Search Results (121)

Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness for mitigating the risk of ankle sprains due to excessive subtalar inversion during high-impact activities, such as landing from a free fall. Methods: We employed biomechanical simulations to assess the influence of translational stiffness on subtalar inversion control, given that inversion angles exceeding 25 degrees are strongly correlated with injury risk. Simulations were conducted using a musculoskeletal model with and without a passive AFO; the stiffness varied in three anatomical directions. A Design of Experiments (DoE) approach was utilized to capture nonlinear interactions among stiffness parameters. Results: The results indicated that increased translational stiffness significantly reduced inversion angles to safer levels, though direction–dependent effects were noted. Based on these insights, we developed a 4D visualization tool that integrates simulation data with an interactive color–coded interface to depict ”safe design” zones for various AFO stiffness configurations. This tool supports clinicians in selecting stiffness values that optimize both safety and functional performance. Conclusions: The proposed framework enhances clinical decision-making and engineering processes by enabling more accurate and individualized AFO designs. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

This study examined the impact of different breath-holding conditions on iliopsoas and other hip flexor muscle activity in individuals with chronic ankle instability (CAI). It has been hypothesised that impaired diaphragmatic function influences iliopsoas activation, potentially contributing to motor control deficits in patients with CAI. Eleven adults with a history of chronic ankle sprain participated in this study. Maximal isometric hip flexion was assessed under three breath-holding conditions: end-expiration, end-inspiration, and the intermediate state. Surface electromyography was used to record the muscle activity of the iliopsoas, rectus femoris, sartorius, and tensor fasciae latae, while the peak hip flexion torque was measured using an isokinetic dynamometer. Under the end-inspiration condition, iliopsoas activity on the affected side was significantly lower than that on the control side (p < 0.05). However, no significant differences were observed between the affected and control sides in the activity of the other hip flexor muscles or the peak hip flexion torque across breath-holding conditions. This study highlights the association between reduced iliopsoas activity during end-inspiration and compromised diaphragmatic function in patients with CAI. Future research should explore dynamic movement tasks and larger sample sizes to elucidate neuromuscular mechanisms further and refine rehabilitation strategies. Full article

Background/Objectives: Adolescent female basketball players are frequently affected by lateral ankle sprains that may progress to chronic ankle instability (CAI) if not adequately managed. This double-blind, prospective, cluster-randomized controlled trial aimed to compare the effects of hop-stabilization training (hop training) and those of traditional balance training on ankle instability and functional performance of this population. Methods: Thirty-two adolescent female basketball players with CAI were cluster-randomized into the hop training group (HG; n = 16) or balance training group (BG; n = 16). Participants completed three 20 min sessions per week for 6 weeks. The hop training protocol comprised multiplanar hopping exercises with progressive increases in the landing volume and an emphasis on controlled landing mechanics. The balance training protocol included single-leg stance and basketball-specific dynamic activities with gradually increasing difficulty. Primary outcomes were self-reported ankle stability (Cumberland ankle instability tool [CAIT] score) and performance test results (t-test, lateral hop test, figure-8 hop test results). Secondary outcomes included static and dynamic balance and isometric ankle strength (dorsiflexion [DF], plantar flexion, inversion, eversion [EV]). Assessments were conducted at baseline and after interventions. Results: The HG and BG exhibited significant improvements in CAIT scores and balance. However, the HG demonstrated significantly greater enhancements in dynamic performance test results and notable improvements in DF and EV strength compared to those of the BG. Conclusions: Hop training comprising the close replication of the multidirectional and dynamic demands of basketball was more effective than traditional balance training for enhancing functional performance and ankle strength. Full article

Background: Lateral ankle sprains can result in adverse outcomes, including reinjuries or chronic ankle instability. The peroneal musculature plays a key role in stabilizing the ankle and preventing sudden ankle inversions that may lead to sprains. Objective: The purpose of the study is to investigate (1) inter-limb differences in peroneal myoelectrical activity in athletes with a history of ankle sprain during the past six months and (2) to investigate peroneal myoelectrical activity differences between athletes with and without a history of ankle sprain. Methods: Sixty-seven athletes (53% females, 46.3% males) were included in this observational cross-sectional study. Self-reported data regarding history of ankle sprain were collected. The peroneal myoelectrical activity was obtained during (1) isometric ankle eversion, (2) dynamic ankle eversions, (3) single leg squat, (4) unilateral and (5) bilateral drop jump test, (6) sprint, and (7) change of direction. Results: No significant differences in peroneal myoelectrical activity were observed between individuals with (n = 46) and without (n = 21) a history of ankle sprain in the past six months (p > 0.05). Additionally, no significant inter-limb differences were found within the previous ankle sprain group (p > 0.05). Conclusions: This study found no significant inter-limb differences in peroneal muscle activity among athletes with a history of ankle sprain during the past six months. Moreover, no differences were observed between athletes with and without a history of ankle sprain. This study has certain limitations, including the lack of data regarding the timing and severity of the ankle sprain, as well as the duration and specific characteristics of the rehabilitation process. Full article

