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Moving to New Jersey from Philadelphia was stressful, but at least Jada has found Ms. Marianne's Academy of Dance, where she can continue to dance ballet. She's not sure that the other girls at the Academy welcome her, and when she sprains her ankle in practice she's sure that the whole universe is against her.

Limited ankle dorsiflexion range of motion is one of the most important risk factors for lower limb injury, which changes the biomechanics and the neuromuscular control of the lower limb muscles. This study aims to test the effectiveness of a comprehensive corrective exercise program (CCEP) on the range of motion, proprioception, dynamic balance, and muscle activation in female athletes with limited weight-bearing lunge ankle dorsiflexion range of motion. 30 female athletes aged 15 to 25 years with dorsiflexion under 34° were randomized to two groups. The intervention group (n = 15) received eight weeks of CCEP including soft tissue mobilization, joint mobilization, stretching, and strengthening, and the control (n = 15) group did not receive any intervention. range of motion, proprioception, dynamic balance, and muscle activation were assessed before and after the intervention. The training group showed clinically acceptable and statistically significant changes in ankle dorsiflexion range of motion (ES = 0.714), balance (ES = 0.423), and proprioception (ES = 0.253; P < 0.05). There were significant changes in the activity of the tibialis anterior and soleus muscles in the dynamic overhead squat test (descending and ascending phases) and the activity of the medial gastrocnemius in the descending phase decreased significantly (P < 0.05). No significant change was observed in the activity of the peroneus longus muscle (P > 0.05). The findings show that CCEP appears to be beneficial in increasing dorsiflexion range of motion, proprioception, balance, and decreasing ankle muscle activity among individuals with limited ankle dorsiflexion. Improving the dorsiflexion range of motion may be promising for reducing ankle sprain injury.

Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown. To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI. Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652). High school athletic training facilities. Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups. Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises. Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different. Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P < .05). However, no intervention group was superior. All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

Purpose The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions. Methods A questionnaire was sent to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects. Results Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3–6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered. Conclusions Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI. Level of evidence V.

Background Total ankle arthroplasty (TAA) is an alternative to arthrodesis, but no randomized trial has examined whether a fixed bearing or mobile bearing implant provides improved gait mechanics. Questions/purposes We wished to determine if fixed- or mobile-bearing TAA results in a larger improvement in pain scores and gait mechanics from before surgery to 1 year after surgery, and to quantify differences in outcomes using statistical analysis and report the standardized effect sizes for such comparisons. Methods Patients with end-stage ankle arthritis who were scheduled for TAA between November 2011 and June 2013 (n = 40; 16 men, 24 women; average age, 63 years; age range, 35–81 years) were prospectively recruited for this study from a single foot and ankle orthopaedic clinic. During this period, 185 patients underwent TAA, with 144 being eligible to participate in this study. Patients were eligible to participate if they were able to meet all study inclusion criteria, which were: no previous diagnosis of rheumatoid arthritis, a contralateral TAA, bilateral ankle arthritis, previous revision TAA, an ankle fusion revision, or able to walk without the use of an assistive device, weight less than 250 pounds (114 kg), a sagittal or coronal plane deformity less than 15°, no presence of avascular necrosis of the distal tibia, no current neuropathy, age older than 35 years, no history of a talar neck fracture, or an avascular talus. Of the 144 eligible patients, 40 consented to participate in our randomized trial. These 40 patients were randomly assigned to either the fixed (n = 20) or mobile bearing implant group (n = 20). Walking speed, bilateral peak dorsiflexion angle, peak plantar flexion angle, sagittal plane ankle ROM, peak ankle inversion angle, peak plantar flexion moment, peak plantar flexion power during stance, peak weight acceptance, and propulsive vertical ground reaction force were analyzed during seven self-selected speed level walking trials for 33 participants using an eight-camera motion analysis system and four force plates. Seven patients were not included in the analysis owing to cancelled surgery (one from each group) and five were lost to followup (four with fixed bearing and one with mobile bearing implants). A series of effect-size calculations and two-sample t-tests comparing postoperative and preoperative increases in outcome variables between implant types were used to determine the differences in the magnitude of improvement between the two patient cohorts from before surgery to 1 year after surgery. The sample size in this study enabled us to detect a standardized shift of 1.01 SDs between group means with 80% power and a type I error rate of 5% for all outcome variables in the study. Results This randomized trial did not reveal any differences in outcomes between the two implant types under study at the sample size collected. In addition to these results, effect size analysis suggests that changes in outcome differ between implant types by less than 1 SD. Detection of the largest change score or observed effect (propulsive vertical ground reaction force [Fixed: 0.1 ± 0.1; 0.0–1.0; Mobile: 0.0 ± 0.1; 0.0–0.0; p = 0.0.051]) in this study would require a future trial to enroll 66 patients. However, the smallest change score or observed effect (walking speed [Fixed: 0.2 ± 0.3; 0.1–0.4; Mobile: 0.2 ± 0.3; 0.0–0.3; p = 0.742]) requires a sample size of 2336 to detect a significant difference with 80% power at the observed effect sizes. Conclusions To our knowledge, this is the first randomized study to report the observed effect size comparing improvements in outcome measures between fixed and mobile bearing implant types. This study was statistically powered to detect large effects and descriptively analyze observed effect sizes. Based on our results there were no statistically or clinically meaningful differences between the fixed and mobile bearing implants when examining gait mechanics and pain 1 year after TAA. Level of Evidence Level II, therapeutic study.

