Plantar pressure analysis of different orthoses in patients after first metatarsophalangeal joint arthrodesis.

BACKGROUND: There is no gold standard for a walking orthosis after first metatarsophalangeal joint (MTPJ) arthrodesis surgery. Evaluation of plantar pressure measures and patient perceptions for different orthoses may assist surgeons to choose a postsurgery orthotic. The purpose of this study was to measure plantar pressure under the distal first ray during walking and patient perceptions of comfort, stability, and preference with 4 different orthoses in patients with a history of first MTPJ arthrodesis. METHODS: Crossover study in a university laboratory. Eleven patients volunteered (8 female, 3 male, age = 59.4 ± 9.1 years, 21.9 ± 17.5 months since surgery) who had a unilateral first MTPJ arthrodesis procedure more than 6 months before study participation. Four orthosis conditions were evaluated in all participants: patient's shoe, carbon fiber insert, OrthoWedge, and Post-Op Shoe. We analyzed peak plantar pressure and pressure-time integral under the whole foot and the distal first ray as well as recorded subjective rating for comfort and stability. Rank ordered for preferred orthosis. RESULTS: OrthoWedge had significantly lower whole-foot and distal first ray peak pressure than the other conditions. The pressure-time integral for the OrthoWedge was significantly less than the Carbon Fiber Insert and Post-Op Shoe. For stability, comfort, and condition preference, the OrthoWedge was ranked lowest among the 4 conditions. CONCLUSIONS: The OrthoWedge generated the lowest peak plantar pressure but was subjectively ranked as the least preferred orthosis. This discrepancy between objective biomechanical and subjective comfort measures must be weighed as surgeons prescribe an orthosis to patients after first MTPJ arthrodesis.

Transference of outdoor gait-training to treadmill running biomechanics and strength measures: A randomized controlled trial.

Outdoor gait-training has been successful in improving pain and reducing contact time during outdoor running for runners with exercise-related lower leg pain (ERLLP). However, it is unclear if these adaptations translate to gold standard treadmill running and clinical strength assessments. The study purpose was to assess the influence of a 4-week outdoor gait-training intervention with home exercises (FBHE) on treadmill running biomechanics and lower extremity strength compared to home exercises alone (HE) among runners with ERLLP. Seventeen runners with ERLLP were randomly allocated to FBHE and HE groups (FBHE: 3 M, 6F, 23 ± 4 years, 22.0 ± 4.6 kg/m2; HE: 3 M, 5F, 25 ± 5 years, 24.0 ± 4.0 kg/m2). Both groups completed eight sessions of home exercises over 4 weeks. The FBHE group received gait-training through wearable sensors to reduce contact time. Treadmill running gait and clinical strength assessments were conducted at baseline and 4-weeks. Multivariate repeated measures analyses of variance were used to assess the influence of group and timepoint for all outcomes. The FBHE group demonstrated significantly decreased contact time at 4-weeks compared to baseline and the HE group (Mean Difference [MD] range: -42 ms - -39 ms; p-range: <0.001-0.02). The FBHE group had significantly increased cadence (MD: +21 steps/min; p = 0.003) and decreased loading impulse (MD: -51, p < 0.001) during treadmill running at 4-weeks compared to the HE group. Strength did not significantly differ adjusting for multiple comparisons (p > 0.007). The outdoor FBHE intervention transferred to favorable changes in treadmill running biomechanics. Clinicians treating runners with ERLLP patients should implement data-driven outdoor gait-training to maximize patient benefits across running locations.

Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol.

BACKGROUND: Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS: This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION: The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).

An Absence of Persistent Postural Stability Deficits Following a Sport Concussion in Collegiate Athletes.

