Investigating the Effects of Intrinsic Foot Muscle Exercises on Dynamic Balance after Sub-Acute Ankle Sprain
,
Abstract
Introduction: This study compares the efficacy of routine treatment plus short foot exercises (SFE) with routine treatment alone on dynamic balance and pain in subjects with sub-acute ankle sprain.
Materials and Methods: A total of 32 patients (18-45 years old) with primary ankle sprain were randomly enrolled into the control group performing routine treatment alone or the SFE group performing routine treatment plus SFE. The dynamic balance was assessed using the star excursion balance test. Pain and ankle dorsiflexion range of motion were assessed using the numeric pain rating scale and a goniometer. The outcomes were evaluated at the baseline and after the end of treatment. The groups were compared using the one-way analysis of variance/analysis of covariance test. The effect sizes also were calculated to determine the efficacy of the SFE.
Results: Dynamic balance in the SFE group had a significant increase in the anterior, lateral, medial, and anteromedial directions compared to the control group (P=0.001, P=0.002, P=0.014, P=0.0001). No significant differences were observed between the groups in other directions of the star excursion balance test (P>0.05). Additionally, pain intensity was lower significantly in the SFE group than in the control group (P=0.0001). In the SFE group ankle dorsiflexion range was significantly more than the control group (P=0.025). The effect sizes also showed a high efficacy favoring SFE.
Conclusion: The combination of routine treatment and SFE can be an effective intervention for managing ankle sprain.
Wilson B, Bialocerkowski A. The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains--A Systematic Review. PloS One. 2015;10(6):e0124214.
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med Auckl NZ. 2014 Jan;44(1):123–40.
Maeda N, Ikuta Y, Tsutsumi S, Arima S, Ishihara H, Ushio K, et al. Relationship of Chronic Ankle Instability With Foot Alignment and Dynamic Postural Stability in Adolescent Competitive Athletes. Orthop J Sports Med [Internet]. 2023 Oct [cited 2024 Jan 12];11(10). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10583524/
D’Hooghe P, Cruz F, Alkhelaifi K. Return to Play After a Lateral Ligament Ankle Sprain. Curr Rev Musculoskelet Med. 2020 Jun;13(3):281–8.
McGovern RP, Martin RL. Managing ankle ligament sprains and tears: current opinion. Open Access J Sports Med. 2016;7:33–42.
McKeon PO, Wikstrom EA. The effect of sensory-targeted ankle rehabilitation strategies on single-leg center of pressure elements in those with chronic ankle instability: A randomized clinical trial. J Sci Med Sport. 2019 Mar;22(3):288–93.
Hadadi M, Haghighat F, Mohammadpour N, Sobhani S. Effects of Kinesiotape vs Soft and Semirigid Ankle Orthoses on Balance in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. Foot Ankle Int. 2020 Jul;41(7):793–802.
Eils E, Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc. 2001 Dec;33(12):1991–8.
Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.
Ruiz-Sánchez FJ, Ruiz-Muñoz M, Martín-Martín J, Coheña-Jimenez M, Perez-Belloso AJ, Pilar Romero-Galisteo R, et al. Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review. Medicine (Baltimore). 2022 Oct 21;101(42):e31087.
Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020 Dec 18;11(12):534–58.
Ortega-Avila AB, Cervera-Garvi P, Marchena-Rodriguez A, Chicharro-Luna E, Nester CJ, Starbuck C, et al. Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J Clin Med. 2020 Sep 27;9(10):3128.
Docherty CL, Arnold BL. Force sense deficits in functionally unstable ankles. J Orthop Res Off Publ Orthop Res Soc. 2008 Nov;26(11):1489–93.
Rivera MJ, Winkelmann ZK, Powden CJ, Games KE. Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review. J Athl Train. 2017 Nov;52(11):1065–7.
Zwipp H. Conservative Functional Treatment of Acute Fibular Ligament Rupture of the Ankle. Dtsch Arzteblatt Int. 2023 Jun 30;120(26):454–60.
Delahunt E, Bleakley CM, Bossard DS, Caulfield BM, Docherty CL, Doherty C, et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018 Oct;52(20):1304–10.
Mulligan EP, Cook PG. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man Ther. 2013 Oct;18(5):425–30.
Moon DC, Kim K, Lee SK. Immediate Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet. J Phys Ther Sci. 2014 Jan;26(1):117–9.
Lee E, Cho J, Lee S. Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial. Med Sci Monit Int Med J Exp Clin Res. 2019 Jan 21;25:618–26.
Lee DR, Choi YE. Effects of a 6-week intrinsic foot muscle exercise program on the functions of intrinsic foot muscle and dynamic balance in patients with chronic ankle instability. J Exerc Rehabil. 2019 Oct;15(5):709–14.
Veltrie R. The Effects of Intrinsic Foot Muscle Strengthening on Foot Posture, Balance, and Agility in Ice Hockey Players. Grad Theses Diss Probl Rep [Internet]. 2020 Jan 1; Available from: https://researchrepository.wvu.edu/etd/7602
Gogate N, Satpute K, Hall T. The effectiveness of mobilization with movement on pain, balance and function following acute and sub acute inversion ankle sprain - A randomized, placebo controlled trial. Phys Ther Sport Off J Assoc Chart Physiother Sports Med. 2021 Mar;48:91–100.
Weerasekara RMIM, Tennakoon SUB, Suraweera HJ. Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains. Foot Ankle Spec. 2016 Aug;9(4):307–23.
