• Physical Therapy Korea
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• v.31 no.1
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• pp.18-28
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• 2024

Background: Lateral instability of the ankle is one of the most common causes of musculoskeletal ankle injuries. The peroneus longus (PL) and peroneus brevis (PB) contribute to ankle stability. In early rehabilitation, isometric exercises have been selected for improvement of ankle stability. To effectively train the peroneal muscles during eversion, it is important to consider ankle and body posture. Objects: This study aimed to compare activation of the PL, PB, and biceps femoris (BF) muscles during eversion in different ankle postures (neutral [N], plantarflexed [PF]) and body postures (sitting and side-lying). Methods: Thirty healthy individuals with no history of lateral ankle sprains within the last 6 months were included in the study. Maximal isometric strength of eversion and muscle activation were measured simultaneously. Muscle activation at submaximal eversion was divided by the highest value obtained from maximal isometric eversion among the four postures (percent maximal voluntary isometric contraction [%MVIC]). To examine the differences in muscle activation depending on posture, a 2 × 2 repeated measures analysis of variance (ANOVA) was conducted. Results: There were significant interaction effects of ankle and body postures on PL muscle activation and evertor strength (p < 0.05). The PL muscle activation showed a significantly greater difference in the side-lying and PF conditions than in the sitting and N conditions (p < 0.05). Evertor strength was greater in the N compared to the PF condition regardless of body posture (p < 0.05). In the case of PB and BF muscle activation, only the main effects of ankle and body posture were observed (p < 0.05). Conclusion: Among the four postures, the side-lying-PF posture produced the highest muscle activation. The side-lying-PF posture may be preferred for effective peroneal muscle exercises, even when considering the BF muscle.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.183-188
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• 2019

Purpose: Bone contusion is usually treated with conservative therapy for 3 months. Bone contusion around knee and hip joints has been extensively reported on, but there are scant reports on this condition in foot and ankle joints. This study evaluated the nature, characteristics and location of bone contusion around foot and ankle joints to enlighten clinicians on how to better treat this disease entity. Materials and Methods: We classified bone contusion of the 76 patients into three types (102 sites; 47 ankle sprains, 18 traffic accidents, 11 falls) according to the Costa-Paz system with employing magnetic resonance imaging (MRI), and the study then analyzed the common sites and areas of occurrence according to the mechanism of injury and duration of pain after first conducting conservative therapy. Results: Of the 76 patients (102 sites) on the MRI, 43 case (42.2%) for talus, 19 cases for distal tibia, and 12 cases for calcaneus were involved. The classification, according to the Costa-Paz system, was Type I, 51 cases; Type II, 32 cases; and Type III, 19 cases. The duration of pain after conservative treatment was 12.15±2.17 weeks for Type I, 14.5±2.15 weeks for Type II, and 21.0±3.8 weeks for Type III. Conclusion: The most common location of post-traumatic bone contusion around both the foot and ankle is the talus, distal tibia, and calcaneus. The most common type of injury noted on MRI is a diffuse signal with change of the medullary component (Type I), In cases of bone contusion extending to a subjacent articular surface or disruption or depression of the normal contour of the cortical surface (Types II, III), the patients' pain appears to last longer. Thus, it is necessary to consider a longer period of conservative treatment in cases of Types II and III bone contusion because the patients' pain may last longer than 3 months.

• Korean Journal of Applied Biomechanics
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• v.29 no.2
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• pp.61-70
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• 2019

Objective: This study aimed to investigate the characteristics of the declination of the subtalar joint rotation axis and the structural features of the ankle joint complex such as rear-foot angle alignment and ligament laxity test between chronic ankle instability (CAI) patients and healthy control. Method: A total of 76 subjects and CAI group (N=38, age: $23.11{\pm}7.63yrs$, height: $165.67{\pm}9.54cm$, weight: $60.13{\pm}11.71kg$) and healthy control (N=38, age: $23.55{\pm}7.03yrs$, height: $167.92{\pm}9.22cm$, weight: $64.58{\pm}13.40kg$) participated in this study. Results: The declination of the subtalar joint rotation axis of the CAI group was statistically different from healthy control in both sagittal slope and transverse slope. The rear-foot angle of CAI group was different from a healthy control. Compared to healthy control, they had the structure of rear-foot varus that could have a high occurrence rate of ankle varus sprain. CAI group had loose ATFL and CFL compared to the healthy control. Conclusion: The results of this study showed that the deviation of the subtalar joint rotation axis and the structural features of the ankle joint complex were different between the CAI group and the healthy control and this difference is a meaningful factor in the occurrence of lateral ankle sprains.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.2
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• pp.57-63
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• 2016

