DOI QR코드

DOI QR Code

The Structural Characteristics of the Ankle Joint Complex and Declination of the Subtalar Joint Rotation Axis between Chronic Ankle Instability (CAI) Patients and Healthy Control

만성 발목 불안정성(CAI) 환자와 건강 대조군 간의 발목 관절 복합체 구조적 특징과 목말밑 관절 회전 축 기울기

  • Kim, Chang Young (Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University) ;
  • Ryu, Ji Hye (Graduate School of Education, Yonsei University) ;
  • Kang, Tae Kyu (Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University) ;
  • Kim, Byong Hun (Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University) ;
  • Lee, Sung Cheol (Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University) ;
  • Lee, Sae Yong (Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University)
  • Received : 2019.03.13
  • Accepted : 2019.05.02
  • Published : 2019.06.30

Abstract

Objective: This study aimed to investigate the characteristics of the declination of the subtalar joint rotation axis and the structural features of the ankle joint complex such as rear-foot angle alignment and ligament laxity test between chronic ankle instability (CAI) patients and healthy control. Method: A total of 76 subjects and CAI group (N=38, age: $23.11{\pm}7.63yrs$, height: $165.67{\pm}9.54cm$, weight: $60.13{\pm}11.71kg$) and healthy control (N=38, age: $23.55{\pm}7.03yrs$, height: $167.92{\pm}9.22cm$, weight: $64.58{\pm}13.40kg$) participated in this study. Results: The declination of the subtalar joint rotation axis of the CAI group was statistically different from healthy control in both sagittal slope and transverse slope. The rear-foot angle of CAI group was different from a healthy control. Compared to healthy control, they had the structure of rear-foot varus that could have a high occurrence rate of ankle varus sprain. CAI group had loose ATFL and CFL compared to the healthy control. Conclusion: The results of this study showed that the deviation of the subtalar joint rotation axis and the structural features of the ankle joint complex were different between the CAI group and the healthy control and this difference is a meaningful factor in the occurrence of lateral ankle sprains.

Keywords

OOOSBL_2019_v29n2_61_f0001.png 이미지

Figure 1. Normal and medial deviated axis of subtalar joint

OOOSBL_2019_v29n2_61_f0002.png 이미지

Figure 2. Subtalar locator measurement

OOOSBL_2019_v29n2_61_f0003.png 이미지

Figure 3. Rear-foot angle measurement

OOOSBL_2019_v29n2_61_f0004.png 이미지

Figure 4. Normal inclination of subtalar joint axis of rotation with shoes on

OOOSBL_2019_v29n2_61_f0005.png 이미지

Figure 5. Rear foot angle alignment between two groups

Table 1. Inclusion criteria (CAI)

