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A dissertation submitted to the Faculty of Health in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic,Technikon Natal, 2001. / The purpose of this study was to evaluate Piroxicam versus Protease administration, in terms of subjective and objective clinical findings, in order to determine the effectiveness of each approach in the treatment of grade 1 and 2 acute ankle inversion sprains. The study was a prospective, randomized, double blinded, controlled study. The study involved 30 subjects, 15 in each group which were selected from the general population. One group received Protease and strapping while the other group two received Piroxicam and strapping. Patients received 3 treatments over a period of one week. Patients in the Protease group received 1200mg (3 x 400mg) of Protease daily before meals for seven days. Patients in the Piroxicam group received 40mg (2 x 20mg) of Piroxicam for the first two days, and then 20mg (1 x 20mg) for the following five days, administered with meals. All patients were taught how to apply an elastic crepe bandage to the ankle, which was to be used at all times, except during bathing for the duration of the study / M

CONTEXT: 3-D kinematics and kinetics of the lower extremity during the Star Excursion Balance Test (SEBT) have not been examined in FAI subjects. Additionally, the effects of Kinesio® tape use in subjects with functional ankle instability (FAI) during functional tasks is uninvestigated. OBJECTIVE: To determine if lower extremity kinematics and kinetics differed in FAI subjects using Kinesio® tape during maximal SEBT reach. SUBJECTS: Twenty subjects with FAI (Age=24.2±3.8yrs; Ht=169±11.6cm; Wt=69±12.4kg) and twenty uninjured subjects (Age=25.7±5.6yrs; Ht=170.1.4±8.8cm; Wt=69.9±10.5kg) with no history of ankle sprain. FAI was operationally defined as repeated episodes of ankle “giving way” and/or ankle “rolling over”, regardless of neuromuscular deficits or pathologic laxity. All FAI subjects scored < 26 on the Cumberland Ankle Instability Tool. METHODS: SEBT reaches included the anteromedial, medial, and posteromedial directions. FAI subjects used their unstable side as the stance leg, while control subjects were side-matched to the FAI group. The stance leg ankle was taped using 1) Kinesio® tape and the Kinesio taping method (Kinesio method); 2) white linen tape with the Kinesio method; 3) Kinesio® tape along the distal peroneals tendons (lateral method); 4) white tape with the lateral method. Three-dimensional lower extremity kinematics, kinetics, and force plate data were collected during SEBT performance. A repeated measures ANOVA analyzed the effects of group, tape, tape method, and reach direction on all variables (α=0.05). Tukey HSD post-hoc analyses were performed for significant interactions. RESULTS: Normalized reach distance was not significantly different between groups in any direction (F2,76=1.16, P=.32). A significant four-way interaction for tape, method, direction, and group (F2,72=3.874, P=.03) was found. Post-hoc testing showed FAI subjects exhibited hip abduction while control subjects used hip adduction (Condition 1: .65±8.23° vs. -2.14±8.51°; Condition 2: 1.29±7.71° vs. -1.75±8.29°; Condition 3: 1.08±8.39° vs. -1.88±18.33°; Condition 4: 2.13±7.62° vs. -1.54±6.61°). Additionally, a significant difference in FAI subjects’ hip abduction angles between the white tape/Kinesio method (.65±8.23°) and Kinesio tape/Kinesio method (1.08±8.39°) was found. Conclusions: These results indicate that FAI subjects’ movement strategies differ from those of uninjured subjects. Furthermore, the use of Kinesio® tape at a distal joint can alter proximal joint movement in subjects with FAI.

