• The Journal of Korean Physical Therapy
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• v.33 no.1
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• pp.28-33
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• 2021

Purpose: This study examined the effects of heel raise exercises combined with neuromuscular electrical stimulation (NMES) on the muscle strength and postural control ability of subjects with functional ankle instability (FAI). Methods: Twenty-two subjects with FAI participated in this study. They were assigned randomly to two groups: 11 each in the NMES and the sham-NMES groups. Heel raise exercise was applied, and NMES electrodes were attached to the peroneus longus muscles. The NMES group applied NMES during the heel raise exercise. NMES was applied for 20 minutes during the heel raise exercise. The heel raise exercise was performed four times a week for five weeks. The muscle strength and balance error scoring system (BESS) were measured before and after the intervention. Results: A comparison of before and after the intervention within the groups revealed improved muscle strength in the NMES and Sham-NMES groups, but the BESS was improved under all conditions only in the NMES group. The Sham-NMES group showed no improvement in the unstable support surface. Furthermore, when comparing the amount of change before and after the intervention between the groups, there were significant differences in the total score and unstable support in the BESS and muscle strength. Conclusion: NMES had a positive effect on the functional activities of the functional ankle instability subjects, such as balancing on an unstable support surface during postural control and increasing muscle strength.

• Journal of Korean Foot and Ankle Society
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• v.23 no.1
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• pp.6-11
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• 2019

As a result of the increased participation in recreational and competitive sports activity, the incidence of chronic lateral instability has risen. Because chronic ankle instability can cause significant comorbidity and increase the social cost, the interest in this issue is growing. Although there are well-documented and effective surgical treatments for managing this condition, conservative treatments are a viable first option in selected patients. Through conservative treatment, surgical treatments can be reduced or delayed without necessarily affecting the overall outcome, but the failure of conservative treatment results in the need for surgical treatment to reduce the long term complications. Appropriate postoperative rehabilitation is essential for adequate functional recovery, even when surgical treatment is required.

• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.171-176
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• 2022

Purpose: This study reports on a series of patients with chronic lateral ankle instability that underwent the Brostrom procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace. Materials and Methods: This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Brostrom procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months). Results: Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months. Conclusion: Early unrestricted weight-bearing in a stirrup brace following the Brostrom procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.3
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• pp.27-37
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• 2018

PURPOSE: The purpose of this study was to investigate and evaluate muscle activity and foot pressure during gait, and isokinetic strength and balance in persons with functional ankle instability (FAI). METHODS: Nine healthy subjects (CON, n=9) without FAI and 11 patients (FAI, n=11) with FAI participated in the study after having been screened with an ankle instability instrument and a balance error scoring system. In addition, FAI was classified as non-involved (FAI-N) or involved (FAI-I), and CON was classified as dominant or non-dominant. All subjects were evaluated for isokinetic strength (plantar flexion, dorsiflexion, inversion and eversion of $30^{\circ}/sec$ and $60^{\circ}/sec$), balance (static and dynamic), muscle activity (tibialis anterior, peroneus longus and gastrocnemius) and foot pressure (static and dynamic) during gait. RESULTS: Results showed that plantar flexion (p<.05), dorsiflexion (p<.05), inversion (p<.01) and eversion (p<.00) of $60^{\circ}/sec$ were significantly decreased in FAI-I compared to those in FAI-N and CON. C 90 of static balance with eyes open (p<.01) and closed (p<.00) were significantly increased in FAI compared to those in CON. Forward position of dynamic balance (p<.01) was significantly decreased in FAI compared to that in CON. Gastrocnemius and peroneus longus of dynamic muscle activity (p<.01), left and right weight distribution of static foot pressure (p<.00) and pressure distribution of dynamic foot pressure (p<.00) were significantly decreased in FAI-I compared to those in FAI-N. CONCLUSION: We demonstrated that ankle strength, balance, muscle activity and foot pressure were significantly correlated with FAI.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.1
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• pp.19-27
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• 2022