Truyols-Domí Nguez S, Salom-Moreno J, Abian-Vicen J, Cleland JA, Fernández-de-Las-Peñas C. Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial. J Orthop Sports Phys Ther. 2013 May;43(5):300–9.
Green T, Refshauge K, Crosbie J, Adams R. A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Phys Ther. 2001 Apr;81(4):984–94.
Brison RJ, Day AG, Pelland L, Pickett W, Johnson AP, Aiken A, et al. Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial | The BMJ. BMJ. 2016 Nov 16;355.
Lynn SK, Padilla RA, Tsang KKW. Differences in static- and dynamic-balance task performance after 4 weeks of intrinsic-foot-muscle training: the short-foot exercise versus the towel-curl exercise. J Sport Rehabil. 2012 Nov;21(4):327–33.
Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47(3):339–57.
Modarresi S, Lukacs MJ, Ghodrati M, Salim S, MacDermid JC, Walton DM. A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain. Clin J Pain. 2022 Feb;38(2):132.
Tavares P, Landsman V, Wiltshire L. Intra-examiner reliability of measurements of ankle range of motion using a modified inclinometer: a pilot study. J Can Chiropr Assoc. 2017 Aug;61(2):121–7.
Sulowska I, Oleksy Ł, Mika A, Bylina D, Sołtan J. The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PloS One. 2016;11(6):e0157917.
McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015 Mar;49(5):290.
Cohen J. Statistical power analysis for the behavioral sciences. 2. ed., reprint. New York, NY: Psychology Press; 2009. 567 p.
Richardson JTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011 Jan;6(2):135–47.
Fullam K, Caulfield B, Coughlan GF, Delahunt E. Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test. J Sport Rehabil. 2014 Feb;23(1):27–35.
Rothermel SA, Hale SA, Hertel J, Denegar CR. Effect of active foot positioning on the outcome of a balance training program. Phys Ther Sport. 2004 May 1;5(2):98–103.
McKeon PO, Fourchet F. Freeing the foot: integrating the foot core system into rehabilitation for lower extremity injuries. Clin Sports Med. 2015 Apr;34(2):347–61.
Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM. Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J Orthop Sports Phys Ther. 2008 Jul;38(7):403–9.
Hoch MC, Staton GS, McKeon PO. Dorsiflexion range of motion significantly influences dynamic balance. J Sci Med Sport. 2011 Jan;14(1):90–2.
Moseley GL, Hodges PW. Are the changes in postural control associated with low back pain caused by pain interference? Clin J Pain. 2005;21(4):323–9.
Joshi DG, Balthillaya G, Prabhu A. Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals - A randomized clinical trial. J Bodyw Mov Ther. 2018 Jul;22(3):832–7.
Mitchkash M, Robinson D, Tenforde AS. Efficacy of Extracorporeal Pulse-Activated Therapy in the Management of Lower-Extremity Running-Related Injuries: Findings From a Large Case Cohort. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2020;59(4):795–800.
Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Elsevier Health Sciences; 2014. 348 p.
Ostiak W, Kaczmarek-Maciejewska M, Kasprzak P. Foot and shin in terms of Anatomy Trains. J Orthop Trauma Surg Relat Res. 2011;(5):38–41.
Sulowska-Daszyk I, Mika A, Oleksy Ł. Impact of Short Foot Muscle Exercises on Quality of Movement and Flexibility in Amateur Runners. Int J Environ Res Public Health. 2020 Sep 8;17(18):6534.
Kim JS, Lee MY. The effect of short foot exercise using visual feedback on the balance and accuracy of knee joint movement in subjects with flexible flatfoot. Medicine (Baltimore). 2020 Mar;99(13):e19260.
Sulowska I, Mika A, Oleksy Ł, Stolarczyk A. The Influence of Plantar Short Foot Muscle Exercises on the Lower Extremity Muscle Strength and Power in Proximal Segments of the Kinematic Chain in Long-Distance Runners. BioMed Res Int. 2019;2019:6947273.
Lazarou L, Kofotolis N, Pafis G, Kellis E. Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain. J Back Musculoskelet Rehabil. 2018;31(3):437–46.
Fraser JJ, Koldenhoven R, Hertel J. Ultrasound Measures of Intrinsic Foot Muscle Size and Activation Following Lateral Ankle Sprain and Chronic Ankle Instability. J Sport Rehabil. 2021 Apr 9;30(7):1008–18.
Jaffri AH, Koldenhoven R, Saliba S, Hertel J. Evidence for Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-Analysis. J Athl Train. 2023 Nov 1;58(11–12):941–51.
Taira T, Hori T. The role of neurosurgical interventions for control of spasticity in neurorehabilitation: new findings on functional microanatomy of the tibial nerve. Acta Neurochir Suppl. 2003;87:103–5.
Calixtre LB, Oliveira AB, Alburquerque-Sendín F, Armijo-Olivo S. What is the minimal important difference of pain intensity, mandibular function, and headache impact in patients with temporomandibular disorders? Clinical significance analysis of a randomized controlled trial. Musculoskelet Sci Pract. 2020 Apr;46:102108.
Laigaard J, Pedersen C, Rønsbo TN, Mathiesen O, Karlsen APH. Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: a systematic review. Br J Anaesth. 2021 May 1;126(5):1029–37.
| Files | ||
| Issue | Vol 18 No 4 (2024) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i4.16913 | |
| Keywords | ||
| Ankle sprain Intrinsic muscles Foot exercises | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