OBJECTIVE: The purpose of our study was to determine whether persistent postural stability deficits exist in athletes following sport concussion (SC) in comparison with preinjury (baseline) values using Sample Entropy (SampEn). SETTING: Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: Participants consisted of 71 collegiate athletes (44 male, 27 female) with an average age of 19.9 ± 0.96 years who had a history of 1 concussion that occurred during their time as a collegiate athlete. DESIGN: In our prospective, cohort design participants completed the Sensory Organization Test (SOT) at baseline, upon reporting symptom-free following a diagnosed SC, and upon establishing a new baseline prior to the start of the subsequent sport season. MAIN OUTCOME MEASURES: The SOT's condition scores were calculated and analyzed in alignment with the manufacturer's instructions. SampEn was calculated in the anterior-posterior (AP) and medial-lateral (ML) directions from the center-of-pressure oscillations over the 20-second time series for each SOT condition. The SOT and SampEn outcome scores for each condition were analyzed with repeated-measures analyses of variance. RESULTS: Significant main effects were observed for the SOT's conditions 3 ( F1.6, 114.8 = 7.83, P = .001, η2 = 0.10 [0.02-0.20]), 5 ( F1.8, 126.8 = 11.53, P < .001, η2 = 0.14 [0.04-0.25]), and 6 ( F1.9, 134.5 = 25.11, P < .001, η2 = 0.26 [0.14-0.37]), with significant improvements across time. Significant main effects were also observed for SampEn in the AP direction for conditions 3 ( F2, 140 = 7.59, P = .001, η2 = 0.10 [0.02-0.19]) and 6 ( F2, 140 = 6.22, P = .003, η2 = 0.08 [0.011-0.170]), with significant improvements across time. CONCLUSIONS: Following a diagnosed SC, our results suggest that collegiate athletes returned if not exceeded baseline values at the symptom-free and new baseline assessments. The application of linear and nonlinear measures of postural stability following a SC yielded similar outcomes in conjunction with a baseline assessment. Our findings support the clinical utility of the baseline SC assessment when evaluating persisting balance deficits when using linear or nonlinear measures.

Influence of Reduced-Gravity Treadmill Running on Sensor-Derived Biomechanics.

BACKGROUND: Reduced gravity treadmills have become increasingly prevalent in clinical settings. The purpose of this study was to assess the influence of manipulated levels of bodyweight during reduced gravity treadmill running on sensor-derived spatiotemporal, kinematic, and kinetic measures. HYPOTHESES: Reduced gravity conditions would result in significantly altered biomechanical measures compared with 100% gravity conditions, with the most pronounced effects anticipated in the 20% condition. STUDY DESIGN: Cross-sectional clinic-based study. METHODS: A total of 16 runners (8 male [M; age, 28.88 ± 5.69 years; body mass index [BMI], 25.08 ± 3.74 kg/m2], 8 female [F; age, 28.75 ± 5.23 years, BMI, 21.05 ± 3.46 kg/m2]) participated in this study. Participants wore commercially available sensors on their shoelaces and ran in a reduced gravity treadmill at a self-selected pace for 5 minutes each at 100%, 80%, 60%, 40%, and 20% bodyweight in a randomized order. The pace remained constant across all conditions, and rating of perceived exertion (RPE) was obtained following each condition. Step-by-step spatiotemporal, kinematic, and kinetic metrics were extracted to calculate mean outcome measures for each bodyweight condition. Repeated measures analyses of variance were conducted to assess the influence of the different bodyweight reduction levels on RPE and runners' biomechanics. RESULTS: Higher pressure creating lower bodyweight conditions resulted in significantly increased stride length and decreased cadence, contact time, impact g, and RPE, along with a shift toward forefoot strike types compared with higher body weight conditions (P < 0.01). All other outcomes were comparable across conditions. CONCLUSION: Reduced bodyweight running significantly altered spatiotemporal measures and reduced the vertical component of loading. CLINICAL RELEVANCE: Our findings offer objective information on expected biomechanical changes across pressure levels that clinicians should consider when incorporating reduced gravity treadmill running into rehabilitation plans.

Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial.

Objectives: To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes. Design: Randomised controlled trial. Setting: Laboratory and field-based study. Participants: 20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m2). Interventions: Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running. Primary and secondary outcome measures: Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes. Results: The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline. Conclusion: FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence. Trial registration number: NCT04270565.

Effects of Midfoot Joint Mobilization on Perceived Ankle-Foot Function in Chronic Ankle Instability: A Crossover Clinical Trial.

