• Physical Therapy Korea
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• v.28 no.3
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• pp.200-207
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• 2021

Background: Postural control deficit is a major characteristic in patients with chronic ankle instability (CAI). Elastic ankle tapings are commonly used to facilitate postural control in patients with CAI as well as prevent relapse of a lateral ankle sprain. However, equivocal evidence exists concerning the effect of elastic ankle taping on postural control. Objects: This study aimed to evaluate the effects of elastic ankle tapings using kinesio taping (KT) and dynamic taping (DT) on static and dynamic postural control in patients with CAI. Methods: Fifteen subjects with CAI were participated in this study. The participants performed tests under three conditions (barefoot, KT, and DT). Static postural control was evaluated using the one-leg standing test (OLST) and dynamic postural control using the modified Star Excursion Balance Test (mSEBT). One-way repeated-measures analysis of variance was used to compare center of pressure (CoP) data and normalized mSEBT reach distances among the three conditions (with α = 0.05). Results: The CoP parameters (path length, ellipse area, and mean velocity) of the OLST significantly decreased on applying KT and DT compared with those when barefoot. The normalized reach distances in the anteromedial (AM), medial (M), and posteromedial (PM) directions of the mSEBT significantly increased with DT compared to that in the control condition. Further, the higher reach distances with KT compared with those in the control condition were obtained in the M and PM directions of the mSEBT. No significant differences were identified in any of the OLST and SEBT parameters between the two different taping applications. Conclusion: KT and DT improved static postural control during the OLST compared with the control condition. Moreover, these tapes improved dynamic postural control during the mSEBT compared to the control. Therefore, elastic ankle tapings are useful prophylactic devices for the prevention and treatment of ankle sprain in people with CAI.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.127-136
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• 2003

Posterolateral instability of the knee occurs more commonly in association with an injury to anterior and posterior cruciate ligament and combined injuries are severe injuries that result in significant functional instability and articular cartilage degeneration. Reconstruction of the anterior and posterior cruciate ligament without an appropriate treatment of posterolateral corner injury result in failure of the reconstructed cruciate ligaments. Meticulous physical examinations, imaging studies, lower limb alignment and gait pattern should be evaluated. Acute grade III isolated or combined injury of the posterolateral corner is best treated within three weeks by direct repair, or augumentation, or reconstruction. The appropriate surgical method or combined methods are selected among the several methods of posterior and posterolateal reconstruction, and all injuried posterolateral and cruciate ligament structures are anatomically reconstructed simultaneously or by stages. If a varus alignment and varus thrust is disclosed in chronic posterolateral instability of knee, soft tissue reconstructions laterally are highly unlikely to be able to correct tile problem. It is appropriate that valgus osteotomy should be done before soft tissue reconstruction and reevaluate the posterolateral instability about 6 months later.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.4
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• pp.191-200
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• 2021

Purpose : Chronic ankle instability can lead to problems in balance and gait due to weakness of the ankle muscles and decreased proprioceptive sensation. Balance training that stimulates proprioceptors is necessary to improve ankle stability. We aimed to compare the effects of unstable support balance exercises using whole body sonic vibration and an aero-step (TOGU) on proprioception and balance in individuals with unilateral functional ankle instability. Methods : Thirty-six participants with unilateral functional ankle instability were randomly recruited and divided into two groups (group 1 = sonic whole body vibration, group 2= TOGU). Individuals in each group participated in training for 5 weeks, 40 minutes per session, 5 times per week, and performed weight-bearing exercises in five postures on different unstable support surfaces. Proprioception was measured by digital inclinometer (Dualer IQ), and balance was measured by force platform (Biodex balance system). Results : Significant differences were observed in proprioception before and after intervention within both group (p<.05). Significant differences were also observed in the balance index before and after intervention within both groups (p<.05). Conclusion : As a result of this study, it is suggested that for individuals with ankle instability, unstable support surface training using a whole body sonic vibrator and TOGU can have a positive effects on proprioception and balance ability.

• The Journal of Korean Physical Therapy
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• v.15 no.1
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• pp.155-170
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• 2003

Lumbar segmental instability is considered to represent a significant sub-group within the chronic low back pain population. This condition has a unique clinical presentation that displays its symptoms and movement dysfunction within the neutral zone of the motion segment. The loosening of the motion segment secondary to injury and associated dysfunction of the local muscle system renders it biomechanically vulnerable in the neutral zone. There in evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems in presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. The local stability muscles demonstrate evidence of failure of aeequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction. The clinical diagnosis of this chronic low back pain condition is based on the report of pain and the observation of movement dysfunction within the neutral zone and the associated finding of excessive intervertebral motion at the symptomatic level. Four different clinical patterns are described based on the directional nature of the injury and the manifestation of the patient's symptoms and motor dysfunction. A specific stabilizing exercise intervention based on a motor learning model in proposed and evidence for the efficacy of the approach provided.

