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Foot impairments contribute to functional limitation in individuals with ankle sprain and chronic ankle instability

  • Ankle
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the clinical measures of foot posture and morphology, multisegmented joint motion and play, strength, and dynamic balance in recreationally active young adults with and without a history of a lateral ankle sprain (LAS), copers, and chronic ankle instability (CAI).

Methods

Eighty recreationally active individuals (healthy: n = 22, coper: n = 21, LAS: n = 17, CAI: n = 20) were included. Foot posture index (FPI), morphologic measures, joint motion (weight-bearing dorsiflexion (WBDF), rearfoot dorsiflexion, plantar flexion, inversion, eversion; forefoot inversion, eversion; hallux flexion, extension), joint play (proximal and distal tibiofibular; talocrural and subtalar, forefoot; 1st tarsometatarsal and metatarsophalangeal), strength (dorsiflexion, plantar flexion, inversion, eversion, hallux flexion, lesser toe flexion), and Star Excursion Balance Test (SEBT) (anterior, posteromedial, posterolateral) were assessed.

Results

There were no group differences in FPI or morphological measures. LAS and CAI groups had decreased ankle dorsiflexion (p = 0.001) and greater frontal plane motion (p < 0.001), first MT plantar flexion, and sagittal excursion (p < 0.001); increased talocrural glide (p = 0.02) and internal rotation (p < 0.001) and decreased forefoot inversion joint play (p < 0.001); and decreased strength in all measures (p < 0.001) except dorsiflexion compared to healthy controls. The LAS group also demonstrated decreased distal tibiofibular (p = 0.04) and forefoot general laxity (p = 0.05) and SEBT performance (anterior: p = 0.02; posteromedial: p < 0.001; posterolateral: p < 0.001).

Conclusion

Individuals with LAS or CAI have increased pain, impaired physiologic and accessory joint motion, ligamentous tenderness, and strength in the foot and ankle. Clinicians should assess the multiple segments of the ankle–foot complex when caring for individuals with an LAS or CAI.

Level of evidence

II.

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Acknowledgements

The University of Virginia’s Curry School of Education Foundation for their generosity in providing funding.

Funding

This study was funded in part by the University of Virginia's Curry School of Education Foundation and the Navy Medicine Professional Development Center.

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Authors and Affiliations

  1. Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA, 22904-4407, USA

    John J. Fraser, Rachel M. Koldenhoven, Abbis H. Jaffri, Susan F. Saliba, Joseph M. Hart & Jay Hertel

  2. Department of Orthopaedic Surgery, University of Virginia, 545 Ray C Hunt Drive, Charlottesville, VA, 22908, USA

    Joseph S. Park, Joseph M. Hart & Jay Hertel

  3. Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA

    John J. Fraser

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  1. John J. Fraser
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Contributions

JJF contributed to the conception and design, acquisition of funding, acquisition and interpretation of data, and drafting and revision of the manuscript. RMK and AHJ contributed to the acquisition and interpretation of data. JSP, SFS, and JMH contributed to the conception and design, interpretation of data, and critical revision of the manuscript. JH contributed to the conception and design, acquisition of funding, interpretation of data, and critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to John J. Fraser.

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Conflict of interest

I affirm that I have no financial affiliation or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. The views expressed in this manuscript reflect the results of research conducted by the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. Lieutenant Commander John J. Fraser is a military service member and this work was prepared as part of his official duties. Title 17, USC, § 105 provides that ‘Copyright protection under this title is not available for any work of the US Government.’ Title 17, USC, § 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties. This work was performed in partial fulfillment of the requirement for the doctor of philosophy degree and is archived in the Online Archive of University of Virginia Scholarship (https://doi.org/10.18130/V3GN1K)

Ethical approval

This study was approved by the Institutional Review Board for Health Sciences Research at the University of Virginia in compliance with all applicable federal regulations governing the protection of human subjects.

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All participants provided informed consent.

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Fraser, J.J., Koldenhoven, R.M., Jaffri, A.H. et al. Foot impairments contribute to functional limitation in individuals with ankle sprain and chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 28, 1600–1610 (2020). https://doi.org/10.1007/s00167-018-5028-x

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