OOOSBL_2019_v29n2_61_t0001.png 이미지

Table 2. Characteristic subject

OOOSBL_2019_v29n2_61_t0002.png 이미지

Table 3. Research equipment

OOOSBL_2019_v29n2_61_t0003.png 이미지

Table 5. Result of subtalar joint locator

OOOSBL_2019_v29n2_61_t0004.png 이미지

Table 6. Result of rear-foot angle

OOOSBL_2019_v29n2_61_t0005.png 이미지

Table 4. Intra-class correlation coefficient (ICC) of all measure

OOOSBL_2019_v29n2_61_t0006.png 이미지

Table 7. Result of anterior drawer test and talar tilt test

OOOSBL_2019_v29n2_61_t0007.png 이미지

References

  1. Bahr, R., Pena, F., Shine, J., Lew, W. D., Lindquist, C., Tyrdal, S. & Engebretsen, L. (1997). Mechanics of the anterior drawer and talar tilt tests. A cadaveric study of lateral ligament injuries of the ankle. Acta Orthopaedica, 68(5), 435-441. https://doi.org/10.3109/17453679708996258
  2. Balduini, F. C. & Tetzlaff, J. (1982). Historical perspectives on injuries of the ligaments of the ankle. Clinical Journal of Sport Medicine, 1(1), 3-12. https://doi.org/10.1016/S0278-5919(20)31504-0
  3. Beynnon, B. D., Murphy, D. F. & Alosa, D. M. (2002). Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training, 37(4), 376-380.
  4. Beynnon, B. D., Renstrom, P. A., Alosa, D. M., Baumhauer, J. F. & Vacek, P. M. (2001). Ankle ligament injury risk factors: a prospective study of college athletes. Journal of Orthopaedic Research, 19(2), 213-220. https://doi.org/10.1016/S0736-0266(00)90004-4
  5. Brockett, C. L. & Chapman, G. J. (2016). Biomechanics of the ankle. Orthop Trauma, 30(3), 232-238. https://doi.org/10.1016/j.mporth.2016.04.015
  6. Carcia, C. R., Martin, R. L. & Drouin, J. M. (2008). Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability. Journal of Athletic Training, 43(2), 179-183. https://doi.org/10.4085/1062-6050-43.2.179
  7. Cho, J. H., Kim, K. H., Moon, G. S., Cho, Y. J. & Lee, S. C. (2010). Analysis of Injury Mechanism on Ankle and Knee during Drop Landings According to Landing Directions. Korean Journal of Sport Biomechanics, 20(1), 67-73.
  8. Croy, T., Koppenhaver, S., Saliba, S. & Hertel, J. (2013). Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. Journal of Orthopaedic & Sports Physical Therapy, 43(12), 911-919. https://doi.org/10.2519/jospt.2013.4679
  9. Croy, T., Saliba, S., Saliba, E., Anderson, M. W. & Hertel, J. (2013). Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity. Journal of Sport Rehabilitation, 22(4), 257-263. https://doi.org/10.1123/jsr.22.4.257
  10. Delahunt, E., Coughlan, G. F., Caulfield, B., Nightingale, E. J., Lin, C. W. & Hiller, C. E. (2010). Inclusion criteria when investigating insufficiencies in chronic ankle instability. Medicine & Science in Sports Exercise, 42(11), 2106-2121.
  11. Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J. & Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine, 44(1), 123-140. https://doi.org/10.1007/s40279-013-0102-5
  12. Donatelli, R., Wooden, M., Ekedahl, S. R., Wilkes, J. S., Cooper, J. & Bush, A. J. (1999). Relationship between static and dynamic foot postures in professional baseball players. Journal of Orthopaedic & Sports Physical Therapy, 29(6), 316-325; discussion 326-330. https://doi.org/10.2519/jospt.1999.29.6.316
  13. Dubin, J. C., Comeau, D., McClelland, R. I., Dubin, R. A. & Ferrel, E. (2011). Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of Chiropractic Medicine, 10(3), 204-219.
  14. Freeman, M. A. (1965). Instability of the foot after injuries to the lateral ligament of the ankle. Journal of Bone and Joint Surgery British, 47(4), 669-677. https://doi.org/10.1302/0301-620X.47B4.669
  15. Friel, K., McLean, N., Myers, C. & Caceres, M. (2006). Ipsilateral hip abductor weakness after inversion ankle sprain. Journal of Athletic Training, 41(1), 74-78.
  16. Garbalosa, J. C., McClure, M. H., Catlin, P. A. & Wooden, M. (1994). The frontal plane relationship of the forefoot to the rearfoot in an asymptomatic population. Journal of Orthopaedic & Sports Physical Therapy, 20(4), 200-206. https://doi.org/10.2519/jospt.1994.20.4.200
  17. Gribble, P. A., Delahunt, E., Bleakley, C. M., Caulfield, B., Docherty, C. L., Fong, D. T. & Wikstrom, E. A. (2014). Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Athl Train, 49(1), 121-127. https://doi.org/10.4085/1062-6050-49.1.14
  18. Hertel, J. (2002). Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. Journal of Athletic Training, 37(4), 364-375.
  19. Hollis, J. M., Blasier, R. D. & Flahiff, C. M. (1995). Simulated lateral ankle ligamentous injury. Change in ankle stability. American Journal of Sports Medicine, 23(6), 672-677. https://doi.org/10.1177/036354659502300606
  20. Hollis, J. M., Blasier, R. D., Flahiff, C. M. & Hofmann, O. E. (1995). Biomechanical comparison of reconstruction techniques in simulated lateral ankle ligament injury. American Journal of Sports Medicine, 23(6), 678-682. https://doi.org/10.1177/036354659502300607
