Chronic Ankle Instability: Therapeutic Exercise and Data Analysis

Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The present paper examines some subjects with a previous history of acute inversion ankle sprain who have developed a subsequent condition of instability, grouping them according to inclusion criteria and analyzing them through four field tests considered objective by the scientific literature: SEBT test, BEES test, TIBT test, SHT test. The data obtained were stored in order to compare them following a re-education protocol aimed at improving proprioception, balance, walking and strengthening the extrinsic and intrinsic muscles of the foot. per year. The subjects were then divided into two categories: subjects with CAI > 1 year and subjects with CAI ≤ 1 year. A protocol lasting 6 weeks was administered to both groups, trying to work on improving balance in single stance, improving static and dynamic stability, strengthening the gluteus medius and maximus (pelvis stabilizers) and strengthening of the intrinsic muscles of the foot. At the end of the protocol the subjects were all re-evaluated with the same field tests used previously and the data obtained were compared both with the pre-protocol data and with the data measured by the control subjects.

Collateral bloodletting at ashi point combined with external application of Sānqī powder for 120 cases of old ankle injury

Objective:To study the clinical effect on old ankle injury treated with collateral bloodletting at ashi point combined with the external application of Sānqī(三七Radix et Rhizoma Notoginseng)powder.Methods:120 outpatients with old ankle injury were collected from the Department of Disease Prevention of Shenzhen Pingle Orthopaedics and Traumatology Hospital.Ashi points were selected.The threeedged needle or the syringe needle for single use was used to prick the ashi points for 5-10 times till the slight bleeding presented in local area.Afterwards,the cupping was used at the pricked area for 10-15 min to ensure the complete elimination of stagnant blood.Such therapies were given once a week.On the day after the day of bleeding and cuping,Sanqi powder was applied externally,once a day.The pain score(visual analogue scale,VAS)and the clinical effect were observed in the patients.Results:A total of 115 patients accomplished the whole procedure of treatment The pain mean score of VAS was(3.2±0.4)points before treatment and it were(0.28±0.5)points after treatment.Of them,104 cases were cured completely,8 cases effective significantly and 3 cases failed.Conclusion:The combined treatment with bloodletting therapy at ashi point and the external application of Sanqi powder achieves the satisfactory clinical effect on old ankle injury and this therapy deserves to be promoted in clinical practice.

Chinese Massage Therapy for Ankle Injury

Purpose: To explore the therapeutic methods and effects in the treatment of acute and chronic injuries of the ankle joint by Chinese massage therapy in combination with external application of Chinese herbal drugs and functional exercises.Methods: Totally, 36 cases of the patients with acute soft tissue injury, chronic soft tissue injury and post-fracture sequelae of the ankle joint were treated by Chinese massage therapy, external application or external wash of Chinese herbal drugs, and exercises of dorsal flexion and extension of the ankle joint, to observe the restoration of the ankle functions.Results: In 36 cases of the patients, the results showed remarkable effect in 18 cases, effect in 16 cases, failure in 2 cases and the effective rate in 94.4%.Conclusion: The combined use of Chinese massage therapy, external application of Chinese herbal drugs and functional exercises can produce precise effect in the treatment of soft tissue injury of the ankle joint. Key Words Ankle Injuries - Tuina - Massage Author: CHEN Ming-xia (1971-), female, physicianTranslator: HUANG Guo-qi

Effect of Huoxue Huayu Lishui Decoction on P65 and TAK1 of acute soft tissue injury in rats