Background: This study investigated the effects of a single-leg hopping test and Q-angle when applying Mulligan taping, flossing bands, and a combination of Mulligan taping and flossing bands to chronic ankle instability (CAI) patients. Methods: The subjects of the study were 68 patients with chronic ankle instability, randomly divided into three groups receiving the following treatments: Mulligan taping (n=22), flossing bands (n=23), and a combination of Mulligan taping and flossing bands (n=23). The immediate effects of the treatments were evaluated using the single-leg hopping test and Q-angle measurement for functional movement before and after the intervention. Results: All three groups showed significant improvements in the single-leg hopping test after the intervention, and there was a significant difference between the performance of the simultaneous application group and the Mulligan taping group (p<.01). As a result of the post-hoc test, there was a significant difference in the simultaneous application group than in the mulligan taping group (p<.01). When measuring the Q-angle change during the activity of descending stairs, there was also a significant effect in all three groups, with no significant differences when comparing the changes between groups (p>.05). Conclusions: In conclusion, Mulligan taping and flossing bands were confirmed as effective interventions for the functional movement of the lower extremities in patients with CAI. This study can provide basic data on the effectiveness of interventions in patients with CAI.

• Journal of Korean Foot and Ankle Society
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• v.18 no.3
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• pp.108-114
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• 2014

Purpose: Ligament reattachment technique using a suture anchor appears to show satisfactory functional outcomes and mechanical stability compared with conventional bone tunnel technique. This study was prospectively conducted in order to evaluate functional outcomes of modified Brostrom procedures using the suture bridge technique for chronic ankle instability in athletes. Materials and Methods: Twenty eight athletes under 30 years of age were followed for more than two years after undergoing the modified Brostrom procedure using the suture bridge technique. Functional evaluation consisted of the foot and ankle outcome score (FAOS), foot and ankle ability measure (FAAM) score. Range of motion and time to return to exercise were evaluated using a periodic questionnaire. Talar tilt angle and anterior talar translation were measured through stress radiographs for evaluation of mechanical stability. Results: FAOS improved significantly from preoperative mean 59.4 points to 91.4 points (p<0.001). Daily living and sport activity scores of FAAM improved significantly from preoperative mean 50.5, 32.5 points to 94.8, 87.3 points, respectively (p<0.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean $16.8^{\circ}$, 13.5 mm to $4.2^{\circ}$, 4.1 mm at final follow-up (p<0.001). Times to return to exercise were as follows: mean 10.2 weeks in jogging, 15.4 weeks in spurt running, 13.1 weeks in jumping, 11.5 weeks in walking on uneven ground, 9.1 weeks in standing on one leg, 7.2 weeks in tip-toeing gait, 8.4 weeks in squatting, and 10.6 weeks in descending stairs. Conclusion: Modified Brostrom procedure using the suture bridge technique showed satisfactory functional outcomes for chronic ankle instability in athletes. Optimal indication and cost-effectiveness of the suture bridge technique will be studied in the future.

• PNF and Movement
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• v.18 no.2
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• pp.183-194
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• 2020

Purpose: Functional ankle instability (FAI) causes tension in the joints, ligaments, and tendons, and the impact on visual and vestibular organs leads to imbalance. This study compared the effects of a traditional balance training program to virtual reality training to improve FAI. Methods: Twenty-four participants with FAI (CAIT score < 24) were assigned to a virtual reality training group (n = 13) and a traditional balance training group (n = 11). Both groups pursued their respective training program for four weeks. After a ten-minute warm-up, participants completed a 30-minute training session, three times per week. The traditional balance training group underwent static and dynamic training using a balance board and a stability trainer pad while the virtual reality group underwent balance training using a virtual reality program. Biorescue was used to measure changes in the speed and length of center of pressure (COP) for single-leg stance pre- and post-training. Results: The speed and length of COP improved significantly in both groups after training as compared to before (p < 0.05). However, there were no significant differences in these outcomes between the virtual reality training group and the traditional balance training group (p>0.05). Conclusion: The study findings confirm the effectiveness of both virtual reality training and traditional balance training in reducing ankle instability, with no difference in treatment effects.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.1
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• pp.101-108
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• 2022