CONTEXT: To investigate the effects of midfoot joint mobilization and a 1-week home exercise program, compared with a sham intervention, and home exercise program on pain, patient-reported outcomes, ankle-foot joint mobility, and neuromotor function in young adults with chronic ankle instability. DESIGN: Crossover clinical trial. METHODS: Twenty participants with chronic ankle instability were instructed in a stretching, strengthening, and balance home exercise program and were randomized a priori to receive either midfoot joint mobilizations (forefoot supination, cuboid glide, and plantar first tarsometatarsal) or a sham laying of hands on the initial visit. Changes in foot morphology, joint mobility, strength, dynamic balance, and patient-reported outcomes assessing pain, physical, and psychological function were assessed pre to post treatment and 1 week following post treatment. Participants crossed over to receive the alternate treatment and were assessed pre to post treatment and 1 week following. Linear modeling was used to assess changes in outcomes. RESULTS: Participants demonstrated significantly greater perceived improvement immediately following midfoot mobilization in the single assessment numeric evaluation (sham: 5.0% [10.2%]; mobilization: 43.9% [26.2%]; ß: 6.8; P < .001; adj R2: .17; Hedge g: 2.09), and global rating of change (sham: -0.1 [1.1]; mobilization: 1.1 [3.0]; ß: 1.8; P = .01; adj R2: .12; Hedge g: 0.54), and greater improved 1-week outcomes in rearfoot inversion mobility (sham: 4.4° [8.4°]; mobilization: -1.6° [6.1°]; ß: -6.37; P = .01; adj R2: .19; Hedge g: 0.81), plantar flexion mobility (sham: 2.7° [6.4°]; mobilization: -1.7° [4.3°]; ß: -4.36; P = .02; adj R2: .07; Hedge g: 0.80), and posteromedial dynamic balance (sham: 2.4% [5.9%]; mobilization: 6.0% [5.4%]; ß: 3.88; P = .04; adj R2: .10; Hedge g: 0.59) compared to the sham intervention. CONCLUSION: Greater perceived improvement and physical signs were observed following midfoot joint mobilization.

Evidence of Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-analysis.

OBJECTIVE: To critically assess the literature focused on strength training of the intrinsic foot muscles (IFM) and resulting improvements in foot function. DATA SOURCES: A search of electronic databases PubMed, CINHAL, Scopus, and SPORT Discus was completed between January 2000 to March 2022. STUDY SELECTION: Randomized control trials (RCTs) with an outcome of interest with at least two weeks of IFM exercise intervention were included. Outcomes of interest were broadly divided in to five categories of foot posture (navicular drop (ND) and Foot Posture Index (FPI)), balance, strength, patient-reported outcomes (PROs), sensory function, and motor performance. The PEDro scale was used to assess the methodological quality of included studies with two independent reviewers rating each study. Studies with a PEDro score greater than 4/10 were included. DATA EXTRACTION: Data from the included studies were extracted by two independent reviewers. These data included design, participant characteristics, inclusion and exclusion criteria, type of intervention, outcomes, and the primary results. Random effects meta-analysis was performed to analyze difference between intervention and control groups for each outcome when there were at least two studies. Standardized mean differences (SMD) describe effect size with a 95% confidence interval (SMD range). When the confidence interval crossed zero the effect was not significant. DATA SYNTHESIS: Thirteen studies were included and IFM exercise interventions were associated with decreasing ND (SMD range=0.37,1.83), and FPI (SMD range=1.03,1.69), improving balance (SMD range=0.18,1.86), strength (SMD range=0.06,1.52) and PROs for disability (SMD range=0.12,1.00) with pooled effect sizes favoring IFM intervention over control. There was no superiority of IFM exercises (SMD range=-0.15,0.66) seen in reducing pain. We could not perform meta-analysis for sensory function and motor performance as there was only study reporting each outcome, however, these results supported the use of IFM strength training. CONCLUSION: IFM strength training is helpful for patients in improving foot and ankle outcomes.

Clinical usage, application procedures, and perceived effectiveness of cupping therapy among healthcare professionals in the United States: A cross-sectional survey.

BACKGROUND: Despite its growing popularity since the mid-1900s, the application procedures and factors influencing the usage of cupping therapy among healthcare professionals in the United States remains unclear. Therefore, the purpose of this study was to investigate the clinical usage, application procedures, and perceived effectiveness of cupping therapy among healthcare professionals in the United States. MATERIALS AND METHODS: A convenience sample of 158 healthcare professionals (age: 29.36 ± 7.42 years) participated in this cross-sectional study (completion rate = 86.15%; n = 158/195). A custom web-based survey designed to assess respondents' clinical incorporation of cupping therapy, was disseminated through snowball sampling on various social media platforms. Descriptive statistics including means, standard deviations, and frequencies were calculated per survey item. RESULTS: Ninety-one percent of respondents reported working as an athletic trainer in either a secondary school (30%) or collegiate setting (48%). Dry cupping was the most commonly reported type of cupping therapy (99%), and 75% of respondents reported using both static and moving cupping techniques. Significant differences in cup application time and the amount of air extraction were noted between static and moving cupping. Cupping therapy was reported as most effective for treating muscle tightness, myofascial trigger points, and musculoskeletal pain. CONCLUSION: While the usage and application of cupping therapy may vary based on the type and style of cupping as well as the patient's condition, respondents reported cupping therapy to be an effective method for treating various musculoskeletal conditions.