A Dissertation submitted to the Department of Physiology, University of Witwatersrand, Johannesburg in fulfilment of the requirements for the degree of Master of science in Medicine. / The management and prevention of ankle sprains had been a topic of controversy in the sport medical literature to date, with various rehabilitative and preventative protocols having been suggested. In part one of this study, a relatively new rehabilitative device, the Cybex II Dynamometer,was used to determine whether the rehabilitation period of ankle sprain injuries could be reduced in recently injured patients. In part two, the Cybex II Dynamometer was used in conjunction with other training techniques in a preventative trial of first league volleyball players, to see whether the incidence of ankle sprains (which is particularly high in this population group) could be reduced. Although the experimental group was discharged almost 35 percent sooner than the control group in part one, the difference was not found to be statistically significant. In part two the preventative measures resulted in a notable difference in the incidence of injuries (32 percent in the control group compared to 11 percent in the experimental, group). Differences were just not statistically significant (p=O.059). / Andrew Chakane 2018

by Yeung Ming San, Josephine. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves 161-172). / ABSTRACT --- p.1 / Chapter I. --- INTRODUCTION --- p.4 / Chapter II. --- LITERATURE REVIEW --- p.12 / Chapter 2.1 --- Functional Anatomy of Ankle and Subtalar Joint --- p.12 / Chapter 2.1.1 --- Bony Configuration --- p.12 / Chapter 2.1.2 --- Axis of Motion --- p.13 / Chapter 2.1.3 --- Lateral Ligaments --- p.13 / Chapter 2.1.4 --- Ankle Musculature --- p.13 / Chapter 2.2 --- Biomechanics of Ankle Ligaments --- p.14 / Chapter 2.2.1 --- Characteristics of Lateral Ligaments of the Ankle --- p.15 / Chapter 2.2.1.1 --- Ligaments for Stability --- p.15 / Chapter 2.2.1.2 --- Ligaments Properties to Loading --- p.15 / Chapter 2.3 --- Lateral Ankle Ligaments Injuries --- p.17 / Chapter 2.3.1 --- Etiology --- p.17 / Chapter 2.3.2 --- Definition of Sprain --- p.18 / Chapter 2.3.3 --- Classification of Inversion Ankle Sprain --- p.18 / Chapter 2.3.4 --- Diagnosis of Lateral Ligaments Injury --- p.19 / Chapter 2.3.4.1 --- Anterior Draw Test --- p.19 / Chapter 2.3.4.2 --- Talar Tilt Test --- p.21 / Chapter 2.3.4.3 --- Anthrogram --- p.21 / Chapter 2.3.4.4 --- Controversies in Various Diagnostic Methods for Lateral Ankle Ligaments Injury --- p.21 / Chapter 2.3.5 --- Orthopedic Management of Inversion Ankle Sprain --- p.22 / Chapter 2.3.5.1 --- Operative Method --- p.22 / Chapter 2.3.5.2 --- Conservative Method --- p.23 / Chapter 2.4 --- Rehabilitation of Inversion Ankle Injury --- p.24 / Chapter 2.4.1 --- Residual Problems Resulted from Inversion Ankle Injury --- p.24 / Chapter 2.4.1.1 --- Epidemiology --- p.24 / Chapter 2.4.1.2 --- Muscle Weakness --- p.25 / Chapter 2.4.1.3 --- Proprioception --- p.27 / Chapter 2.4.1.4 --- Peroneal Muscle Reaction Time --- p.29 / Chapter 2.4.1.5 --- Muscle Tightness --- p.30 / Chapter 2.4.2 --- Rehabilitation Training --- p.31 / Chapter 2.4.2.1 --- Muscle Training --- p.31 / Chapter 2.4.2.2 --- Proprioception Training --- p.32 / Chapter 2.4.2.3 --- Other Training --- p.32 / Chapter 2.5 --- Strength Training --- p.33 / Chapter 2.5.1 --- Effects of Strength Training --- p.33 / Chapter 2.5.1.1 --- On Muscle --- p.33 / Chapter 2.5.1.2 --- On Nervous System --- p.33 / Chapter 2.5.1.3 --- On Ligaments --- p.34 / Chapter 2.5.2 --- Isokinetic Training --- p.34 / Chapter III. --- METHODOLOGY --- p.39 / Chapter 3.1 --- Epidemiological Survey --- p.42 / Chapter 3.1.1 --- Design of Questionnaire --- p.42 / Chapter 3.1.2 --- Pilot Study --- p.43 / Chapter 3.1.3 --- Survey --- p.44 / Chapter 3.2 --- Isokinetic Evaluation for Normal Non-injured Ankle --- p.45 / Chapter 3.2.1 --- Subjects --- p.45 / Chapter 3.2.2 --- Equipment --- p.46 / Chapter 3.2.3 --- Testing Procedure --- p.51 / Chapter 3.3 --- Evaluation for Ankle with Inversion Sprain --- p.59 / Chapter 3.3.1 --- Initial Evaluation --- p.60 / Chapter 3.3.1.1 --- Criteria for Subjects --- p.60 / Chapter 3.3.1.2 --- Interview of Subjects --- p.61 / Chapter 3.3.1.3 --- Testing Procedure --- p.61 / Chapter 3.3.2 --- Training Program --- p.66 / Chapter 3.3.2.1 --- Subjects --- p.66 / Chapter 3.3.2.2 --- Various Methods of Training or Exercise --- p.67 / Chapter 3.3.2.3 --- Isokinetic Exercise Protocol for Ankle --- p.69 / Chapter 3.3.2.4 --- Design of Training Protocol --- p.71 / Chapter 3.3.3 --- Second Evaluation --- p.73 / Chapter 3.3.3.1 --- Subject --- p.73 / Chapter 3.3.3.2 --- The Retest --- p.73 / Chapter 3.4 --- Data Analysis --- p.74 / Chapter IV. --- RESULTS --- p.75 / Chapter 4.1 --- Epidemiological Study --- p.75 / Chapter 4.1.1 --- Athletes' Personal Data --- p.75 / Chapter 4.1.2 --- Athletes' Injury Data --- p.82 / Chapter 4.1.3 --- Residual Problems in Ankle Sprains --- p.84 / Chapter 4.2 --- Isokinetic Evaluation for Normal Non-injured Ankle --- p.89 / Chapter 4.2.1 --- Subjects Data --- p.89 / Chapter 4.2.2 --- Range of Active and Passive Ankle Dorsiflexion --- p.89 / Chapter 4.2.3 --- Muscular Parameters Used for Data Analyzing --- p.90 / Chapter 4.2.4 --- Comparing Muscular Parameters between Dominant and Non-dominant Ankle of Normal Subjects --- p.90 / Chapter 4.2.5 --- Comparing Muscular Parameters between Male and Female Normal Subjects --- p.94 / Chapter 4.2.6 --- Torque Ratio and Work Ratio --- p.98 / Chapter 4.3 --- Evaluation for Ankles with Inversion Sprain --- p.102 / Chapter 4.3.1 --- Initial Evaluation --- p.102 / Chapter 4.3.1.1 --- Subjects Data --- p.102 / Chapter 4.3.1.2 --- Anterior Draw Sign --- p.103 / Chapter 4.3.1.3 --- Range of Motion --- p.103 / Chapter 4.3.1.4 --- Ankle Functional Rating Scale --- p.104 / Chapter 4.3.1.5 --- Isokinetic Evaluation --- p.104 / Chapter 4.3.2 --- Second Evaluation --- p.116 / Chapter 4.3.2.1 --- Subjects Data --- p.116 / Chapter 4.3.2.2 --- Comparing the Initial and Second Evaluation Ankle Functional Rating Scale --- p.117 / Chapter 4.3.2.3 --- Comparing Initial and Second Evaluation for Isokinetic Parameters of the Ankle --- p.118 / Chapter 4.3.3 --- Correlation of Various Isokinetic Parameters of the Ankle with Ankle Functional Rating Score --- p.124 / Chapter V. --- DISCUSSION --- p.127 / Chapter 5.1 --- Epidemiological Study --- p.127 / Chapter 5.2 --- Evaluation for Normal Non-injured Ankle --- p.132 / Chapter 5.3 --- Evaluation for Ankle with Inversion Sprain --- p.141 / Chapter 5.4 --- Isokinetic Rehabilitation --- p.148 / Chapter 5.5 --- Limitations and Future Direction of Research --- p.153 / Chapter VI. --- CONCLUSION --- p.156 / Chapter VII. --- REFERENCE --- p.161 / APPENDIX I --- p.i / APPENDIX II --- p.vi / APPENDIX III --- p.viii / APPENDIX IV --- p.xiii