Purpose To compare the surgical outcomes of the two different ankle stabilization techniques. Methods This randomized controlled trial aimed to compare the outcomes of the modified Broström procedure with [calcaneofibular ligament (CFL) group] or without CFL repair [anterior talofibular ligament (ATFL) only group]. Of the 50 patients randomly assigned to two groups, 43 were followed up prospectively for ≥ 2 years (CFL group: 22 patients, 36.6 ± 13.1 months; ATFL Only group: 21 patients, 35.3 ± 11.9 months). Functional outcomes were assessed using the Karlsson–Peterson and Tegner activity level scoring systems. Anterior talar translation (ATT), talar tilt angle (TTA), and degrees of displacement of the calcaneus against the talus on stress radiographs were measured. All parameters were compared between the two groups. Multiple regression analysis setting the postoperative Karlsson–Peterson score as the dependent variable was performed to determine the significant variable. Results There were no significant differences between the two groups in functional (Karlsson–Peterson and Tegner activity level) scores at the last follow-up and their changes. There were no significant differences between the two groups in the ATT, TTA, their differences compared with the contralateral ankles, and degrees of displacement of the calcaneus against the talus at the last follow-up. Osteochondral lesion of the talus rather than CFL repair was the significant variable related to functional outcome. Conclusion The modified Broström procedure with additional CFL repair did not result in a significant advantage in any measured outcome at 3 years. Level of evidence Randomized controlled trial, Level I.

Background Ankle sprain is one of the common traumatic injuries in daily life, and PRICE (protection, rest, ice, compression pressure bandaging, elevation of the affected limb) principle is routinely recommended at its early stage. In traditional Chinese medicine (TCM), bone-setting technique (BST) can quickly relieve ankle pain and improve walking function, but physicians require high skills and physical strength. In this study, we designed an exercise—heel kicking exercise (HKE) based on the principles and methods of BST. This study aims to observe its true efficacy and safety. Methods 68 patients (18–45 years old) with grade I and II lateral ankle sprain within 48 h were recruited from TCM hospital affiliated to Guangzhou medical university and 60 cases meeting the criteria were enrolled and randomized into control group and intervention group (30 cases separately). The patients in both groups were treated with the PRICE and ankle pump exercise, and the ones in intervention group added heel kicking exercise (HKE). The visual analogue scale (VAS) for pain, swelling degree, and American orthopedic foot & ankle society ankle-hindfoot scale (AOFAS) score before and after the intervention (within 4 W), and Karlsson score (the 26th week follow-up) were measured. Results Before treatment, there were no significant differences in VAS scores, swelling degrees and AOFAS scores between two groups. During the treatment for 4 weeks, VAS scores and swelling degrees of the patients in both groups gradually decreased, and the AOFAS score gradually increased ( p  < 0.01). In addition, patients in the intervention group were observed to get a quicker pain reliever, swelling subsiding, and ankle function restore than those in control group at most of time points of observation (1st d, 3rd d, 1st w, 2nd w, 4th w) ( p  < 0.05, p  < 0.01). But there was no significant difference in Karlsson scores between two groups at the 26th week follow-up. Conclusions HKE is a method designed to provide rapid movement rehabilitation for patients with ankle sprains, which can be used as one of its basic treatments. Trial registration This study was registered in China Clinical Trial Center (NO. ChiCTR2300073709). Trial registration date: August 16th 2022.