This study aims to identify the prevalence and patterns of sports injuries in recreational sports activities in South Korea. This study utilized data from the “survey of safety accidents” conducted by the Korea Sports Safety Foundation and finally, 3182 recreational sports participants who experienced injuries were selected for the study. For data processing, data related to recreational sports injuries were first collected and organized using Excel 2015, and frequency analysis was conducted using the SPSS 25.0 program. Furthermore, the association rule method was applied via Python 3.13.3 to analyze the patterns of injury sites and types. First, by investigating the prevalence of injuries in recreational sports, it was found that the injury frequency was highest in soccer, followed by cycling, hiking, and badminton. Second, in soccer, it was found that when ankle injuries, which have a high injury frequency, occur, knee, toe, and sprain injuries also occur together (Lift: 1.843). Additionally, in cycling, when knee injuries occur, toe, sprain, and strain (bruise) injuries also occur together (Lift: 2.420). In mountain biking, when ankle injuries, which have a high injury frequency, occur, cuts, sprains, stab wounds (cuts), sprains, and strains (bruises) also occur together (Lift: 1.808). The current survey on recreational sports injuries is expected to be used as basic data to prevent injuries in advance for participants in recreational sports, and it is expected that this will allow them to participate in sports by recognizing common injury sites before participating in sports. Full article

Background: Soccer is associated with substantial injury risk, with reported between 13 to 35 injuries per 1000 player-hours of competitive play. Notably, approximately 77% of soccer-related ankle injuries are attributed to ankle sprain injuries (ASIs). ASI can lead to chronic ankle instability, obesity, and post-traumatic osteoarthritis. This study focuses on identifying factors such as gender, age, body mass index (BMI), and a history of ASIs, which contribute to the development of ASI in soccer players. Methods: A systematic literature search was conducted in October 2023 across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and ProQuest, without applying any filters. Keywords included ankle, ankle joint, sprain, risk factors, etc. Data extraction was performed on the included studies, with findings standardized and analyzed using Stata Statistical Software: Release 17 to determine a weighted treatment effect. Results: Our systematic review included 26 studies. The meta-analysis revealed that a history of ankle sprain is the most significant risk factor for future ASIs. BMI emerged as a risk factor in three out of seven studies, while age and height were significant in one out of six studies each. Gender and weight were not found to significantly affect ASI occurrence. Other factors identified but not subjected to a meta-analysis due to methodological heterogeneity or insufficient studies included playing surface, joint laxity, muscle weakness, match congestion, strength asymmetries, ground reaction forces, balance maintenance, skill level, and playing position. Conclusions: This research contributes valuable insights into the prevention of ASIs in soccer, highlighting the importance of previous ankle sprains and playing surface quality. These findings assist sports professionals in developing optimal conditions and strategies for effective ankle sprain prevention. Full article

Aim: The aim of this study was to analyze service-related musculoskeletal injuries of professional firefighters in 2021–2023. Material and methods: Analysis was completed on the basis of annual reports on the injury status of the State Fire Service (SFS) obtained from the Office of Occupational Safety and Health (OOSH) at General Headquarters. The report databases were searched using keywords typical of bone injuries and including anatomical names: “sprain”, “fracture”, “dislocation”, “bone injury”, “bone”, “joint”, “spine”, “skull and “musculoskeletal injury”. Results: Events matching the analysis target of N = 1944 (2021—n = 707; 2022—n = 589; 2023—n = 648) accounted for 49.4% from all accidents in the State Fire Service in Poland in the analyzed period. A significant increase in the analyzed period 2021–2023 was observed in events where the cause of injury was sports activities (45% vs. 49% vs. 63%, p < 0.001). A significant decrease was observed in events where the cause of injury was interventions (26% vs. 27% vs. 17%, p < 0.001), technical and maintenance (TM) work (8% vs. 6% vs. 5%, p = 0.008) and category “other” (15% vs. 14% vs. 11%, p = 0.034). Statistically significant differences were found between cause and the type of injury (p = 0.002), season (p < 0.001) and the location of injury (p < 0.001). Conclusions: A large number of musculoskeletal injuries are associated with sports activities, which is inherent in the risks of the activities. The lower extremities are most affected by injuries during sports activities The spring period dominates in the season category, which may be related to the difficulty of the terrain and return to increased sports activity after the winter period. Full article