by Fu Siu Ngor. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 117-124). / abstract --- p.I / acknowledgments --- p.III / contents --- p.V / list of figures --- p.VII / list of tables --- p.VIII / Chapter chapter 1: --- introduction / Chapter 1.1 --- Dance and jump --- p.1 / Chapter 1.2 --- Research objectives --- p.4 / Chapter 1.3 --- Research hypothesis --- p.5 / Chapter 1.4 --- Definition of terms --- p.7 / Chapter chapter 2 : --- dance injuries / Chapter 2.1 --- Epidemiology of dance injuries --- p.12 / Chapter 2.2 --- Etiology of dance injuries --- p.19 / Chapter 2.3 --- Implication to this study --- p.30 / Chapter chapter 3 : --- biomechanical studies on landing from vertical jumps / Chapter 3.1 --- Biomechanics on landing from vertical jumps --- p.31 / Chapter 3.2 --- Biomechanical studies on ballet jumps --- p.46 / Chapter 3.3 --- Kinetics and kinematics studies on jumping sports --- p.49 / Chapter 3.4 --- Implication to this study --- p.57 / Chapter CHAPTER 4 : --- MATERIAL AND METHOD / Chapter 4.1 --- Study design --- p.58 / Chapter 4.2 --- Subject and sampling method --- p.58 / Chapter 4.3 --- Instrumentation --- p.60 / Chapter 4.4 --- Method --- p.70 / Chapter CHAPTER 5 : --- RESULTS / Chapter 5.1 --- Demographic characteristics --- p.79 / Chapter 5.2 --- "kinetic and kinematics changes on landing with ""pull-up""" --- p.82 / Chapter 5.3 --- "kinetics and kinematics changes on landing with and without ""pull-up""" --- p.92 / Chapter CHAPTER 6 : --- DISCUSSION / Chapter 6.1 --- Kinetic changes --- p.96 / Chapter 6.2 --- Kinematics changes --- p.102 / Chapter 6.3 --- Correlation between kinetics and kinematics --- p.105 / Chapter 6.4 --- "Effects of'pull-up""" --- p.107 / Chapter 6.5 --- Limitation of the study --- p.108 / Chapter 6.6 --- Suggestion for future studies --- p.110 / Chapter 6.7 --- Implication of this study --- p.112 / Chapter CHAPTER 7 : --- CONCLUSIONS --- p.115 / REFERENCES --- p.117-124 / APPENDIX 1 : Demographic characteristics --- p.i / APPENDIX 2 : Kinetic data --- p.v / APPENDIX 3 : Kinematics data --- p.x / APPENDIX 4 : Summary of kinetic and kinematics results --- p.xiv / APPENDIX 5 : Statistical results --- p.xv

Background: Diabetic peripheral neuropathy (DPN) is diagnosed clinically as a loss of sensation in the feet and affects over 2 million people in the UK. One of the functional effects of DPN is a decrease in standing stability giving rise to a risk of falls. In an attempt to stabilise in the mediolateral direction, people with DPN frequently walk with a wider base of support and stand with a larger stance width. This is often seen in the elderly and is not always beneficial for stability contributing to falls risk. Standing balance requires the integration of sensory information from somatosensory, vestibular and visual systems. Alterations in distal sensory input may result in a re-weighting of the effectiveness of remaining sensations in mediating a stabilising postural response; termed sensory re-weighting. Alterations in posture such as adopting a wider stance width and wearing Ankle Foot Orthoses (AFOs) may also affect sensory input as well as altering the mechanics of the ankle and hip joints. The impact of distal sensory loss on the sensory control of balance in people with DPN compared to the healthy population is unknown. Moreover, it is not known whether standing balance or the sensory control of balance is affected by the adoption of an increased stance width and wearing (AFOs) that restrict mediolateral ankle motion. A better understanding of the mechanisms underlying balance dysfunction in diabetic peripheral neuropathy and how it might be manipulated could inform the development of future interventions to improve balance. Aim: To explore the effects of ankle foot