Background: Instability due to ankle sprains will be accompanied by a problem of balance and pain change. Balance trainer is used to improve the ankle strength and balance ability. The purpose of this study was to evaluate the change of pain and postural balance ability in ankle joint after balance trainer application in patients with ankle sprain and instability. Methods: Twenty patients in K hospital in Incheon were enrolled. Balance trainer was applied to 10 subjects in the experimental group and 10 subjects in the Balance cushion under the same conditions as the experimental group to compare the pain and balance ability. Results: In the experimental group, there was a significant difference in the change of the pain variation. In the postural balance ability comparison, there was a significant difference in total and post - posterior comparison compared to the control, but there was no significant difference in the postural balance ability comparison. Conclusion: Pain and postural balance ability of patients with instability due to ankle sprain improved the pain and balance ability of the Balance trainer group compared to the Balance cushion training group.

• Korean Journal of Acupuncture
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• v.35 no.1
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• pp.27-35
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• 2018

Objectives : The purpose of this study was to investigate the analgesic effect of electroacupuncture(EA) and radio-frequency warm needling(RFWN) stimulation in acupoint combination on ankle sprained pain in rats. Methods : The lateral ligaments of the Sprague-Dawley rats ankle were injured surgically resulting in sprain, of which was divided into EA, RFWN treatment groups and control group without treatment. The level of pain was measured through foot weight bearing force ratio followed by calculating pain relief. To stimulate proximal or distal area in ankle sprain, combination of proximal acupoints(GB34-GB39) and distal acupoints(GB39-GB42) from sprain area were applied, respectively, to either EA or RFWN stimulation. In addition, naltrexone or phentolamine was injected intraperitoneally before the stimulation to observe the pathway of analgesic effects. Results : In the proximal combination of GB34-GB39, EA and RFWN significantly increased pain relief compared to the control group (p<0.05). However, in distal combination with GB39-GB42, both EA and RFWN stimulation did not relieve pain due to ankle sprains. In the combination of GB34-GB39, the analgesia of EA was inhibited by blockade of the ${\alpha}$-adrenoceptor receptor. The analgesia of RFWN was inhibited by blockade of the ${\alpha}$-adrenoceptor receptor as well as ${\mu}$-opioid receptor. Conclusions : We observed that the proximal combination was effective in relieving pain when the treatment by acupoint combination was applied to the ankle sprain pain. Also, it was confirmed that this analgesia was also related to the pathways of ${\mu}$-opioid receptors and/or ${\alpha}$-adrenoceptors.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.3
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• pp.55-66
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• 2018

Objectives To evaluate the evidence supporting the effectiveness of bee venom acupuncture for ankle sprain. Methods We conducted search across 11 electronic databases (Pubmed, EMBASE, Cochrane CENTRAL [CENTRAL], KoreaMed, Kmbase, Koreanstudies Information Service System [KISS], National Digital Science Library [NDSL], Korea Institute of Science and Technology Information [KISTI], China National Knowledge Infrastructure [CNKI], Wanfang and Chinese Scientific Journals Database [VIP] database) to find clinical trials that used bee venom acupuncture as treatment for ankle sprain. The methodological quality of randomized controlled clinical trials (RCTs) were assessed using the Cochrane Risk of Bias (RoB) tool, while non-randomized controlled clinical trials (NRCTs) were assessed using the Cochrane Risk of Bias Assessment tool for Non-randomized Study (RoBANS) tool. Results Four RCTs and one nRCT met our inclusion criteria. Almost studies showed that bee venom acupuncture has positive effect on ankle sprain. 4 studies of same intervention and control included in the meta-analysis. When comparing bee venom acupuncture and acupuncture with acupuncture, the effect size of standardized mean difference (SMD) was -0.19 (95% confidence interval [CI]: -1.95~1.56, Z=0.55, p=0.83). And when comparing bee venom acupuncture with acupuncture, the effect size of SMD was -0.17 (95% CI: -0.65~0.31, Z=0.71, p=0.48). Conclusions Although our systematic review found encouraging but limited evidence of bee venom acupuncture for ankle sprain, most of the studies included in the analysis were evaluated as methodologically high risk of bias. From now on further well-designed RCTs should be encouraged.