Background/Objectives: Ankle sprain is one of the most common sports injuries globally. Despite its prevalence, the adequacy of knowledge in managing ankle sprain among physiotherapists in Saudi Arabia has not been assessed. This study aimed to assess the knowledge and degree of adherence to clinical practice guidelines (CPG) for the management of ankle sprains among physiotherapists. Methods: This study was a cross-sectional with national online questionnaire administered to participants through an online platform. It comprised three sections. The first section collected demographic data. The second section presented two clinical cases as the basis for the participants’ management decisions (the first with negative Ottawa Ankle Rules (OAR) and the second with positive OAR); participants were classified as “following”, “partially following”, “not following”, and “partially not following” the CPGs. In the third section, on a Likert scale (1–5), participants indicated how much they agreed with various CPGs statements. Results: A total of 381 physiotherapists (mean age: 28 ± 5; male: 57.1%) completed the questionnaire. In the case of acute ankle sprain with negative OAR, 0.2% of the participants were considered as “following” CPGs, 31.4% as “partially following”, 19.6% as “partially not following”, and 48.5% as “not-following”. In the case of acute ankle sprain with positive OAR, 5.2% were considered as “following” CPGs, 55.9% as “partially not following”, and 38.8% as “not following”. The knowledge assessment section elicited a 50% agreement among the participants on the 11 provided statements. Conclusions: Most physiotherapists have suboptimal adherence to CPG for managing ankle sprains, thus highlighting an evidence-to-practice gap. Full article

Background: Contrast therapy (CT) is a non-pharmacological treatment that alternates between cryotherapy and thermotherapy. It helps reduce VAS pain, improve joint ROM, enhance function, alleviate muscle soreness, and manage swelling, while also improving blood circulation. This scoping review summarizes recent studies on its use for musculoskeletal injuries (e.g., exercise-induced muscle damage, ankle sprain), degenerative conditions (e.g., osteoarthritis), and painful disorders (e.g., complex regional pain syndrome), assessing its healing potential compared to other conservative therapies. Methods: PubMed, Scopus, and Cochrane Library were searched to identify relevant publications. Articles were selected using the following inclusion criteria: randomized controlled trials, written in English, published between 2004 and 2024, and addressing the use of CT in the management of musculoskeletal painful conditions. Results: Data from 7 articles and 303 patients with musculoskeletal painful conditions treated with CT were included. There was considerable heterogeneity in terms of treatment protocols, with significant differences in the application method, duration, sequence of individuals in each hot/cold cycle, total treatment time, and the pathologies studied. Nevertheless, all studies showed an improvement in the patients’ initial clinical conditions. Conclusions: This review highlights the lack of guidelines for the clinical use of CT in musculoskeletal painful conditions. The heterogeneity of the studies reviewed (different clinical scores, follow-up periods, data, and samples) makes the results imprecise. In addition, the modest quality of the trials does not allow the authors to draw clear conclusions about the effectiveness of CT compared with other therapies. Full article

Background: An ankle sprain is a frequent musculoskeletal injury, often leading to chronic instability and an increased risk of post-traumatic osteoarthritis. Kinesio Tape, an elastic adhesive tape, is widely used in rehabilitation for its supposed benefits in reducing pain, controlling edema, and improving ankle function. However, its effectiveness in managing acute ankle sprains remains debated. Methods: This systematic review aims to evaluate the evidence on the impact of Kinesio Taping on pain reduction, edema control, and return to sport in patients with acute ankle sprains. A systematic review was conducted in line with the PRISMA guidelines. The literature from PubMed, MEDLINE, and the Cochrane Library was searched for studies published from 2004 to 2024. Seven studies met the inclusion criteria, involving 247 patients with acute ankle sprains. Data on patient demographics, follow-up duration, Kinesio Taping protocols, and clinical outcomes were extracted and analyzed. Results: The review revealed mixed findings. Some studies reported short-term pain relief and reduced need for analgesics in the Kinesio Taping group, especially when combined with manual therapy. However, no significant differences were found in the edema control compared to bracing or casting. Functional recovery, as assessed by scales like the Karlsson scoring scale, showed no clear advantage for Kinesio Taping over other treatments. Conclusions: Kinesio Taping provides limited benefits for ankle sprain management, particularly in terms of long-term functional recovery and edema reduction. While it may offer short-term pain relief, it should be considered as an adjunctive treatment rather than a primary intervention. Full article