orthoses and stance width on standing balance and the sensory control of mediolateral balance in people with DPN and healthy controls. Objectives: To assess how mediolateral postural stability and the sensory control of balance is affected by (a) AFO use and alterations in stance width in healthy participants (study 1) (b) acute distal sensory loss in healthy participants (study 2) (c) chronic sensory loss in people with DPN and how this in turn is modulated by AFO use and alterations in stance width (study 3). Methods: Postural stability and the response to selective muscle vibration that stimulates muscle spindle afferents was measured by 3D motion analysis. Study 1 investigated the effects of stance width and AFOs on postural sway and the response to selective hip proprioception stimulation induced by vibration of the hip abductors in healthy participants. Study 2 investigated the effect of an acute reduction of somatosensory information induced by cooling in healthy participants on the response to ankle evertor and hip abductor vibration. This provided a model of the acute effects of sensory loss. Study 3 compared healthy people with people with chronic DPN. It investigated the impact on stance stability and whether there was a change in the postural response (gain) to ankle evertor and hip abductor vibration. It further explored the effect of altering the stance width and wearing an AFO on stability and the postural response to hip abductor vibration. Results: Study 1: In healthy controls postural sway was significantly reduced when wearing an ankle foot orthoses and when standing at wider stance widths. Whilst this was also seen during balance perturbation, trunk motion increased at larger stance widths. This could be the result of the AFO restricting ankle motion and affecting the interpretation of the hip vibratory input by the postural control system. Study 2: Experimental reduction in distal sensation by cooling resulted in a reduction in postural responses to ankle evertor muscle vibration. Conversely postural responses at the level of the hip, to proximal (hip) muscle vibration, significantly increased. Study 3: Baseline sway velocity was higher in people with DPN compared to healthy controls. Postural strategies were modified in the DPN group, with increased motion at more proximal segments of the shoulder and head. In both groups, AFO and stance width significantly reduced baseline sway velocity, and the size of postural responses (translations) to hip abductor muscle vibration. Conclusion: Alterations in stance width and the use of AFOs can affect postural sway and the response to selective proprioceptive stimulation. Whilst acute reductions in distal sensory loss are associated with sensory re-weighting of distal and proximal proprioceptive information this is not seen in people with chronic DPN, possibly resulting from long term adaptive changes in the multi-sensory control of balance. Novel differences were found in postural strategies between healthy and DPN groups. The increase in head and trunk motion in people with DPN may have a negative impact on visual acuity and therefore a risk factor for falls. In people with diabetic peripheral neuropathy AFOs and increased stance width led to a reduction in postural response size and postural sway. The effect of AFO on sway velocity was more pronounced in those with DPN at smaller stance widths. Clinically this suggests that an AFO could be used in those with diabetic peripheral neuropathy to slow down the velocity of sway and increase stability.