Objective:To explore the mechanism of the action of Huoxue Huayu Lishui prescription on acute ankle joint injury.Methods:Forty-eight SPF rats were randomly divided into blank group,model group,Shujin Huoluo capsule group,low,medium and high dose groups for promoting blood circulation and removing blood stasis.The blank group was not modeled,and the other groups were modeled.Each group of 8 animals,the Shujin Huoluo capsule group was given 0.2g/ml mixed liquid by gavage,and the low,medium and high blood circulation and blood stasis Lishui prescription group was given 1.03g/ml,2.06g/ml,4.12g/ml decoction For the stomach,the normal group was given 1.5ml/100g,once a day for 1 week.The expression of NF-κB P65 and transforming growth factor kinase 1(TAK1)protein in the soft tissue around the ankle joint of rats was detected by sports protein immunoblotting method,and the mRNA expression of NF-κB P65 and TAK1 was detected by PCR technology.Results:One day after modeling,the expressions of P65 and TAK1 mRNA and protein in the model group,the positive drug group,and low,medium and high doses of Huoxue Huayu Lishui Recipe were significantly different from those of the blank control group(P<0.05).After taking the medicine for 7 days,compared with the model group,the expressions of P65 and TAK1 mRNA and protein in the Shujin Huoluo capsule group and the low,medium and high dose Huoxue Huayu Lishui Recipe group were all decreased(P<0.05).After 7 days of taking the medicine,compared with the Shujin Huoxue Capsule group,there was no difference in P65 protein in the low-dose Huoxue Huayu Lishui Recipe group.The expression of P65 protein in the middle and high groups and the Shujin Huoxue Capsule group were all decreased(P<0.05).Compared with the Shujin Huoxue Capsule group,the expressions of TAK1 protein,P65 and TAK1 mRNA in the low,medium,and high groups and the Shujin Huoxue Capsule group were all decreased(P<0.05).The results suggest that Huoxue Huayu Lishui Recipe can inhibit the expression of NF-κB P65 and TAK1 protein in ankle joint injury.Conclusion:Huoxue Huayu Lishui prescription may regulate the expression of NF-κB P65 and TAK1 in ankle joint injury of NF-κB rats,so as to improve the clinical symptoms of local swelling and pain in the ankle joint.

Fibula pro-tibia vs standard locking plate fixation in an ankle fracture saw bone model

BACKGROUND Locking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork failure.Fibula pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance stability in ankle fractures by achieving tri or tetra-cortical fixation.With locking plates,the strength of this fixation construct can be further enhanced.There is lack of evidence currently on the merits of tibiapro-fibula augmented locking plate fixation of unstable ankle fractures.AIM To assess if there is increased strength to failure,in an ankle fracture saw bone model,with a fibula pro-tibia construct when compared with standard locking plate fixation.METHODS Ten osteoporotic saw bones with simulated supination external rotation injuries were used.Five saw bones were fixed with standard locking plates whilst the other 5 saw bones were fixed with locking plates in a fibula pro-tibia construct.The fibula pro-tibia construct involved fixation with 3 consecutive locking screws applied across 3 cortices proximally from the level of the syndesmosis.All fixations were tested in axial external rotation to failure on an electromagnetic test frame(MTS 858 Mini-Bionix test machine,MTS Corp,Eden Praire,MN,United States).Torque at 30 degrees external rotation,failure torque,and external rotation angle at failure were compared between both groups and statistically analyzed.RESULTS The fibula pro-tibia construct demonstrated a statistically higher torque at 30 degrees external rotation(4.421±0.796 N/m vs 1.451±0.467 N/m;t-test P=0.000),as well as maximum torque at failure(5.079±0.694N/m vs 2.299±0.931 N/m;t-test P=0.001)compared to the standard locking plate construct.The fibula pro-tibia construct also had a lower external rotation angle at failure(54.7±14.5 vs 67.7±22.9).CONCLUSION The fibula pro-tibia locking plate construct demonstrates biomechanical superiority to standard locking plates in fixation of unstable ankle fractures in this saw bone model.There is merit in the use of this construct in patients with unstable osteoporotic ankle fractures as it may aid improved clinical outcomes.

