In stroke our chronic ankle problem is ankle rolling; WHAT IS YOUR COMPETENT? DOCTOR'S EXACT PROTOCOL TO ADDRESS THAT? NONE? So, you don't have a functioning stroke doctor, do you?
Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 185 (2024)
Abstract
Background
Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.
Purpose
The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.
Methods
A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.
Results
The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.
Conclusions
The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.
Introduction
Lateral ankle sprains rank among the most prevalent musculoskeletal injuries in both athletes and non-athletes [1, 2], while chronic ankle instability (CAI) is its common cascade, as approximately 40% of those affected go on to develop CAI [3,4,5]. The defining features of CAI encompass recurring ankle sprains, pain, ankle muscle weakness, limited ankle motion, and a subjective sensation of the ankle giving way, remaining for at least one year post-injury [4, 6].
Both sensorimotor and mechanical impairments could result in CAI [4, 6]. Mechanical factors involve ligamentous dysfunction due to hyperlaxity, as well as restrictions in arthrokinematics and osteokinematics [7,8,9]. This can also manifest even in the absence of mechanical constraints at the ankle [10]. While sensorimotor factors involve altered somatosensation, joint position sense, and reflexes, pain, ankle muscle weakness, reduced ankle range of motion (ROM), and impaired postural control [10,11,12,13,14,15,16,17].
Chronic ankle instability could result in negative health consequences such as diminished physical activity, altered movement patterns in tasks like walking, jogging, and turning, a higher risk of falls due to impaired postural control, and a higher incidence of posttraumatic ankle osteoarthritis. Also, individuals with CAI often experience functional limitations affecting daily activities, leading to poor quality of life, so CAI is a major public health issue [6, 18,19,20,21,22,23,24,25,26,27].
Gait alterations have been documented in CAI, and most of the studied parameters were spatiotemporal ones. Step length, cadence, walking speed, and single limb duration were reduced in those with CAI, while their base of support was larger. These changes in gait could be the result of patients adopting a modified gait to make up for their sensation of instability [28, 29]. Thus, these changes might have a detrimental impact on neuromuscular strategies and motor performance [30, 31].
Individuals with chronic ankle instability show altered regional activation of the peroneus longus muscle.
Researchers’ attention has been drawn to these altered neuromuscular strategies during walking, such as changes in activation patterns of ankle muscles, altered ankle kinematics, and variability in location of the center of pressure (COP), but their findings were inconsistent [3, 32,33,34]. In the proneus longus, tibialis anterior, and gastrocnemius, some research has found a reduction in their activity [34], while other studies have observed greater activation in the same muscles [33]. However, a recent study revealed that individuals with chronic ankle instability show altered regional activation of the peroneus longus muscle [35]. In ankle kinematics and location of COP during a stance phase, greater ankle inversion and a lateral deviation of the COP have been reported [26]. On the other hand, greater inversion was observed when running but not when walking [27]. Also, previous studies had methodological flaws due to the inclusion of subjects with bilateral CAI, ignoring that one limb influences the other and could lead to an gait alterations [36].
Besides these conflicting results and methodological flaws, the specific gait loading strategy is still not well studied. As far as we are aware, no research has thoroughly investigated how CAI affects the biomechanical aspects of gait loading strategy. In order to fill in the knowledge gap left by earlier studies and accurately specify gait loading strategy for this population, the current study used a more thorough and appropriate design that took into account the homogeneity of the sample, the elimination of bilateral CAI, and the existence of healthy controls. The study’s objectives were to investigate the changes in gait loading strategy in CAI compared to health control, hypothesizing that there was a significant difference in loading strategy between both groups. Understanding how CAI affects gait loading strategy can help design interventions to restore normal loading patterns and reduce injury risk. This knowledge can help clinicians to develop targeted rehabilitation programs, improve rehabilitation effectiveness, reduce risk of fall, and avoid complications, and improve quality of life for individuals with CAI, thereby reducing the risk of further injuries.
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