Self-Reported Injury History and Health-Related Quality of Life in Competitive, Collegiate Baton Twirlers.

OBJECTIVE: Injury epidemiology and health-related quality of life (HRQOL) have not been researched in baton twirlers. This cross-sectional study described time-loss injuries sustained by competitive collegiate baton twirlers, identified the relationship between training volume and injuries, and established injury impact on HRQOL. METHODS: An online survey was used to collect activity volume, number and characteristics of time-loss injuries experienced within a 12-month window, and HRQOL via the Short Form-36. Current injury status was addressed to place participants into categories: no injury history (No Injury), history of injury but no symptoms (Injury Hx, No Sx), and currently injured (Current Injury). RESULTS: One hundred forty-two participants met the inclusion criteria. One hundred twenty-eight (90%) participants experienced a time-loss injury with 295 total reported injuries (2.1±1.4; range 1-9 injuries). Sixty-two percent of all reported injuries were still producing symptoms. There was a high average reported injury severity score (6.3±2.3). The most commonly affected area was the hip/thigh (30%), followed by the knee (15%) and ankle (14%). The Current Injury group had worse SF-36 bodily pain (p=0.003), vitality domains (p=0.001), and physical composite score (p=0.015) compared to the No Injury group. Both the No Injury and Injury Hx, No Sx groups performed better than the Current Injury group on physical function (p=0.007 and 0.02, respectively). CONCLUSION: Competitive collegiate baton twirlers experience the majority of injuries in the lower extremity which cause prolonged physical and non-physical symptoms.

Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prospective Cohort Study.

CONTEXT: Return-to-activity (RTA) assessments are commonly administered after anterior cruciate ligament reconstruction (ACLR) to manage the patient's postoperative progressions back to activity. To date, few data are available on the clinical utility of these assessments to predict patient outcomes such as secondary anterior cruciate ligament (ACL) injury once the athlete has returned to activity. OBJECTIVE: To identify the measures of patient function at 6 months post-ACLR that best predict RTA and second ACL injury at a minimum of 2 years after ACLR. DESIGN: Prospective cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6 months post-ACLR. Of these, 192 (82.1%) completed follow-up at ≥2 years post-ACLR. MAIN OUTCOME MEASURE(S): The 6-month functional assessments consisted of patient-reported outcomes, isokinetic knee-flexor and -extensor strength, and single-legged hopping. We collected RTA and secondary ACL injury data at ≥2 years after ACLR. RESULTS: Of the patients who were able to RTA (n = 155), 44 (28.4%) had a subsequent ACL injury, 24 (15.5%) to the ipsilateral graft ACL and 20 (12.9%) to the contralateral ACL. A greater proportion of females had a secondary injury to the contralateral ACL (15/24, 62.5%), whereas a greater proportion of males reinjured the ipsilateral ACL graft (15/20, 75.0%; P = .017). Greater knee-extension symmetry at 6 months increased the probability of reinjury (B = 0.016, P = .048). Among patients with RTA at <8 months, every 1% increase in quadriceps strength symmetry at 6 months increased the risk of reinjury by 2.1% (B = 0.021, P = .05). Among patients with RTA at >8 months, every month that RTA was delayed reduced the risk of reinjury by 28.4% (B = -0.284, P = .042). Descriptive statistics of patient function stratified between the early and delayed RTA groups can be found in the Supplemental Table (available online at http://dx.doi.org/10.4085/1062-6050-0407.20.S1). CONCLUSIONS: Patients with more symmetric quadriceps strength at 6 months post-ACLR were more likely to experience another ACL rupture, especially those who returned to sport at <8 months after the index surgery. Clinicians should be cognizant that returning high-functioning patients to activity at <8 months post-ACLR may place them at an increased risk for reinjury.

