Acute and Recurrent Ankle Sprains

Ankle sprains represent one of the most common musculoskeletal injuries which can significantly affect an individual’s capability to participate in a wide range of physical activities.

The debilitating impact of ankle sprains creates instability in the foot/ankle complex which can further lead to cartilage degeneration, increasing the risk of post-traumatic ankle osteoarthritis.

Patients with acute lateral ankle sprains usually experience impairment in the joint position sense, isometric strength in multiple planes of motion, postural control on the involved and uninvolved limb, temporal and spatial parameters of gait – all these increase the possibility of recurrences.

Wikstrom et al. describe the pathophysiology of chronic ankle instability as not just ligamentous laxity, but a culmination of adaptations brought about by acute ankle sprains that gradually lead to decreased functional performance of the ankle.

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The authors outline the following characteristics as being often observed in patients with chronic ankle instability – increased laxity, anterior positional faults of the distal fibula and talus, decreased dorsiflexion range of motion, static and dynamic balance deficits.

A review by Doherty et al. focused on systematic reviews of treatment and preventative strategies for acute and recurrent ankle sprains that have been conducted in the past; the aim was to highlight any conflicting evidence that exists between reviews.

As stated in the review, “the general consensus of the reviews that investigated a surgical intervention was that a trial of conservative treatment should always be attempted before surgery is undertaken, that surgery should be considered only in patients with persistent symptoms”.

Among conservative treatment options that should be considered before a surgical intervention, foot orthotic therapy presents a high potential for favourable patient outcomes when implemented effectively as part of a more comprehensive rehabilitative programme for chronic ankle instability.

Douglas Richie Jr., from the Department of Applied Biomechanics at the California School of Podiatric Medicine, prescribes foot orthoses as a means of improving neuromuscular control of the ankle which can promote better postural control and reduce the risk of repetitive sprains.

With studies having shown increased pressure being placed on the lateral aspect of the foot by individuals with ankle instability, it is essential for a thorough gait analysis to be performed in order to customise the MASS4D® foot orthotic in a manner that enhances overall balance and stability.

More specifically, MASS4D® foot orthotics can be customised to help address four of the main symptoms identified by experts in patients with chronic ankle instability – reduced range of motion, reduced strength, impaired proprioception/ neuromuscular control, and altered gait patterns.

By maintaining ankle range of motion and improving alignment of the musculoskeletal system, MASS4D® provides a strong base of support helping the individual resist body sway and prevent recurrences; this bolsters the strength of peroneal muscles that counteract ankle invertors during gait.

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References:

Doherty, C., Bleakley, C., Delahunt, E., Holden, S. (2016) Treatment and Prevention of Acute and Recurrent Ankle Sprain: An Overview of Systematic Reviews with Meta-analysis. British Journal of Sports Medicine: October 2016, pp. 1-17. doi: 10.1136/bjsports-2016-096178
Wikstrom, E. A., Hubbard-Turner, T., McKeon, P. O. (2013) Understanding and Treating Lateral Ankle Sprains and their Consequences. Sports Medicine: April 2013, Vol. 43, No. 6. DOI: 10.1007/s40279-013-0043-z
Richie Jr., D. (2013) A Closer Look At Foot Orthoses For Chronic Ankle Instability. PodiatryToday: May 2013, Vol. 26, No. 5.

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