Date completed: -Oct-2014



|Date completed: 17-Oct-2014 |[pic] |

|Ref: MUNRO-10102014-NUVUVU325381 | |

|Literature Search and Enquiry Service |

|Search requested by | |Search Carried out by |

|Nicola Munro | |Liz Garrity |

|Advanced Specialist Orthotist | |NHSGGC Library Network |

|Westmarc | |0141 211 1239 (x21239) |

|Southern General Hospital | |liz.garrity@ggc.scot.nhs.uk |

|1345 Govan Rd | | |

|Glasgow | | |

|G51 4TF | | |

| | | |

|55 abstracts found | | |

| |

|SEARCH DETAILS |

| |

|Does orthotic intervention improve patient outcomes in lateral ankle instability |

| | | |

|Problem : |Intervention : |NOT : |

| | |Not paediatrics (< 18 years old) |

|Lateral ankle instability |insole |Not systemic arthritis |

|Unstable ankle |insert |Not diabetes |

|Lateral ankle instability functional |orthotic device | |

|Lateral ankle instability structural |orthosis | |

|Lateral ankle instability neurological |[orthotic foot orthosis] | |

|Anterior talofibular ligament injury/rupture |splint | |

|Calcaneo-fibular ligament injury/rupture |[night splint] | |

| |immobilisation | |

| |footwear | |

| |AFO [Ankle Foot orthosis] | |

| |Footwear adaptation | |

| |strap | |

| |heel raise | |

|This literature search will contain a selection of material gathered from a search of the evidence base, and is not intended to be |

|comprehensive. Professional judgement should be exercised when appraising the material. The Library takes no responsibility for the |

|wording, content and accuracy of the information supplied, which has been extracted in good faith from reputable sources. NHSGGC is |

|not responsible for the content of external internet sites. |

|For instructions on how to locate and/or order the full text of any articles listed please see the attached guide. |

|Resources Searched |Medline, Embase, Journals@Ovid Full Text, Cinahl |

|Notes on Search |Date limits: 1946- (Medline), 1947- (Embase) |

| |English language limit applied. |

| |Medline/Embase duplicates removed from results. |

| |Age limits: >18 yrs |

| | |

| |Further limits: Not systemic arthiritis, not diabetes (I deleted results manually which |

| |contained these terms; I didn’t apply filters in case of excluding relevant articles) |

Search history Ovid (Medline 1946-2014, Embase 1947-2014)

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Search history Ebsco

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Article results

• Authors -D. Bishop, A. Moore and N. Chandrashekar.

Article title:- A new ankle foot orthosis for running.

Journal title:- Prosthetics & Orthotics International     2009     33     3     192-197

Abstract:- Traumatic knee injuries in automobile accidents and sports often lead to damage of the peroneal nerve. A lack of control of muscles innervated by the peroneal nerve due to this damage, results in the inability to dorsiflex and evert the foot and to extend the toes. This condition is commonly known as foot drop. Foot drop reduces the stability in the body while walking and running and may also cause injury due to lack of foot clearance during the swing phase of the gait. Traditionally, an ankle foot orthosis (AFO), comprised of a moulded sheet of plastic that conforms around the posterior calf and distally contains all or part of the calcaneous as well as the plantar foot, is used to treat foot drop. The intent of this orthosis is to dorsiflex the foot to provide clearance during the swing phase of walking and running. Traditional AFO results in increased pressures due to a decrease in dorsiflexion range of motion at the ankle and make the orthosis increasingly uncomfortable to wear. Several other existing designs of foot drop AFO suffer from similar inadequacies. To address these issues, a new AFO was developed. The device was successfully used by one person with foot drop without issues for more than one year. This new design conforms to the lower anterior shin and dorsum of the foot using dorsiassist Tamarack ankle joints to allow for greater plantar and dorsiflexion range of motion. While still limiting ankle inversion it does allow for more ankle eversion. This orthosis can be discretely worn inside shoes due to its smaller size, and can be worn for a longer period of time without discomfort.

• Authors -J. Bruns and H. Staerk.

Article title:- Mechanical ankle stabilisation due to the use of orthotic devices and peroneal muscle strength. An experimental investigation.