Purpose : This study was conducted to investigate the effect of muscle taping and joint taping on static and dynamic balance in normal adults with chronic ankle instability. Methods : The subjects of this study were 32 people who met the inclusion criteria. This cross-sectional study was conducted using the Kinesio tape, an elastic tape, was used. Subjects were randomized to exclude the effect of sequence, and no taping, joint taping, and muscle taping were applied as taping interventions. One-leg standing test and a Functional reach test were conducted to measure static balance, and Y-balance test was conducted to measure dynamic balance. One way repeated ANOVA was performed to investigate the difference in balance ability according to the taping intervention. If there was a significant difference, a post-hoc was performed using the Bonferroni method. Results : In the case of static balance, joint taping showed more significant results than did no taping and muscle taping (p<.05), and muscle taping showed more significant results than did no taping (p<.05). In the case of dynamic balance, muscle taping showed significantly larger results than did no taping and joint taping (p<.05) and joint taping showed significantly larger results than did no taping (p<.05). Conclusion : This study found that mechanical stimulation of muscles and joint compression by elastic taping increased ankle stability and improved static and dynamic balance. In particular, for static balance, joint taping was more effective than muscle taping, and for dynamic balance, muscle taping was more effective than joint taping. Applying the appropriate taping method to individual subjects has the advantage of maximizing the therapeutic effect for the recovery of balance ability. Similarly, the application of various tapings to subjects with ankle instability will have a positive effect on functional improvement.

• Journal of Korean Orthopaedic Sports Medicine
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• v.12 no.1
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• pp.37-41
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• 2013

Purpose: We investigated the short term results of medial deltoid ligament repair after diagnosis of chronic medial ankle instability. Materials and Methods: 262 military patients with ankle instability symptom were evaluated between May 2007 and December 2009. We diagnosed 29 chronic medial ankle instability cases with medial drive through sign under arthroscopy, radiologic findings and physical exam, treated with deltoid talo-navicular band repair using anchor suture. We used the American orthopedic foot and ankle society ankle-hindfoot score (AOFAS), visual analog scale (VAS) and ankle functional satisfactory scores were carried out. Results: 29 patients (11.1%) has chronic medial ankle instability, mean AFOAS score, VAS was improved from 65.4(range; 43-83), 6.0(range; 4-10) to 82.0(range; 60-100), 3.2(range; 1-7). Patients satisfaction were excellent 13(44.8%), good 11(37.9%) and poor 5(17.2%). Two cases was recurred and revised with allo-tendinous reconstruction. Conclusion: We underwent surgery to repair the talo-navicular ligament for chronic medial ankle instability, and about 83% of satisfactory results were obtained.

• Physical Therapy Korea
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• v.27 no.4
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• pp.292-297
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• 2020

Background: Ankle sprain is one of the most common musculoskeletal injuries in the sports population or during usual daily life activities. The sprain can cause functional ankle instability (FAI), and it is very important to treat FAI. However, the optimum intervention method for FAI has yet to be determined. Objects: This study investigated the impact that virtual reality (VR) training program on balance with ankle kinesio taping for FAI. Methods: Twenty-two people were selected for the study and randomly divided into the experimental (n = 11) and the control group (n = 11). The experimental group had attached kinesio taping on the ankle and then implemented a virtual reality exercise program for 30 minutes a day. Nintendo Wii Fit Plus was used for the VR intervention three times a week for four weeks. The control group performed only two measurements without intervention. Results: There were no statistically significant differences in overall, anterior-posterior (AP), medial-lateral (ML) index of the static balance, and significant differences in overall, AP, ML index of the dynamic balance when taping and VR exercise were applied at the same time (p < 0.05). There were no significant differences in overall and ML index of static and dynamic balance compared with before and after assessment between the experimental and the control group, and found differences in AP index of static and dynamic balance (p < 0.05). Conclusion: Kinesio taping may not influence the balance of FAI as great as people expected. VR approach does not affect the static balance of FAI, but it influences dynamic balance in overall, AP, ML index. The authors suggest that VR-based exercises can be used as an additional concept in clinicians for FAI or as part of a home program because the exercises still have limitations.