• Journal of Korean Foot and Ankle Society
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• v.20 no.1
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• pp.12-18
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• 2016

Purpose: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. Materials and Methods: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brőstrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. Results: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >$15^{\circ}$, anterior draw >10 mm or the difference of contralateral side talar tilt >$5^{\circ}$, anterior draw >3 mm), and 4) overweight (body mass index >$30kg/m^2$). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. Conclusion: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.35-40
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• 2011

Purpose: This study was performed to evaluate the diagnostic usefulness of ankle stress radiograph for evaluation of chronic lateral ankle instability. Materials and Methods: Among patients undergoing the modified-Brostrom procedure, 42 cases with complete rupture of the anterior talofibular ligament were enrolled in this study. Sixty Korean adults (120 cases) were recruited as the control group. Radiologic measurement of talar tilt and anterior talar translation was performed through stress radiographs using Telos device. We obtained the normal range of Korean adults, and used as a standard value for judgment of mechanical instability. We analyzed the sensitivity, specificity, positive and negative prediction value of ankle stress radiograph. Results: On ankle stress radiograph, normal range of talar tilt angle and anterior talar translation was below $8.3^{\circ}$, below 7.6mm. Talar tilt angle on varus stress radiograph showed 57% of sensitivity, 97% of specificity, 89% of positive and 86% of negative prediction value. Anterior talar translation on anterior drawer stress radiograph showed 69% of sensitivity, 97% of specificity, 91% of positive and 90% of negative prediction value. Conclusion: Ankle stress radiograph had a good specificity, positive and negative prediction value for the evaluation of mechanical instability. However it underestimated the mechanical instability of ankle joint. It must be remembered that normal stress radiograph does not exclude ankle instability.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.1
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• pp.27-36
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• 2020

Purpose : The purpose of this study is to apply kinesiology taping and dynamic taping to subjects with ankle instability and to find out the change of static balance and dynamic balance ability and to use it more usefully in daily life. Methods : The subjects were based on 30 Cumberland Ankle Instability Tool questionnaire scores of 24 or less, and were randomly assigned to the kinesiology taping group (n=15) and the dynamic taping group (n=15) to change the static balance and dynamic balance before and after taping Measured. The eyes were closed for 30 seconds and the average balance was measured three times through the Wii balance board in static balance, and the balance ability was evaluated by measuring functional reach test and star excursion balance test in dynamic balance. Results : As a result, the static balance showed significant results in the dynamic speed and the moving distance in the dynamic taping group (p<.05). However, there was no significant difference in the shaking area and the difference in the kinesiology taping group (p<.05) However, both groups showed significant differences in dynamic balance (p<.05). Conclusion : It was confirmed that the application of taping was effective for static and dynamic balance in subjects with ankle instability, and the application of dynamic taping was more effective than kinesiology taping.

• PNF and Movement
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• v.18 no.2
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• pp.173-182
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• 2020

Purpose: The purpose of the study was to investigate the effects of visual feedback exercise (VFE), sandal exercise (SE), and thera-band exercise (TE) on people with functional ankle instability. Methods: The 45 study participants were divided into three groups of 15. In the VFE group, participants performed short-foot exercises using visual feedback; the SE group performed sandal exercises, and the TE group performed thera-band exercises. Over a period of 8 consecutive weeks, the experimental groups exercised for 15 minutes per session, four times per week. Balance was measured using the Biodex Balance System for dynamic balance ability (overall balance index [OBI], mediolateral balance index [MBI], and anterioposterior balance index [ABI]). Vibration threshold sense (VTS) was assessed using a vibratory sensory analyzer. Ankle muscular strength was measured using the Biodex 4 Pro. The main outcome measures were assessed at baseline and after 8 weeks of training. Results: Significant improvements in dynamic balance were noted in all three groups (p < 0.05). Significant improvements in VTS and muscular strength were also noted in the VFE and TE groups but not in the SE group (p < 0.05). Conclusion: Appropriate environmental and situational mediation may be of great clinical significance for patients suffering from chronic ankle instability. It is hoped that the findings will inform a program for prevention of ankle instability.

• Journal of Korean Foot and Ankle Society
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• v.26 no.1
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• pp.40-47
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• 2022

Purpose: The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST). Materials and Methods: Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m²; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. Results: FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%). There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). Conclusion: The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

• Korean Journal of Radiology
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• v.22 no.3
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• pp.384-394
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• 2021

Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping. Materials and Methods: This study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student's t test, and Pearson's correlation coefficient. Results: T2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = -0.687, p = 0.007; r = -0.609, p = 0.021, respectively). Conclusion: CLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.