Influence of the COVID-19 pandemic on running behaviors, motives, and running-related injury: A one-year follow-up survey.

The purpose of this study was to compare running behaviors, motives, and injury during the first full year of the pandemic compared to the year prior, and month of eased restrictions. 466 runners responded to this follow-up survey. Paired t-tests were used to compare timepoints. Logistic regressions were used to assess demographic influences on behaviors. During the first full year of the pandemic, runners were more likely to increase their weekly runs (Mean Differences [MD]: 0.29±0.10, p < .001), yet had fewer motives (MD: -0.20±0.06, p = .02) compared to the month of eased restrictions. 18-25-year-olds were most likely to increase running volume (Odds Ratio [OR]: 2.79 [1.06, 7.32], p = .04) during the first full year of the pandemic compared to the year prior. Inexperienced runners reported fewer motives (OR: 3.00-4.41, p = .02-.04), and reduced sustained runs (OR: 2.36 [1.13, 4.96], p = .02) during the first full year of the pandemic compared to the year prior. Inexperienced runners and runners who lost access to preferred locations were at increased injury risk (OR: 1.98-2.63, p: .01-.04) during the first full year of the pandemic compared to the year prior. Our findings highlight pandemic-related changes among the running community that are likely to influence behaviors and injury risk.

Prospective running assessments among division I cross-country athletes.

OBJECTIVES: To prospectively monitor biomechanics, session-rating of perceived exertion (sRPE), and wellness in a cohort of collegiate Division-1 cross-country athletes over the course of a single competitive season. DESIGN: Prospective cohort study. METHODS: Healthy Division-1 cross-country athletes (9 males, 13 females) were prospectively followed over a single competitive cross-country season. Wearable sensors were used to collect biomechanics twice per week, along with surveys to assess sRPE and wellness. Mixed model linear regressions were used to assess the relationship among biomechanical measures to sRPE, and to wellness z-scores. RESULTS: Stride length, contact time, impact g, pace, weekly mileage, and running a meet in the day prior to the recorded run explained 25.4% of the variance in sRPE scores across the season (R2 = 0.254, p < 0.001). Contact time and braking g helped explain 3.7% of the variance in wellness (R2 = 0.037, F = 5.70, p = 0.01). CONCLUSIONS: There were several identified associations between gait biomechanics and sRPE, yet minimal associations with wellness measures. These findings suggest there are movement adaptations associated with perceived running intensity, however biomechanical measures alone do not lend additional insight into wellness measures.

Intrinsic foot muscle size and quality in a single leg weight bearing position across foot posture types in individuals with Patellofemoral Pain compared to healthy.

OBJECTIVE: To identify if any differences exist in IFM size and quality in single leg weight bearing position between healthy and PFP participants based on foot posture. DESIGN: Cross-sectional, matched case-comparison study SETTING: University Laboratory Setting PARTICIPANTS: 35 PFP (age:20.46 ± 3.79yrs, mass:73.28 ± 26.58 kg, height:170.80 ± 11.91 cm) and 35 healthy (age:20.40 ± 3.16yrs, mass:64.76 ± 11.52 kg, height:169.55 ± 9.10 cm) participants METHODS: After measuring Foot Posture Index (FPI), ultrasound images (USI) of Abductor Hallucis (AH), Flexor Digitorum Brevis (FDB) and Quadratus Plantae (QP) were taken in a single limb weight bearing position. Cross-sectional area (CSA) and echogenicity were measured on the USI. RESULTS: FPI was not different between groups (PFP:2.34 ± 3.76, Healthy:2.34 ± 3.10, 9 pronated and 26 non-pronated in both groups). AH CSA was smaller in PFP than healthy group (PFP:0.030 ± 0.01 cm (Smith et al., 2018)/kg, Healthy:0.042 ± 0.01 cm (Smith et al., 2018)/kg, P < 0.001) with a large effect (d = -1.20(-1.71, -0.69). There were no other significant group main effects or group-by-FP interactions in AH/FDB/QP CSA or echogenicity. CONCLUSION: AH CSA was smaller in PFP than healthy controls, but no difference in CSA or echogenicity of FDB/QP exist, as well as no difference in foot posture between groups. While single limb weight bearing, the PFP group presented with a smaller IFM which provides eccentric control of medial longitudinal arch, which may have implications up the chain during weight bearing functional tasks.