Clinical study on Tuina plus physical agents for lateral collateral ligament injury of ankle in gymnasts

Objective To compare the efficacy of Tuina(Chinese therapeutic massage)plus physical agents and physical agents alone for lateral collateral ligament injury of ankle in gymnasts,and to explore the feasibility of Tuina for injury intervention in competitive athletes.Methods A total of 64 gymnasts with types Ⅰ-Ⅱ lateral collateral ligament injury of ankle were selected and divided into a control group and an observation group according to a full analysis set based on the intention-to-treat principle,with 32 cases in each group.Patients in the control group received ultrasound and microwave treatment,while those in the observation group received additional Tuina manipulations.The efficacy was evaluated by total effective rate,visual analog scale(VAS)score,and American Orthopedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AHS)score.Results The total effective rate was 96.9% in the observation group and 90.6% in the control group.There was no statistical difference in the total effective rate between the two groups(P>0.05).The markedly effective rate was 75.0% in the observation group and 46.9% in the control group.The markedly effective rate in the observation group was higher than that in the control group(P<0.05).After treatment,the VAS scores of both groups showed a downward trend,and there were statistical differences between different treatment time points in the same group(P<0.05).After one and three months of treatment,the VAS scores of the observation group were lower than those of the control group(P<0.05).There were statistical differences in the AOFAS-AHS score before and after treatment within the same group(P<0.05).After one month of treatment,there was no statistical difference in the AOFAS-AHS score between the two groups(P>0.05).After three months of treatment,the AOFAS-AHS score in the observation group was higher than that in the control group,indicating statistical significance(P<0.05).There was an interaction between time and group(P<0.05).Conclusion Tuina plus physical agents can improve the symptoms of lateral collateral ligament injury of ankle in gymnasts.This combined treatment is superior to physical agents alone in relieving pain and improving joint functions.Therefore,Tuina plus physical agents can be used as a treatment for lateral collateral ligament injury of ankle in gymnasts.

The applications of wearable devices in the rehabilitation of ankle injuries: A systematic review and meta-analysis

Wearable devices have been used in the treatment and rehabilitation of ankle injuries.This article systematically reviewed the trials that summarize and evaluate the effectiveness of rehabilitation treatment after an ankle injury.Three databases,PubMed(1974–2021),Embase,and Web of Science(1950–2021),were searched.The intervention was any wearable device,and the outcome measures were Activities Scale for Kids performance(ASKp),Foot and Ankle Outcome Score(FAOS),American Orthopaedic Foot and Ankle Society(AOFAS),Olerud-Molander Ankle Score(OMAS),and Circumference as measured by any validated outcome measure.Two independent authors evaluated the studies with the Cochrane risk-of-bias tool.Four papers were included,involving 476 participants,with a mean age of 29.3±6.7 years.The mean duration of wearable devices was 3.83 weeks,and the mean length of training was 3.75 weeks.Wearable devices achieved better results compared with control on the functional performance(standardized mean difference[SMD]0.66;95%confidence interval[CI]0.29 to 1.04;I^(2)=76%;P<0.001),as well as ankle score(SMD 0.78;95%CI 0.22 to 1.35;I^(2)=82%;P<0.001).The definitive judgment could not be made due to the variability in training,training duration,and outcomes measurement.Wearable devices are a promising approach that has positive effects on ankle injuries in terms of functional performance and reducing the extent of swelling.There is insufficient evidence from randomized controlled trials(RCTs)to support this for ankle injury patients using wearable devices.Therefore,there is an need for well-conducted randomized controlled trials investigating more adaptive orthoses to achieve more effective strategies for early functional rehabilitation.PROSPERO registration number:CRD42021246289.

CLINICAL APPLICATION OF THE TONIFICATION METHOD IN ORTHOPEDICS AND TRAUMATOLOGY

Traumatological and orthopedical diseases with obstruction and blockage are in most cases treated by the reducing method like promoting qi flow and activating blood circulation, dispersing and removing obstruction. However, the therapeutic

Predicting factors for better outcomes of stable supination external rotation type 2 ankle fractures