The primary inquiry of this study was to determine if exergaming is more effective than balance training in improving dynamic postural control during jump-landing movements among athletes with chronic ankle instability (CAI). Additionally, the study aimed to compare the effectiveness of these interventions on clinical and psychological outcomes. This study was a randomized, single-blinded, controlled trial in which participants were assigned to either an exergaming group or a balance training group. Outcome measures were assessed before, after, and one month following the intervention. Primary outcomes included the stability index (SI) and time to stabilization (TTS) in the anteroposterior (AP), mediolateral (ML), and vertical (V) directions, the dynamic postural stability index (DPSI), and the resultant vector time to stabilization (RVTTS). Secondary outcomes included performance, fear of movement, and perceived ankle instability, measured using the side-hop test, the Tampa Scale for Kinesiophobia (TSK), and the Cumberland Ankle Instability Tool (CAIT), respectively. Results indicated a significant decrease in ML SI in both groups one month after treatment compared to before and after treatment (P = 0.013 and P<0.001, respectively). Additionally, one-way ANCOVA revealed a significant difference between the groups post-treatment (F(1,31) = 6.011, P = 0.020, η2 = 0.162) and one month post-treatment (F(1,31) = 4.889, P = 0.035, η2 = 0.136), with ML SI being significantly lower in the exergaming group than the balance training group at both time points. In both group, the DPSI also decreased significantly one month post-treatment compared to before and after treatment (P = 0.040 and P = 0.018, respectively). Both groups showed improvements in performance, severity of perceived ankle instability, and fear of movement. Thus, the study concluded that both exergaming and balance training effectively improved postural control during jump-landing, with exergaming showing superior performance in the ML direction both after and one month post-treatment. In terms of clinical and psychological outcomes, both interventions were effective, with neither showing superiority over the other.

Background The presence of chondral lesions in patients with chronic ankle instability is common and has been suggested as a possible cause of persistent pain in some cases, even after successful ligament reconstruction. For this reason, some authors have proposed combining ankle stabilization with cartilage microfracture; however, the results reported in literature are contradictory. Materials and methods The study was designed as a prospective randomized clinical study with two parallel arms. Patients with an anterior talofibular ligament tear causing pain and instability, associated with a Berndt–Harty stage I–IIb talar osteochondral lesion of < 150 mm 2 that had not responded to conservative treatment, were blindly assigned to either isolated ligament reconstruction (REC) or reconstruction plus microfracture (REC + MIC). Evaluators were also blinded. Results A total of 71 patients were included in the study, with 36 in the REC group and 35 in the REC + MIC group. The groups were comparable in terms of anthropometry and pathology. The operating time was significantly longer in the REC + MIC group (48.0 ± 4.5 min) compared with the REC group (24.9 ± 3.9 min; p  < 0.001). At the end of follow-up, both patient groups showed similar results on the American Orthopaedic Foot and Ankle Society (AOFAS) score ( p  = 0.755), Self-Reported Foot and Ankle Score (SEFAS) ( p  = 0.862), Karlsson score ( p  = 0.993), and visual analog scale (VAS) ( p  = 0.870). However, the time to recovery differed between the groups, with patients in the REC group recovering faster from before the operation (pre-op) through the third month after the operation (post-op). The difference in recovery at 3 months post-op was statistically significant on the AOFAS ( p  < 0.001), SEFAS ( p  < 0.001), and Karlsson ( p  < 0.001) scores. No statistically significant difference was observed in terms of pain ( p  = 0.342). The failure rate was also comparable between the groups, with four (11.1%) reoperations in the REC group and five (14.3%) in the REC + MIC group ( p  = 0.735). Conclusions At 2 years post surgery, no differences were observed in function (according to the AOFAS, SEFAS, and Karlsson scores), pain, or complications in patients with ankle instability and associated chondral damage treated with or without microfractures. However, patients who underwent microfractures experienced a significantly slower recovery of function. Level of evidence: Level 1. Trial registration: ClinicalTrials.gov Identifier NCT06947317 (retrospectively registered). Date: 1 May 2025. ( https://clinicaltrials.gov/study/NCT06947317 ).