Biomechanics and Intrinsic Foot Muscle Roles in Subjects With Chronic Ankle Instability

Université Catholique de Louvain72 enrolled

Overview

The current study involves a prospective interventional study that primarily intends to compare foot joint loadings of participants with chronic ankle instability (CAI) with those of subjects who recovered after an ankle sprain (LAS copers) and healthy controls during running and more challenging tasks. This study further aims to explore the impact of foot muscle properties and fatigue on the same biomechanical outcomes. Therefore, the investigators will recruit 72 participants (24 per group) aged from 18 to 44 years. Each of them will come only once to the CMAL laboratory (UZ Leuven, Pellenberg).

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

SCREENING

Masking

SINGLE

Enrollment

Conditions

Chronic Ankle Instability Lateral Ankle Sprain

Interventions

Eligibility

Sex: MALEMin age: 18 YearsMax age: 44 YearsHealthy volunteers:

Medical Language ↔ Plain English

Three groups of participants : Chronic ankle instability, lateral ankle sprain copers and healthy controls. INCLUSION CRITERIA: 1. For all three groups : * Physically active male subjects between 18 and 44 years of age * Able to run at low speed. * For homogeneity purposes, the investigators will only recruit subjects who perform a regular physical activity on a weekly basis, including competition participation. 2. Chronic ankle instability : * A history of at least one significant ankle sprain that occurred at least 12 months before study enrolment, associated with inflammatory symptoms, creating at least 1 interrupted day of desired physical activity; * The most recent injury occurred more than 3 months prior to study enrolment; * At least two episodes of giving way in the 6 months prior to study enrolment, recurrent sprain, and/or "feelings of instability"; and * Poor disability status according to the Cumberland Ankle Instability Tool (CAIT) (score ≤ 24/30). 3. Lateral ankle sprain copers : * A history of one significant ankle sprain that occurred at least 12 months before study enrolment, associated with inflammatory symptoms, creating at least 1 interrupted day of desired physical activity; * A return to at least moderate levels of weight-bearing physical activity less than 12 months after initial sprain without recurrent injury, episodes of giving way, and/or feelings of instability; * Minimal, if any, level of self-reported disability (CAIT score ≥ 28/30); and * Minimal, if any, alteration in self-reported function (ADL- and Sport-subscales ≥95%). 4. Healthy controls : * The same inclusion criteria as the LAS coper group, with the exception reported in the exclusion criteria. EXCLUSION CRITERIA: 1. For all three groups : * Being younger than 18 years * Any medical contraindication to physical exertion, * Any systemic or neurological disease, * A recent surgery, * A difference in leg length of more than 3 cm, * Pregnancy, * A body mass index higher than 30kg/m² (due to less accurate motion analysis by absence of anatomical landmarks). * LAS copers and controls will also be excluded if: constant or intermittent ankle pain, ankle fractures, or surgeries, and recent participation in a physical revalidation programme. * Healthy participants must never have suffered an inversion trauma resulting in disability. 2. For healthy controls : the healthy control subjects may not have suffered from an ankle sprain.

Outcomes

Primary Outcomes

Lower limb joint angles

Part of "Kinematic data" Unit of measurement: Degrees Measurement tools: Vicon software (data acquisition) + Matlab routine (data processing) Method: Joint angles will be measured based on the position of passive markers placed on participants' anatomical landmarks all over the lower limbs. The position of those markers will be tracked by 10 infrared high-speed cameras that surround the walkway (sampled at 100Hz - type T-10, 1 megapixel, captures 10-bit grayscale using 1120 \* 896 pixels, Vicon Motion System Ltd, Oxford, Metrics, UK). The angular positions of the multiple joints that constitute the lower limb (hip, knee, ankle, chopart, lisfranc and metatarsophalangeal) will be assessed during running, side-cutting and crossing over a small obstacle in the gait laboratory.