  21. Hubbard, T. J. & Cordova, M. (2009). Mechanical instability after an acute lateral ankle sprain. Archives of Physical Medicine and Rehabilitation, 90(7), 1142-1146. https://doi.org/10.1016/j.apmr.2009.01.020
  22. Hubbard, T. J. & Hertel, J. (2006). Mechanical contributions to chronic lateral ankle instability. Sports Medicine, 36(3), 263-277. https://doi.org/10.2165/00007256-200636030-00006
  23. Jeon, K. K., Kim, K. W., Ryew, C. C. & Hyun, S. H. (2018). Effect of Functional Ankle Instability and Surgical Treatment on Dynamic Postural Stability and Leg Stiffness Variables during Vertical-Drop Landing. Korean Journal of Sport Biomechanics, 28(2), 135-141. https://doi.org/10.5103/kjsb.2018.28.2.135
  24. Kim, B. H., Kim, C. Y., Kang, T. K., Cho, Y. J. & Lee, S. Y. (2018). Immediate Effects of Joint Mobilization Techniques on Clinical Measures in Individuals with CAI. Korean Journal of Sport Biomechanics, 28(4), 219-225. https://doi.org/10.5103/KJSB.2018.28.4.219
  25. Kirby, K. A. (1987). Methods for determination of positional variations in the subtalar joint axis. Journal of the American Podiatric Medical Association, 77(5), 228-234. https://doi.org/10.7547/87507315-77-5-228
  26. Kirby, K. A. (1992). The medial heel skive technique. Improving pronation control in foot orthoses. Journal of the American Podiatric Medical Association, 82(4), 177-188. https://doi.org/10.7547/87507315-82-4-177
  27. Kirby, K. A. (2001). Subtalar joint axis location and rotational equilibrium theory of foot function. Journal of the American Podiatric Medical Association, 91(9), 465-487. https://doi.org/10.7547/87507315-91-9-465
  28. Larsen, E. (1988). Tendon transfer for lateral ankle and subtalar joint instability. Acta Orthopaedica, 59(2), 168-172. https://doi.org/10.3109/17453678809169701
  29. Lilley, T., Herb, C. C., Hart, J. & Hertel, J. (2018). Lower extremity joint coupling variability during gait in young adults with and without chronic ankle instability. Sports Biomechanics, 17(2), 261-272. https://doi.org/10.1080/14763141.2017.1287215
  30. Lynch, S. A. (2002). Assessment of the Injured Ankle in the Athlete. Journal of Athletic Training, 37(4), 406-412.
  31. McPoil, T. G., Knecht, H. G. & Schuit, D. (1988). A Survey of Foot Types in Normal Females between the Ages of 18 and 30 Years*. Journal of Orthopaedic & Sports Physical Therapy, 9(12), 406-109.
  32. Monaghan, G. M., Hsu, W. H., Lewis, C. L., Saltzman, E., Hamill, J. & Holt, K. G. (2014). Forefoot angle at initial contact determines the amplitude of forefoot and rearfoot eversion during running. Clinical Biomechanics, 29(8), 936-942. https://doi.org/10.1016/j.clinbiomech.2014.06.011
  33. Monaghan, G. M., Lewis, C. L., Hsu, W. H., Saltzman, E., Hamill, J. & Holt, K. G. (2013). Forefoot angle determines duration and amplitude of pronation during walking. Gait Posture, 38(1), 8-13. https://doi.org/10.1016/j.gaitpost.2012.10.003
  34. Morrison, K. E. & Kaminski, T. W. (2007). Foot characteristics in association with inversion ankle injury. Journal of Athletic Training, 42(1), 135-142.
  35. Nigg, B. M., Cole, G. K. & Nachbauer, W. (1993). Effects of arch height of the foot on angular motion of the lower extremities in running. Journal of Biomechanics, 26(8), 909-916. https://doi.org/10.1016/0021-9290(93)90053-H
  36. Rockar, P. A., Jr. (1995). The subtalar joint: anatomy and joint motion. Journal of Orthopaedic & Sports Physical Therapy, 21(6), 361-372. https://doi.org/10.2519/jospt.1995.21.6.361
  37. Smith, L. S., Clarke, T. E., Hamill, C. L. & Santopietro, F. (1986). The effects of soft and semi-rigid orthoses upon rearfoot movement in running. Journal of the American Podiatric Medical Association, 76(4), 227-233. https://doi.org/10.7547/87507315-76-4-227
  38. Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., Pertence, A. E. & Fonseca, S. T. (2009). Late rearfoot eversion and lower-limb internal rotation caused by changes in the interaction between forefoot and support surface. Journal of the American Podiatric Medical Association, 99(6), 503-511. https://doi.org/10.7547/0990503
  39. Spooner, S. K. & Kirby, K. A. (2006). The subtalar joint axis locator: a preliminary report. Journal of the American Podiatric Medical Association, 96(3), 212-219. https://doi.org/10.7547/0960212
  40. Tomaro, J. (1995). Measurement of tibiofibular varum in subjects with unilateral overuse symptoms. Journal of Orthopaedic & Sports Physical Therapy, 21(2), 86-89. https://doi.org/10.2519/jospt.1995.21.2.86
  41. Tropp, H., Askling, C. & Gillquist, J. (1985). Prevention of ankle sprains. Am J Sports Med, 13(4), 259-262. https://doi.org/10.1177/036354658501300408