• Korean Journal of Acupuncture
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• v.35 no.4
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• pp.174-186
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• 2018

Objectives : The aim of this survey was to investigate the general characteristics of sports injury patients in Korean medical institutions by Korean Medicine Doctors (KMDs) and the treatment patterns of Korean medicine for ankle sprain which is one of the common sports injuries. Methods : An online survey was conducted on KMDs interested in sports injuries to assess their experience and perception of sports injuries including diagnosis, intervention, and treatment plan for ankle sprain. Results : A total of 276 KMDs participated in the survey. They answered that 12% (median, range 0~80%) of patients visiting a Korean medical institution had sports injuries. Sports injuries frequently occur in the ankle, back, shoulder, knee, and elbow and the most common sports injury was sprain/strain. Many participants were aware that sports injuries should be treated differently from other musculoskeletal diseases in general. They reported that confirmation of fracture, swelling, and tenderness was essential to diagnose ankle sprains. Acupuncture was the most commonly used treatment and reported to need 2 to 6 weeks of treatment period, depending on the severity. Conclusions : Based on the findings regarding treatment of sports injury patients by KMDs, this study would be utilized as basic information for pragmatic clinical research design related to sports medicine in the future.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.3
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• pp.67-73
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• 2018

PURPOSE: This study was conducted to investigate the effects of pain, balance, and left / right step time difference between elastic taping and non-elastic taping in patients with acute ankle sprain. METHODS: The subjects were patients with acute ankle sprains who had been injured within 1 day. A total of 30 subjects were divided into three groups (CG: control group, EG1: experimental group 1, EG2: experimental group 2) of 10 people. The intervention period was 3 days. In the CG, only physical therapy (cryotherapy+pulsed ultrasound) was performed, while physical therapy and elastic taping were applied in EG 1 and physical therapy and non-elastic taping were applied in EG 2. RESULTS: Changes in pain, balance and left / right step time difference following intervention decreased significantly in all three groups. After intervention, the balance between the groups differed significantly between the CG and the EGs. In addition, the left / right step time difference differed significantly between the CG and EGs, as well as between the EG 1 and the EG 2. CONCLUSION: Physiotherapy is helpful for treatment of pain associated with acute ankle sprain. Taping is considered to be a way to provide more balance and gait ability.

• Physical Therapy Korea
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• v.31 no.1
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• pp.29-39
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• 2024

Background: Landing from a step or stairs is a basic motor skill but high incidence of lateral ankle sprain has been reported during landing with inverted foot. Objects: This study aimed to investigate the effect of landing height and visual feedback on the kinematics of landing and supporting lower limbs before and after the touch down and the ground reaction force(GRF)s. Methods: Eighteen healthy females were voluntarily participated in landing from the lower (20 cm) and the higher (40 cm) steps with and without visual feedback. To minimize the time to plan the movement, the landing side was randomly announced as a starting signal. Effects of the step height, the visual feedback, or the interaction on the landing duration, the kinematic variables and the GRFs at each landing event point were analyzed. Results: With eyes blindfolded, the knee flexion and ankle dorsiflexion on landing side significantly decreased before and after the touch down. However, there was no significant effect of landing height on the anticipatory kinematics on the landing side. After the touch down, the landings from the higher step increased the knee flexion and ankle dorsiflexion on both landing and supporting sides. From the higher steps, the vertical GRF, anterior GRF, and lateral GRF increased. No interaction between step height and visual feedback was significant. Conclusion: Step height and visual feedback affected the landing limb kinematics independently. Visual feedback affected on the landing side while step height altered the supporting side prior to the touch down. After the touch down, the step height had greater influence on the lower limb kinematics and the GRFs than the visual feedback. Findings of this study can contribute to understanding of the injury mechanisms and preventing the lateral ankle sprain.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.137-143
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• 2023

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.