Journal title:- Int.J.Sports Med.     1992     13     8     611-615

Abstract:- The mechanical stabilising effect of different orthotic devices and artificially applied muscular strength to the peroneal muscles is tested in cadaveric ankle joints and in vivo. Both orthotic devices as well as muscular strengths of 150 N applied to the peroneal muscles can produce a significant reduction in mechanical ankle instability. However, none of these methods alone can stabilise the ankle joint in such way to completely normalise the talar tilt and anterior drawer sign that is found in stable ankle joints. In contrast to that, clinical results in the treatment of sprained ankles with the application of an orthosis, additional muscular strengthening is the best treatment to achieve a sufficient mechanical ankle stability during the period of ligament healing. Additional factors influencing the mechanical ankle stability are supposed.

• Authors -M. J. Carroll, A. M. Rijke and D. H. Perrin.

Article title:- Effect of the Swede-O ankle brace on talar tilt in subjects with unstable ankles

Journal title:- J SPORT REHABIL     1993     2     4     261-267

Abstract:- This study examined the effect of the Swede-O ankle brace on talar tilt in subjects with unstable ankle joints. Six college-age females with talar tilts greater that 9.5 degrees at 15 decaNewtons (daN) of force on a Telos stress test device participated in the study. Each subject was X-rayed at five levels of force (0, 6, 9, 12, and 15 daN), first with a bare ankle then wearing a Swede-O ankle brace. A two-factor (Brace x Force) analysis of variance revealed a main effect for force, but no main effect for brace and no Brace x Force interaction. For the unbraced ankles, mean displacements were 8.2, 10.4, 11.9, and 13.1 degrees at the four levels of force, respectively. After application of the brace, the talar tilts were 5.7, 8.5, 11.1, and 12.8 degrees, respectively. These findings suggest that the Swede-O ankle brace was not effective in reducing talar tilt in subjects with unstable ankles. Any efficacy of the brace may be due to other factors, such as proprioceptive feedback during inversion.

• Authors -J. Choisne, M. C. Hoch, S. Bawab, et al.

Article title:- The effects of a semi-rigid ankle brace on a simulated isolated subtalar joint instability.

Journal title:- Journal of Orthopaedic Research     2013     31     12     1869-1875

Abstract:- Subtalar joint instability is hypothesized to occur after injuries to the calcaneofibular ligament (CFL) in isolation or in combination with the cervical and the talocalcaneal interosseous ligaments. A common treatment for hindfoot instability is the application of an ankle brace. However, the ability of an ankle brace to promote subtalar joint stability is not well established. We assessed the kinematics of the subtalar joint, ankle, and hindfoot in the presence of isolated subtalar instability, investigated the effect of bracing in a CFL deficient foot and with a total rupture of the intrinsic ligaments, and evaluated how maximum inversion range of motion is affected by the position of the ankle in the sagittal plane. Kinematics from nine cadaveric feet were collected with the foot placed in neutral, dorsiflexion, and plantar flexion. Motion was applied with and without a brace on an intact foot and after sequentially sectioning the CFL and the intrinsic ligaments. Isolated CFL sectioning increased ankle joint inversion, while sectioning the CFL and intrinsic ligaments affected subtalar joint stability. The brace limited inversion at the subtalar and ankle joints. Additionally, examining the foot in dorsiflexion reduced ankle and subtalar joint motion. 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

• Authors -C. M. D. De Simoni, H. H. M. D. Wetz, M. M. D. Zanetti, et al.

Article title:- Clinical Examination and Magnetic Resonance Imaging in the Assessment of Ankle Sprains Treated with an Orthosis

Journal title:- Foot & Ankle International     1996     17     3     177-182

Abstract:- This is a prospective clinical study of treatment of ankle sprains with an ankle brace that permits ankle dorsiflexion and plantarflexion of 20 [degrees], but limits inversion and eversion for 6 weeks. The ankle brace is followed by physiotherapy for another 6 weeks. Thirty patients were evaluated with clinical examination and magnetic resonance (MR) imaging before treatment and after 12 weeks of treatment. MR imaging revealed acute tears in the anterior talofibular ligament in all 30 ankles (100%) and tears in the calcaneofibular ligament in 25 of 30 ankles (83%). At 12 weeks after injury, MR evidence of healing was present for the anterior talofibular ligament in 22 of 30 ankles (73%) and for the calcaneofibular ligament in 23 of 25 ankles (92%). Postural sway analysis after therapy was used to quantify functional stability of the ankle. There was no correlation with MR findings, but there was a correlation with the subjective impression of functional instability. Twenty-eight of 30 patients (93%) had a functionally stable ankle after 12 weeks of treatment, MR findings after ankle sprain could not predict clinical outcome. (C) Williams & Wilkins 1996. All Rights Reserved.

