remain poorly understood. (2) Methods: Sixty individuals with CAI and age- and sex-matched controls performed stair-to-ground transitions under single- and dual-task conditions. Spatiotemporal gait parameters, center of pressure (COP) metrics, ankle inversion angle, and relative joint work contributions (Ankle%, Knee%, Hip%) were obtained using 3D motion capture, a force plate, and musculoskeletal modeling. Correlation and regression analyses assessed the relationships between ankle contributions, postural stability, and proximal joint compensations. (3) Results: Compared with the controls, the CAI group demonstrated marked control deficits during the single task (ST), characterized by reduced gait speed, increased step width, elevated mediolateral COP root mean square (COP-ml RMS), and abnormal ankle inversion and joint kinematics; these impairments were exacerbated under DT conditions. Individuals with CAI exhibited a significantly reduced ankle plantarflexion moment and energy contribution (Ankle%), accompanied by compensatory increases in knee and hip contributions. Regression analyses indicated that Ankle% significantly predicted COP-ml RMS and gait speed (GS), highlighting the pivotal role of ankle function in maintaining dynamic stability. Furthermore, CAI participants adopted a “posture-first” strategy under DT, with concurrent deterioration in gait and cognitive performance, reflecting strong reliance on attentional resources. (4) Conclusions: CAI involves global control deficits, including distal insufficiency, proximal compensation, and an inefficient energy distribution, which intensify under dual-task conditions. As the ankle is central to lower-limb kinetics, its dysfunction induces widespread instability. Rehabilitation should therefore target coordinated lower-limb training and progressive dual-task integration to improve motor control and dynamic stability. Full article

Background/Objectives: Chronic ankle instability is a common issue after lateral ankle sprain. The DMA Clinical Pilates method hypothesizes impairments in tibialis anterior and fibularis longus muscles. Methods: A total of 14 adults with chronic ankle instability, and 15 recovered and 16 healthy individuals were prospectively recruited and assessed for lower back, hip, knee, and ankle muscle activities during dominant and non-dominant sides single-leg stand on stable and unstable surfaces using wireless surface electromyography. Results: The study found consistent dysfunction in tibialis anterior muscle activity in adults with chronic ankle instability when compared with healthy adults during single-leg stand on stable and unstable surfaces, and against recovered individuals on unstable surface. As compared to healthy controls, chronic ankle instability group showed higher vastus lateralis activation during dominant side single-leg stand across surface conditions and during dominant side single-leg stand, while the higher dominant side longissimus dorsi activity on stable surface changed to higher dominant side medial gastrocnemius activity on unstable surface. As compared to recovered controls, chronic ankle instability group also showed higher gluteus medius and fibularis longus muscle activities on unstable surface. Conclusions: Tibialis anterior muscle is the main dysfunction among individuals with chronic ankle instability side. Full article

Background: Functional performance interlimb asymmetry may increase the risk of ankle sprains during basic military training. We aimed to (1) evaluate interlimb balance, agility, and ankle instability asymmetry in soldiers in infantry training as a risk factor for acute ankle sprains; (2) evaluate the effect of ankle sprains and sprain prevention exercise program on performance asymmetry. Methods: Newly inducted infantry soldiers were recruited from two induction cycles (intervention [INT] n = 365, control [CON] n = 421). Participants were assessed at the beginning of infantry basic training (T0) and after four months (T1) for anthropometrics, balance, agility, and perceived ankle instability, and were monitored for ankle sprains (SPRAIN/NO-SPRAIN). The INT group performed an ankle sprain prevention program 5 days/week × 5 min/day. Results: at T0 there were differences in interlimb asymmetry in Cumberland Ankle Instability Tool (CAIT) in SPRAIN soldiers in both groups (p-value < 0.001), and differences between the groups in Hexagon, Y-Balance Test (YBT) and CAIT (p-values 0.007, 0.002, 0.002, respectively). There was a decrease in interlimb asymmetry in Hexagon and YBT for SPRAIN soldiers in the INT group, and an increase in CAIT asymmetry in SPRAIN soldiers in both groups. Stepwise logistic regression did not find predictors for ankle sprains during training. Conclusions: The intervention program reduced interlimb asymmetry in balance and agility for soldiers who sprained their ankle during training. In these soldiers, CAIT asymmetry increased during training regardless of the intervention. Ankle sprain intervention programs should be implemented to reduce interlimb asymmetries in functional abilities and reduce the risk of injury. Full article