Purpose:Stable Weber B ankle fractures are treated by a walking boot for 6 weeks and bearing full weight through the boot as tolerated.The aim of the present study was to assess the outcome parameters of this treatment protocol,evaluate the efficacy of using the walking boot,and investigate any possible predicting factors that could affect the outcomes.Methods:All the patients with stable Weber B ankle fractures,treated in our hospital between January 2018 and December 2018,were prospectively included to the study.The patients were evaluated clinically,and the patient-reported outcome measures data were collected at the 2 and 6 weeks post-injury.Chi square,Spearman’’s rho test,independent samples and paired samplet-tests were used for the monovariant analysis.Results:A total of 128 consecutive patients(aged 52.2±19.1 years)with supination external rotation type 2 fracture were finally included to the study.At the 2 weeks follow-up,the reported outcome measures scores were in moderate levels,but improved significantly at the 6 weeks follow-up(p<0.0001).Multivariant analysis revealed that the ability to bear full weight without the boot at the 2 weeks after diagnosis was the only variable,which made statistically unique contribution to the foot and ankle disability index score at the 6 weeks(p=0.005).Conclusion:Conservative treatment using a walking boot with advice to bear full weight of stable ankle Weber B fractures can bring to good functional outcomes.The ability to bear full weight without the aid of the walking boot at 2 weeks after diagnosis was the only significant predicting factor for better outcomes at 6 weeks after diagnosis.

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws： A Retrospective Comparative Cohort Study

Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.

Clinical efficacy of sticking-needle acupuncture plus tendon-regulating manipulation in the treatment of acute ankle sprain

Objective To explore the treatment effect of sticking-needle acupuncture plus tendon-regulating manipulation on pain,swelling and joint dysfunction due to acute ankle sprain.Methods A total of 80 patients with acute ankle sprain were recruited and divided into a control group and a treatment group according to the random number table method,with 40 patients in each group.Both groups received the same conventional interventions.The control group was treated with additional tendon-regulating manipulation,and the treatment group was treated with tendon-regulating manipulation plus sticking-needle acupuncture.The pain,swelling and joint dysfunction of the ankle were observed in both groups before and after 3 d,7 d and 14 d of treatment.Results Before treatment,there was no statistically significant difference in the visual analog scale(VAS)score of pain between the two groups(P>0.05).After treatment,the VAS scores of both groups showed a decreasing trend over time,and the differences within the groups were statistically significant(P<0.05).After 3 d,7 d and 14 d of treatment,the VAS scores in the treatment group were lower than those in the control group,with statistically significant differences(P<0.05).Before treatment,there was no statistically significant difference in the degree of swelling between the two groups(P>0.05).After treatment,the degrees of swelling in both groups showed a decreasing trend over time,and the differences within the groups were statistically significant(P<0.05).After 3 d and 7 d of treatment,the degrees of swelling in the treatment group were lower than those in the control group,with statistically significant differences(P<0.05).There was no statistical difference in the degree of swelling between the two groups after 14 d of treatment(P>0.05).Before treatment,there was no statistically significant difference in the American Orthopedic Foot Ankle Society(AOFAS)ankle-hindfoot scale score between the two groups(P>0.05).After treatment,the AOFAS ankle-hindfoot scale scores of both groups showed an increasing trend over time,and all the differences within the groups were statistically significant(P<0.05).After 3 d,7 d and 14 d of treatment,the AOFAS ankle-hindfoot scale scores in the treatment group were higher than those in the control group,with statistically significant differences(P<0.05).Conclusion Based on the routine intervention,the addition of sticking-needle acupuncture and tendon-regulating manipulation was better in alleviating pain and swelling and improving joint function in patients with acute ankle sprain than the addition of tendon-regulating manipulation alone.

Use of tightrope fixation in ankle syndesmotic injuries

Objective： Conventional fixation of syndesmotic injuries with screws remains problematic. A novel fibrewire device （Tightrope） has suggested advantages. However, small case series have reported high soft tissue complication rates. The purpose of our study was to quantify complication rates and further procedures in patients treated with Tightropes. A secondary objective was to determine incidence of complications and further procedures in those treated with syndesmotic screws over the same period. Methods： All patients undergoing syndesmotic fixa- tion for ankle fracture between May 2008 and October 2009 were retrospectively reviewed. Incidence of complications, secondary procedures, maintenance of syndesmotic reduc- tion and time spent on non-weight bearing were recorded. Family doctors were contacted for those treated with Tight- ropes to check for any complications managed elsewhere. Results： Thirty-five patients required syndesmoticfixation, in which 12 were treated with Tightropes. They were followed up in clinic for a mean of 12.4 weeks. Family doctors were contacted at mean 14.6 months after treatment to determine any complications suffered. There were no complications attributable to method of fixation. In this series, 12 patients underwent 13 procedures and no patient had recurrent diastasis at discharge; 23 patients treated with screw fixation underwent 45 procedures （19 were screw removals）. There was 1 case ofsyndesmotic diastasis. Screw removal resulted in 2 minor complications. Conclusion： Tightrope fixation provideds effective syndesmotic fixation that is maintained at discharge. We do not experience soft tissue complications reported elsewhere.