• Authors -JS de Vries, R. Krips, I. N. Sierevelt, et al.

Article title:- Interventions for treating chronic ankle instability

Journal title:- Cochrane Database Syst.Rev.     2011     8     Abstract:- Background:; Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. Initial treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered.; Objectives:; To compare different treatments, conservative or surgical, for chronic lateral ankle instability.; Search methods:; We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and reference lists of articles, all to February 2010.; Selection criteria:; All identified randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included.; Data collection and analysis:; Two review authors independently assessed risk of bias and extracted data from each study. Where appropriate, results of comparable studies were pooled.; Main results:; Ten randomised controlled trials were included. Limitations in the design, conduct and reporting of these trials resulted in unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting. Only limited pooling of the data was possible.; Neuromuscular training was the basis of conservative treatment evaluated in four trials. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool (AJFAT): mean difference (MD) 3.00, 95% CI 0.3 to 5.70; 1 trial, 19 participants; Foot and Ankle Disability Index (FADI) data: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, 56 participants). The fourth trial (19 participants) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.; Four studies compared surgical procedures for chronic ankle instability. One trial (40 participants) found more nerve injuries after tenodesis than anatomical reconstruction (risk ratio (RR) 5.50, 95% CI 1.39 to 21.71). One trial (99 participants) comparing dynamic versus static tenodesis excluded 17 patients allocated dynamic tenodesis because their tendons were too thin. The same trial found that dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77, 82 participants). One trial comparing techniques of lateral ankle ligament reconstruction (60 participants) found that operating time was shorter using the reinsertion technique than the imbrication method (MD -9.00 minutes, 95% CI -13.48 to -4.52). Two trials (70 participants) compared functional mobilisation with immobilisation after surgery. These found early mobilisation led to earlier return to work (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial).; Authors' conclusions:; Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.; CINAHL Note: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.]

• Authors -J. S. De Vries, R. Krips, I. N. Sierevelt, et al.

Article title:- Interventions for treating chronic ankle instability.

Journal title:- Cochrane Database of Systematic Reviews     2006     4     Abstract:- Background: Chronic lateral ankle instability occurs in 10%to 20%of people after an acute ankle sprain. The initial form of treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered. Objectives: To compare different treatments, both conservative and surgical, for chronic lateral ankle instability. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to July 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 3), and MEDLINE (1966 to April 2006), EMBASE (1980 to April 2006), CINAHL (1982 to April 2006) and reference lists of articles. Selection criteria: All randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included. Data collection and analysis: Two review authors independently assessedmethodological quality and extracted data. Where appropriate, results of comparable studies were pooled. Main results: Seven randomised trials were included and divided into three groups: surgical interventions; rehabilitation programs after surgical interventions; and conservative interventions. None of the studies weremethodologically flawless.Only one study described an adequate randomisation procedure. Only two studies, both about rehabilitation programs after surgery, had a moderate risk of bias; all other studies had a high risk of bias. Due to clinical and methodological diversity, extensive pooling of the data was not possible. Surgical interventions (four studies): one study showed more complications after the Chrisman-Snook procedure compared to an anatomical reconstruction,whereas another study showed greatermean talar tilt after an anatomical reconstruction. Subjective instability and hindfoot inversion was greater after a dynamic than after a static tenodesis in a third study. The fourth study showed that the operating time for anatomical reconstructions was shorter for the reinsertion technique than for the imbrication method. Rehabilitation after surgical interventions (two studies): both studies provided evidence that early functional mobilization leads to an earlier return to work and sports than immobilisation. Conservative interventions: the only study in this group showed better proprioception and functional outcome with the bi-directional than with the uni-directional pedal technique on a cyclo-ergometer. Authors' conclusions: In view of the low quality methodology of almost all the studies, this review does not provide sufficient evidence to support any specific surgical or conservative intervention for chronic ankle instability. However, after surgical reconstruction, early functional rehabilitation was shown to be superior to six weeks immobilisation regarding time to return to work and sports. Copyright 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

• Authors -E. Delahunt, A. McGrath, N. Doran, et al.

Article title:- Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.

Journal title:- Archives of Physical Medicine & Rehabilitation     2010     91     9     1383-1389

Abstract:- OBJECTIVE: To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI). DESIGN: Laboratory-based repeated-measures study. SETTING: University biomechanics laboratory. PARTICIPANTS: Participants (n=16) with CAI. INTERVENTIONS: Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping. MAIN OUTCOME MEASURES: Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions. RESULTS: Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P ................
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