The extent to which sensory impairments in the foot, ankle and lower limb persist into the chronic phase of stroke is unclear. Furthermore, the extent to which these impairments influence walking, balance and falls is not well understood. This thesis investigated the prevalence, functional importance and measurement of lower limb somatosensory impairments in ambulatory people with chronic stroke. Methods This thesis comprised three studies: the first, a qualitative investigation, explored the views and experiences of people with chronic stroke (n=13). This led to the second study: a cross sectional observational study in which the prevalence, distribution and functional relevance of lower limb sensory impairments were investigated in chronic stroke participants (n=180) and healthy controls (n=46). The final study, informed by the findings from the first two studies, a “synthesis” review of current sensory measures and patient and carer involvement, developed and evaluated three novel, functionally oriented measures of lower limb somatosensory discrimination in chronic stroke (n=32) and healthy controls (n=32). Results People with stroke felt problems with foot, ankle and lower limb sensation affected their walking, balance and contributed to falls. Furthermore, sensory impairments in the lower limb are prevalent with up to 59% of chronic stroke survivors having a deficit of one or more somatosensory modality. Despite this, weak associations between traditional measures of tactile and proprioceptive sensation and walking, balance and falls were demonstrated. Novel, functionally oriented measures of tactile and proprioceptive discrimination were developed and evaluated. These measures were reliable and valid, showing greater sensitivity to predicting the presence of sensory impairments and had stronger associations with functional measures than traditional sensory tests. Conclusions This thesis has provided a comprehensive picture of lower limb somatosensory dysfunction in chronic stroke survivors. Sensory impairments persist into the chronic phase of stroke in the majority of stroke survivors. The extent to which such impairments influence functional ability warrants further investigation. The use of functionally oriented measures that assess higher-level somatosensation is encouraged.

Deviations from normal foot structure are thought to result in hyper or hypo mobility preventing the foot from providing sufficient stability or mobility at appropriate times during the stance phase of gait. Such deviations in foot structure are often suggested as a risk factor for the development of common foot and ankle injuries. Though foot structure is believed to influence function its effect on foot motion and mechanisms thought to allow stability during the end of stance phase remain poorly understood. The purpose of this study was to determine the extent to which arch height affects foot kinematics during gait using a four segment foot model. Subjects included 17 healthy individuals with a wide range of arch heights and no past history of foot pathology. A three-dimensional motion tracking system was used to determine kinematics of the hallux, first metatarsal, forefoot, calcaneus and tibia during gait while subjects ambulated at a predetermined walking velocity of 0.78 statures/s. AP and lateral radiographs were used to determine coordinate system orientation for the first metatarsal, forefoot and calcaneus. The sagittal plane angle between the first metatarsal and calcaneus was used to represent foot structure. No association was observed between foot structure, as represented by arch height, and foot kinematics as represented by excursion or coupling during the stance phase of gait. This surprising result provides no evidence to support the assertion that foot structure influences mobility during gait in individuals without foot pathology. The kinematic patterns observed were highly consistent between individuals and provide new insight into the mechanisms underlying the formation of a rigid lever for pushoff at the end of stance phase. Supination, consisting of forefoot and first metatarsal adduction and plantarflexion along with hindfoot inversion, was found to occur at approximately 76 percent stance. Kinematic coupling associated with activation of the windlass mechanism is consistent with the concept of supination and occurs shortly after forward rotation of the first metatarsal and hallux dorsiflexion. In conclusion, deviation from normal foot structure appears to have little or no influence on foot mobility or intersegmental coupling due to activation of the windlass mechanism.

A great deal of research has been done on the adaptive strategies of individuals who have been affected by a gait altering ailment, but there is little research on the adaptive strategies to imposed restrictions in the healthy population. The role of the ankle in healthy gait is to generate a “push-off” force to create forward propulsion of the body (Winter, 2004). The purpose of this thesis was to identify adaptation patterns and compensation strategies in individuals while wearing and not wearing a device to reduce ankle motion(Ankle Motion Minimizer – AMM). Motion capture and force plate data were collected to determine the lower body kinematics and joint powers during both level ground walking and obstacle avoidance tasks. Repeated Measure ANOVAs with an alpha level of 0.05 determined that differences in the ankle angles and the ankle, knee, and hip powers existed between the various conditions. Results showed that participants had a decreased range of motion and power production at the ankle joint while wearing the AMM. Meanwhile, an increase in the power bursts from the ipsilateral knee were observed during the AMM conditions as well as small increases at the contralateral ankle and ipsilateral hip during the unilateral AMM condition. EMG analysis showed a distinct muscle activation pattern for each individual muscle during the different conditions. From this investigation, individuals who are unable to produce power through the ankle joint, were able to increase power propulsion predominately at the knee to compensate for the lack of propulsion provided by the ankle, therefore allowing ambulation to continue.