Gluteal Activity During Gait in Patients With Chronic Ankle Instability Following Rehabilitation: A Randomized Controlled Trial.

CONTEXT: Ankle positioning gait biofeedback (GBF) has improved ankle inversion for patients with chronic ankle instability. However, the effects on proximal deficits remain unknown. The purpose of this study was to determine the effects of impairment-based rehabilitation with GBF and without biofeedback on gluteal activity during walking in patients with chronic ankle instability. DESIGN: Randomized controlled trial. METHODS: Eighteen patients with chronic ankle instability (14 women and 4 men; age 22 [4] y; height 171 [10] cm; mass 71.6 [13.8] kg) were recruited from a university setting, following International Ankle Consortium guidelines. Patients were randomly allocated to GBF or without biofeedback groups (N = 9 per group). Both groups performed 4 weeks of exercises and treadmill walking. The GBF group alone received feedback on frontal ankle positioning at initial contact during walking. Ultrasound videos of the gluteus maximus and medius were recorded during walking at baseline and follow-up by a blinded clinician. Gluteal activity ratios were obtained at each 10% of the gait cycle. Statistical parametric mapping repeated-measures analysis of variance were used to compare groups and time points. RESULTS: Both groups demonstrated significantly increased gluteus medius activity across the gait cycle compared with baseline (P < .01, mean differences: 0.13-0.21, Hedge g: 0.97-1.89); however, there were no significant between-group differences. There were no statistically significant changes noted for the gluteus maximus. No adverse events were observed. CONCLUSIONS: Impairment-based rehabilitation led to increased gluteus medius activity, but GBF did not provide any additional improvement to this parameter. Clinicians may consider implementing impairment-based strengthening interventions to improve gluteus medius function during gait for patients with CAI.

Running gait biomechanics in females with chronic ankle instability and ankle sprain copers.

Limited evidence exists comparing running biomechanics between individuals with chronic ankle instability (CAI) and those who fully recover (copers). The purpose of this study was to simultaneously analyse running gait kinematics, kinetics, and surface electromyography (sEMG) between ankle sprain copers and individuals with CAI. Twenty-six (13 CAI, 13 Coper) recreationally active females participated and ran shod on an instrumented treadmill at 2.68 m/s. We assessed lower extremity kinematics and kinetics and sEMG amplitude for the fibularis longus, tibialis anterior, medial gastrocnemius, and gluteus medius muscles. Ten consecutive strides from the beginning of the trial were analysed using statistical parametric mapping (SPM) independent t-test. The CAI group had significantly more ankle inversion during 0-6%, 42-53%, and 96-100% of the running stride cycle compared to the coper group. At initial contact (0%), the CAI group was in an inverted ankle position (5.9°±6.8°) and the coper group was in an everted ankle position (-3.2°±5.5°; p = 0.01, d = 1.5). There were no significant differences identified for any other outcome measures. Increased ankle inversion during the swing phase leading into the loading phase is concerning because the ankle is in an open packed position and inversion is a primary mechanism of injury for sustaining a lateral ankle sprain.

Effects of rehabilitation on joint-coupling in patients with chronic ankle instability.

Chronic ankle instability (CAI) is associated with kinematic changes in the lower extremity. Alterations in joint-coupling have been identified during gait in patients with CAI. Rehabilitation remains the gold-standard for clinical treatment of CAI but little is known on the effects of rehabilitation on joint-coupling variability. Wearable destabilisation devices have shown an increase in muscle activity during functional tasks and may be useful in rehabilitation. The purpose of this study is to analyse the joint-coupling variability during gait prior to and following a rehabilitation programme performed with and without destabilisation devices. Twenty-six individuals with CAI were randomly assigned to receive 4 weeks of comprehensive rehabilitation with or without destabilisation devices. A 3D motion capture system was used to collect kinematics during walking. A vector-coding analysis was used to assess the joint-coupling variability of knee and hip motion to ankle motion. The destabilisation device group had decreases in joint-coupling variability during periods of walking gait. This decrease in joint-coupling variability may represent a change in sensorimotor organisation following rehabilitation. This decrease is indicative of an adaptation to the rehabilitation using destabilisation devices and may indicate an improvement in sensorimotor function.