Date of Award

5-1-2024

Degree Type

DPT Project

Degree Name

Doctor of Physical Therapy (DPT)

Advisor

Balachandar Kathirvelu

Abstract

I. Introduction: Lateral ankle sprains are amongst the most common injuries to occur in athletes and the general population alike. While most can recover without complications, there exists a considerable risk of recurrent injury which can result in ongoing difficulties related to pain, function, and overall quality of life. This high recurrence rate is due to excessive lateral deviations in the location of pressure-related variables in the foot. Ongoing instability of the foot, known as chronic ankle instability (CAI), results due to these abnormal gait and ankle kinematics which causes significantly greater inversion of the foot during initial contact of gait. Several rehabilitation options are available for those with this debilitating condition, with external biofeedback being one of these. Though previous work has outlined the use that this intervention has on gait mechanics, there is yet to be a systematic review which gathers results from previous studies to draw thorough conclusions about its use in CAI. This article systematically reviews trials that summarize and evaluate the effectiveness of this treatment for the rehabilitation of this condition to draw such conclusions.

II. Methods: A combination of literature from peer-reviewed scientific journals were analyzed to assess the effect sizes of using conservative treatment for chronic ankle instability with and without the addition of external biofeedback. A systematic review of chronic ankle instability will help identify whether the addition of this intervention alongside other treatments contributes to a clinically significant change in abnormal gait deviations and kinematics, which in turn may lead to positive change in symptoms for those involved.

III. Results: A total of 8 studies, including 155 participants, were collected for review. Compared to control groups, patients with CAI who engaged in external biofeedback treatments had clinically significant alterations in center of pressure, peak pressure, and pressure time integral measurements towards the medial side of the foot away from inversion (p < 0.05); the position often associated with CAI.

IV. Discussion: The provision of external biofeedback resulted in positive changes in several important gait and weight bearing variables, with this likely due to the provision of an external focus of attention for those displaying severe deficits in proprioceptive ability which enabled the activation of evertor musculature. The resulting medial shift in the variables discussed alongside greater activation of the evertor muscles caused participants with CAI to employ a greater degree of protective eversion during gait activities. This change in gait kinematics and ankle positioning is more consistent with healthy individuals who have a greater proportion of pressure data points in the posteromedial foot quadrant, with this being correlated with less frequent recurrence of ankle sprains and thus instability at the ankle.

V. Conclusion: The results of this systematic review indicate clinically significant improvements in ankle kinematics with the use of external biofeedback such as visual, auditory, and vibration/tactile feedback. The studies within this SR demonstrated findings of alterations in center of pressure (COP), peak pressure, and pressure time integral of the ankle. It is possible to conclude that the utilization of external biofeedback may improve ankle kinematics in individuals with CAI by enabling medial shifts in the variables discussed and therefore reducing the causal impact that excessive inversion and lateral pressure shifts have on causing recurrent lateral ankle sprains.

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