Spraino:A novel low-friction device for prevention of lateral ankle sprain injuries in indoor sports

A heightened risk for lateral ankle sprain injuries has been associated with excessive shoe-surface friction.‘Spraino’is a novel product specifically designed towards preventing friction-related lateral ankle sprains.In a recent 510-athlete randomized controlled trial,allocation to this“low-friction”shoe-patch resulted in a 53%reduction of severe ankle sprain injuries.Until now,however,a theoretical explanation linking shoe-surface friction and lateral ankle sprain injury mechanism is missing,and the extent to which Spraino reduces shoesurface friction remains unknown.Therefore,the purpose of this study was to present a theoretical link between lateral edge shoe-surface friction and the mechanism of lateral ankle sprain injuries,and ultimately establish the ability of Spraino to reduce lateral edge shoe-surface friction.In this paper,we present a theory on how ankle sprain mechanics are directly affected by the friction between shoe and surface,and why friction modifications might be a viable preventive strategy.When testing slip resistance in a modified mechanical testsetup,we detected a 63%reduction(0.83–0.31)in friction coefficient between the lateral edge of the outsole and the indoor sports floor when adding Spraino to the side of the shoe.Justified in our theory,and the previously established clinical effectiveness,this reduction in friction can mitigate both the risk and severity of lateral ankle sprain injuries.This suggests that reducing friction on the lateral edge of footwear can be an effective ankle sprain injury prevention strategy.

Posterior malleolar fracture： technique and clinical exerience of the posterolateral approach

：Objective：To introduce the posterolateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.Methods：This study consisted of 32 cases,22 males and 10 females with the mean age of 48 years（range,21-63years）,suffering from posterior malleolar fracture.All cases were treated with the posterolateral surgical approach to the ankle.The average follow-up period was 28 months （range,24-35 months）.The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle （OMA）score and plain radiographs.Results：All cases showed radiological evidence of bony union at follow-up.The average OMA score was 82 points; 21 cases had excellent scores（90-100 points）,9 good （61-90 points）,and 2 fair（31-60 points）.The excellent-togood rate was 93.8%.Although most cases did not show any wound dehiscence or necrosis,one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months.In addition,one presented with mild symptoms of peroneal tendonitis that disappeared after plateremoval.Conclusion：The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.

Treatment of closed subtalar joint dislocation:A case report and literature review

Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.

Results of surgically treated talar fractures

Objective：Talar fractures present a great challenge to surgeons due to poor treatment outcome and high incidence of sequelae.The purpose of this study was to report the surgical treatment outcome of displaced talar fractures treated by internal fixation.Methods：Atotal of 30 patients with a mean age of 38 years presenting with talar body or neck fractures were studied retrospectively to assess postoperative outcome based on American Orthopaedic Foot ＆ Ankle Society AnkleHindfoot scale.Results：Postoperatively,malunion was found in 18 cases,infection in 5 cases and avascular necrosis in 12 cases.There were 12 cases with subtalar arthritis and 18 cases with both subtalar and malleolar arthritis.The average score of questionnaire was 64± 12.Functional score was 53± 15 and pain score was 65±13.Range of motion failure was detected as 15±4.Conclusion：Talar injuries can compromise motion of the foot and ankle and result in poor prognosis on longterm evaluation.Late complications subsequent to surgically treated talar body fractures are inevitable,and patients are supposed to be counseled about the adverse outcome.