Time frame: Baseline

Lower limb joint angles

Time frame: 5 minutes after the end of the intervention

Lower limb joint angular velocities

Part of "Kinematic data" Unit of measurement: Degrees/second Measurement tool: Vicon software + Matlab routine Method: Joint angular velocities are also assessed based on reflexive markers placed on anatomical landmarks. This outcome evaluates the rate of change of a certain joint angle over time. Joint angular velocities will be assessed during running, side-cutting and crossing over a small obstacle in the gait laboratory.

Time frame: Baseline

Lower limb joint angular velocities

Time frame: 5 minutes after the end of the intervention

Joint moments

Part of "Kinetic data" Unit of measurement: Newton-meter Measurement tools: Pressure plate + Force plate + Vicon software + Matlab routine Methods: Joint moments will be determined by coupling kinematic data (joint position and velocities) with plantar pressure data from a specially designed pressure plate (sampled at 200Hz, Footscan, dimension 0.5m x 0.4m, 4096 sensors, 2.8 sensors/cm², RsScan International, Olen, Belgium) embedded in the middle of the runway and placed on top of a force plate (sampled at 1000Hz, Advanced Mechanical Technology Inc., Watertown, MA, USA). Kinetic data will be assessed while running, side-cutting and crossing over a small obstacle in the gait laboratory.

Time frame: Baseline

Joint moments

Time frame: 5 minutes after the end of the intervention

Joint powers

Part of "Kinetic data" Unit of measurement: Watt Measurement tools: Pressure plate + Vicon software + Matlab routine Methods: Joint moments will be determined by coupling kinematic data (joint position and velocities) with plantar pressure data from a specially designed pressure plate (sampled at 200Hz, Footscan, dimension 0.5m x 0.4m, 4096 sensors, 2.8 sensors/cm², RsScan International, Olen, Belgium) embedded in the middle of the runway and placed on top of a force plate (sampled at 1000Hz, Advanced Mechanical Technology Inc., Watertown, MA, USA). Kinetic data will be assessed while running, side-cutting and crossing over a small obstacle in the gait laboratory.

Time frame: Baseline

Joint powers

Time frame: 5 minutes after the end of the intervention

Intrinsic foot muscle thickness

Unit of measurement: cm Methods: The thickness of five intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, flexor hallucis, quadratus plantae and abductor digiti minimi) will be measured on images obtained using ultrasonography. To obtain those images, the investigators will scan the muscles in a longitudinal view.

Time frame: Baseline

Intrinsic foot muscle area

Unit of measurement: cm² (cm square) Methods: The area of five intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, flexor hallucis, quadratus plantae and abductor digiti minimi) will be measured on images obtained using ultrasonography. To obtain those images, the investigators will scan the muscles in a transversal view.

Time frame: Baseline

Secondary Outcomes

Cumberland Ankle Instability Tool

This questionnaire assesses the level of perceived instability (higher scores indicate less self-reported instability). Scores ranging from 0 to 30. The CAIT is valid and reliable, and has known minimal detectable changes. It has been validated in French and Dutch. This is an inclusion questionnaire.

Time frame: Baseline

Foot and Ankle Activity Measure

This questionnaire assesses the level of self-reported functional limitations (higher scores indicate less limitations). Score ranging from 0 to 100% The FAAM is valid, reliable and responsive to change. It has been validated in French and Dutch. It contains two subscales: Activity of Daily Life (ADL) and Sports. A "Quick" version has shown strong concurrent validity with the full-length FAAM. This is an inclusion questionnaire

Time frame: Baseline

Ankle-specific Fear-Avoidance Beliefs Questionnaire

This questionnaire is an adapted version of the original FABQ designed to assess kinesiophobia in people with low-back pain. The term "back" was changed to "ankle" and item 8 of the original FABQ was deleted. It contains two subscales: Physical Activity and Work. Higher scores indicate more kinesiophobia. Scores ranging from 0 to 90. The ankle-specific FABQ has shown acceptable internal consistency, and its use is encouraged in people with a history of ankle sprain, with known minimal detectable change. The FABQ questionnaire was validated in French, and a non-validated Dutch version was published.

