Analysis of Ankle Bony Abnormality in the Patients with Chronic Ankle Sprain and Marked Ankle Instability / 대한족부족관절학회지

PURPOSE: We analyzed the ankle bony abnormality of patients with marked ankle instability who had chronic ankle sprain more than 3 years. MATERIALS AND METHODS: We evaluated the chronic ankle sprain (more than 3 years) patients with marked ankle instability tested by varus stress test and anterior draw test from March 2000 to December 2005. Eighty-nine patients (104 ankle) were evaluated and there were 38 males and 51 females. The mean age of patient at the time of diagnosis was 34.5 (range, 18 to 56 years). The average duration of morbidity was 7 years and 3 months (range, 3 years and 3 months to 21 years). The patients who had history of dislocation, fracture, malalignment, operated patients, and rheumatoid ones were excluded. Plain radiographs of AP, lateral, oblique and mortise view were checked. RESULTS: Radilologic abnormalities were found at 74 ankles (71%) among 104 ankles. Frequent sequences of location were anterior talotibial osteophyte, medial malleolar osteophyte, Os subfibulare, lateral malleolar osteophyte. Posteior osteophyte, ankle arthritis, talar articular defect were rarely found. CONCLUSION: Seventy-one percent among patients with chronic ankle sprain and marked ankle instability showed more than one radiologic abnormalities. Thus, more exclusive and accurate ankle examination should be performed in these patients.

Static Posturographic Characteristics during Balance Control under Virtual Moving Surround in Patients with Chronic Ankle Sprain

OBJECTIVE: To investigate static posturographic characteristics during balance control under virtual moving surround (VMS) using force platform and head mount display (HMD) device in patients with chronic ankle sprain as compared with that of normal adults. METHOD: Ten patients with chronic ankle sprain and 24 healthy adults participated. Center of pressure (COP) parameters were obtained for 20 seconds using force platform as total path distance and total sway area in following conditions (1) comfortable standing with opened and closed eyes, (2) VMS delivered using HMD with four different moving patterns. The virtual moving patterns composed of close-far, superior-inferior tilting (pitch), right-left tilting (roll) and horizontal rotation (yaw) movement. RESULTS: No significant difference was found between patients with chronic ankle sprain and healthy adults on comfortable standing with both open and closed eyes. But, patients revealed significantly increased total path distance and sway area of COP on all VMS conditions. CONCLUSION: These results showed that under VMS conditions patients with the weaker balance control problem were more sensitive to balance control than simple comfortable standing conditions with opened and closed eyes.

Postural Stability in Patients with Chronic Ankle Sprain

OBJECTIVE: To investigate the deficit of static and dynamic postural control in patients with chronic ankle sprain using dynamic posturography. METHOD: Twenty patients with unilateral recurrent ankle sprain and functional instability were assessed by Samsung medical center ankle injury score and by computerized dynamic posturography (EquiTest system, Neurocom , international, INC; USA). The posturography test was performed 3 times at 6 different simulated conditions such as fixed of force platform/open eyes/fixed of screen (condition 1), fixed/closed/fixed (condition 2), fixed/open/movement (condition 3), sway/open/fixed (condition 4), sway/closed/fixed (condition 5), sway/open/movement (condition 6). We evaluated anteroposterior sway of center of gravity of the patients and calculated equilibrium scores. We compared the equilibrium scores of patient group and normal data reported previously. We also compared the equilibrium scores of two subgroups of the patients according to severity of ankle injury. RESULTS: Patients showed significantly low equilibrium scores than normal one at the condition 4, 5 and 6 (p<0.05). The group B with severe ankle injury revealed low equilibrium scores at the condition 4, 5 and 6. Especially the group B showed statistically significance at condition 5 (p<0.05). CONCLUSION: Patients with chronic ankle sprain showed the deficit of dynamic postural control due to the proprioceptive dysfunction of injured ankle than normal person.