Background/Objectives: Acute ankle sprains are common injuries that significantly affect both sports and daily activities. Syndesmotic injuries, a specific type of ligamentous damage, can occur as a part of a sprain or alongside fractures, affecting approximately 20% of ankle fractures. The aim of this study was to evaluate negative prognostic factors influencing surgical outcomes in tibiofibular syndesmotic injuries associated with ankle fractures. Methods: Data from 246 patients were analyzed to examine the impact of initial ankle dislocation, fracture type, and fixation method on postoperative complications and reoperation rates. Ankle joint fractures were treated with open reduction and internal fixation using an anatomically contoured plate designed for optimal tibia and fibula fixation. Four methods of syndesmosis fixation were recorded: one three-cortical screw, one four-cortical screw, two screws (either both four-cortex screws or one three-cortex and one four-cortex screw), or one endobutton. Data analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results: Key findings reveal no significant association between initial dislocation and the necessity for reoperation (p = 0.613). However, smoking combined with dislocation significantly increases reoperation rates (35% vs. 15.5%, p = 0.026). Fixation type influenced outcomes, with single four-cortex screws linked to pain but fewer infections. Infection was the most common complication (33.3%), predominantly after fixation with a single three-cortex screw. Men had higher rates of fixation destabilization and infections, while women experienced pain persisting beyond six months postoperatively Conclusions: Patient-specific factors influence syndesmotic injury outcomes. Smoking, gender, and fixation type impact complications, emphasizing the need for tailored surgical approaches to enhance recovery and minimize reoperation risks. Future research should aim to corroborate these findings in larger, multicentric cohorts to refine surgical strategies for syndesmotic injury management. Full article

The ankle, a pivotal and intricate joint within human anatomy, is particularly susceptible to injuries, notably sprains, due to its complex structural composition and the substantial load it endures, especially among high-performance athletes, thereby necessitating the development of innovative, patient-specific rehabilitation solutions to address the challenges presented during the recovery process. In response to this, a non-surgical approach is proposed, involving the meticulous design and implementation of a personalized orthosis. It will be designed employing additive manufacturing with polyethylene terephthalate glycol (PETG), which facilitates immobilization while also enhancing breathability and comfort through the strategic incorporation of hexagonal holes. It demonstrates significant promise in its innovative design, customizability, and potential applicability, contributing to the broader field of biomechanics and orthopedic rehabilitation. Full article

Ultrasound has emerged as a valuable imaging modality for evaluating ligamentous injuries around the ankle joint, offering several advantages over traditional imaging techniques. It is more cost-effective and widely available than MRI, and it avoids the ionizing radiation exposure associated with X-rays, making it a safer option, particularly for pediatric and adolescent populations. In cases of inversion ankle sprains, ultrasound allows for more accurate assessment of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) compared to X-rays and manual examination and yields diagnostic results comparable to MRI. For high ankle sprains involving syndesmosis injuries, ultrasound—especially stress ultrasound—has shown high diagnostic accuracy. Additionally, ultrasound evaluation of the deltoid ligament (DL) in cases of ankle fractures can aid surgeons in determining the need for ligament repair in conjunction with fracture management. This review explores recent developments in ultrasound imaging of the lateral, medial, and syndesmotic ligaments of the ankle joint and discusses its potential applications for evaluating the spring and posterior ligaments. The review provides a comprehensive overview of the ever-expanding role of ultrasound in the management of ankle ligamentous injuries. Full article

The assessment of running kinematics is essential for injury prevention and rehabilitation, including anterior cruciate ligament sprains. Recent advances in computer vision have enabled the development of tools for quantifying kinematics in research and clinical settings. This study evaluated the accuracy of an OpenPifPaf-based markerless method for assessing sagittal plane kinematics of the ankle, knee, and hip during treadmill running using smartphone video footage and examined the impact of clothing on the results. Thirty healthy participants ran at 2.5 and 3.6 m/s under two conditions: (1) wearing minimal clothing with markers to record kinematics by using both a smartphone and a marker-based system, and (2) wearing usual running clothes and recording kinematics by only using a smartphone. Joint angles, averaged over 20 cycles, were analysed using SPM1D and RMSE. The markerless method produced kinematic waveforms closely matching the marker-based results, with RMSEs of 5.6° (hip), 3.5° (ankle), and 2.9° (knee), despite some significant differences identified by SPM1D. Clothing had minimal impact, with RMSEs under 2.8° for all joints. These findings highlight the potential of the OpenPifPaf-based markerless method as an accessible, simple, and reliable tool for assessing running kinematics, even in natural attire, for research and clinical applications. Full article