Time frame: Baseline

Foot muscle strength

Unit of measurement: Newton Method: Foot muscle strength will be evaluated using a hand-held dynamometer, with participants hook lying. The investigators will both report the strength of the big toe and the strength of the other toes (as a whole). This method showed good to excellent intra and inter-rater reliability.

Time frame: Baseline

Change from baseline in hallux flexion strength after the intervention

Unit of measurement: Newton Method: Hallux flexion strength will be evaluated using a hand-held dynamometer, with participants hook lying. The difference between before and after the intervention (fatigue protocol) will be reported.

Foot Posture Index

No unit of measurement. The Foot Posture Index 6-item is a valid measure of foot posture (pronation, neutral and supination). Its reliability is subject of debate, ranging from poor to excellent for inter-rater and from moderate to excellent for intra-rater. The participants will stand bilaterally in a static position during the assessment.

Time frame: Baseline

Navicular drop

Unit of measurement: cm The investigators will assess navicular drop as the difference in distance between the navicular tuberosity to the ground from sitting to double-limb stance

Time frame: Baseline

Modified Star Excursion Balance Test

Unit of measurement: cm The modified Star Excursion Balance Test assesses dynamic balance. In recent studies involving subjects with CAI, the mSEBT was preferred over the original eight-direction version because the former measures are the most often altered in this population and the remaining directions add thus little value. The original SEBT is reliable, valid, reproducible, and responsive to change. The modified SEBT requires the participant to reach the ground as far as possible with his leg in the anterior, postero-medial and postero-lateral directions. The procedure is repeated until three valid trials are measured in each direction for each leg. A mean score will then be calculated for each direction as the mean of the three valid trials with one leg. Those values will first be normalized by the leg length and a composite score will then be calculated as the mean of the three directions reached with one leg.

Time frame: Baseline

Perceived foot fatigue

No unit of measurement. Participants will be asked to score their perceived foot fatigue every four minutes during the fatigue protocol. This will be done based on a verbal scale from 0 (no perceived fatigue at all) to 10 (highest fatigue the participant could imagine). The foot muscle fatigue protocol lasts 16 minutes. Time frame 16 minutes is thus equal to "immediately post-intervention".

Time frame: 4 minutes after the beginning of the intervention

Perceived foot fatigue

NB: Same as above No unit of measurement. Participants will be asked to score their perceived foot fatigue every four minutes during the fatigue protocol. This will be done based on a verbal scale from 0 (no perceived fatigue at all) to 10 (highest fatigue the participant could imagine). The foot muscle fatigue protocol lasts 16 minutes. Time frame 16 minutes is thus equal to "immediately post-intervention".

Time frame: 8 minutes after the beginning of the intervention

Perceived foot fatigue

Time frame: 12 minutes after the beginning of the intervention

Perceived foot fatigue

Time frame: Immediately after the end of the intervention

Electrostimulation current intensity

Unit of measurement: mA (milli-amperes). Every 4 minutes, electrostimulation current intensity will be reported during the foot muscle fatigue protocol. NB: This current intensity should gradually increase during the fatigue protocol as there is a habituation phenomenon. In other words, constant intensity produces decreasing discomfort. The foot muscle fatigue protocol lasts 16 minutes. Time frame 16 minutes is thus equal to "immediately post-intervention".

Time frame: 4 minutes after the beginning of the intervention

Electrostimulation current intensity

NB: Same as above Unit of measurement: mA (milli-amperes). Every 4 minutes, electrostimulation current intensity will be reported during the foot muscle fatigue protocol. NB: This current intensity should gradually increase during the fatigue protocol as there is a habituation phenomenon. In other words, constant intensity produces decreasing discomfort. The foot muscle fatigue protocol lasts 16 minutes. Time frame 16 minutes is thus equal to "immediately post-intervention".

Time frame: 8 minutes after the beginning of the intervention

Electrostimulation current intensity

Time frame: 12 minutes after the beginning of the intervention

Electrostimulation current intensity

Time frame: Immediately after the end of the intervention

Biomechanics and Intrinsic Foot Muscle Roles in Subjects With Chronic Ankle Instability

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes