Functional Ankle Instability (FAI)

• A feeling of the ankle giving way after an acute ankle sprain

• Objectively determined with the Cumberland Ankle Instability Tool
(CAIT)
Who Cares?
• FAI can lead to decreased quality of life and reductions in functional
capacities
Postural Control Deficits in Participants with Functional
Ankle Instability as Measured by the Balance Error Scorin
System
Carrie L. Docherty, PhD, LAT, ATC,*
Tamara C. Valovich McLeod, PhD, ATC,w
and Sandra J. Shultz, PhD, ATCz

(Clin J Sport Med 2006;16:203–208)

Purpose of Study
• Are postural control deficits present in patients with FAI?
Methods
• FAI defined as at least one ankle sprain and a feeling of giving way
• 30 FAI participants and 30 Controls
• Used BESS (Balance Error Scoring System) as outcome measure
BESS (Balance Error Scoring System)
• 6 conditions (double leg, single leg , tandem) (firm surface, foam
surface)
• Count the number of errors (deviations from original position) during a
20 second period
• As expected combination of foam and tandem or single stance caused
the most errors
Results
• Significant difference between FAI and Control for Single foam Tandem
foam and Single firm.
Mechanism?
• One potential explanation is that, following an inversion stress to the
ankle joint, the mechanoreceptors located within the ligaments and
joint capsule may be stretched.
• Additionally the afferent nerve fibers, which distribute the sensory
information, may also be damaged.
• One or both of these functions would reduce the afferent information
and potentially affect postural control.
 Do we have any indication that
proprioception plays a role in FAI?
Matsusaka et al (2001)

Effect of ankle disk training combined with tactile

stimulation to the leg and foot on functional instability
of the ankle. Am J Sports Med 29:25-30
 Two pieces of 1 cm
wide non-elastic
adhesive tape
applied to the skin
during ankle disk
training

Ankle
Disc
Conclusion
• Postural sway improved 2 weeks earlier in the group that had taping in
addition to the ankle disk
So can Orthotics
help with FAI?
Orthotic Intervention and Postural
Stability in Participants With
Functional Ankle Instability After
an Accommodation Period
J Athl Train. 2012 47(2):130-135
Chris Hamlyn, MS, ATC,* Carrie L.
Docherty, PhD, ATC,† and Joanne
Klossner, PhD,
Methods
• Subjects filled out a CAIT (Cumberland Ankle Instability Tool)
• Must score less than 27 to be considered as Functional Ankle Instability
• Other ankle had to be healthy scoring between 28-30
• No ankle injuries less than 2 months or leg fractures, surgeries, ear or sinus
infection or pregnancy.
• Stood on a force plate one legged stance for 20 seconds eyes closed
• area of COP was measured:
• 1. Before Orthotics
• 2. Immediately after orthotics
• 3. Two weeks after orthotics
Methods
• Wore their own shoes
• Orthotics were semi-rigid pre-fab
• Had to wear orthotics for 12 hours a day
• Two groups. Orthotic Group and Control Group
• Picked alternately after initial session of COP determination (worst COP
given orthotics, second worst not given orthotic, third worst given
orthotic, fourth worst not given orthotic etc)
Results
• Orthotic Group improved significantly from Session 1 to Session 2 and
between Session 1 and Session 3
• No significant improvement in Control group across sessions
• Orthotic Group showed significant better postural stability compared to
Control at session 3
• Healthy ankle significantly better postural stability than FAI ankle
Conclusions
• We found that a prefabricated orthotic improved postural stability in
patients with FAI. Therefore, prefabricated orthotics may be an early
intervention option for patients with FAI while allowing them to
continue to participate in physical activity. Ideally, orthotics would be
used in conjunction with traditional rehabilitation exercises to improve
the overall stability and proprioception of patients with FAI.
Effect of foot orthotics on single- and double-limb
dynamic balance tasks in patients with chronic
ankle instability.
Sesma AR1, Mattacola CG, Uhl TL, Nitz AJ, McKeon
PO.

Foot Ankle Spec. 2008 Dec;1(6):330-710

Methods
• Star Excursion Balance Test (SEBT)
• Limits of Stability Test
• CAIT
• Wore orthotics (custom) 4-8 hours a day for 4 weeks
Results
• Significant Improvement in Star Excursion Balance Test (SEBT)
• Significant Improvement in CAIT
Conclusion
• Orthotic intervention may prove beneficial for improving dynamic
balance as measured by the SEBT in individuals with chronic ankle
instability and may be a useful adjunct to clinical and sport
interventions.
The Effect of Molded and Unmolded Orthotics on Balance and Pain
While Jogging Following Inversion Ankle Sprain
Linda Combs Orteza, MS, PT, ATC, W. Daniel Vogelbach, PT, ATC, and Craig
R. Denegar, PhD, ATC, Associate Professor
(Athl Train. 1992; 27(1): 80, 82, 84.)
Methods
• Participants with ankle sprain and a healthy group
• Used a digital balance evaluator
• Moves in inversion/eversion
• When 4 degrees is reached an alarm sounds indicating loss of balance.
• Other outcome measure was pain during jogging
• Used molded (subtalar neutral) and unmolded (flat) orthotics
Results
• Injured participants performed worse than healthy
• Molded orthotics helped balance scores in ankle sprain subjects but
unmolded did not.
• Molded orthotics only helped balance scores in injured subjects
• Molded orthotics reduced pain during jogging in injured subjects but
unmolded did not.
Conclusion
• Molded orthotics may play a role in inversion ankle sprains
What about Balance Improvement
of Healthy Subjects with Mal-
Aligned Feet using Foot Orthotics?
Effect of Orthoses on Postural
Stability in Asymptomatic Subjects
With Rearfoot Malalignment
During a 6-Week Acclimation Period
Carl G. Mattacola, PhD, ATC, Maureen K. Dwyer, MS, ATC, Amy K. Miller, MS, ATC,
Tim L. Uhl, PhD, ATC, Jean L. McCrory, PhD, Terry R. Malone, EdD, PT, ATC

Archives of Physical Medicine and Rehabilitation

Volume 88, Issue 5, May 2007, Pages 653–660
Methods
• Assessed patients for rearfoot valgus or varus
• Malaligned patients were asymptomatic
• So two groups (malaligned versus control)
• Made custom orthotics for subjects (subtalar neutral semi-rigid)
• Also compared orthotic versus no orthotic conditions
• Outcome measures were sway velocity in one legged stance and
equilibrium score in bilateral stance.
Results and Conclusions
• The application of orthoses decreased sway velocity for single-limb
stance, improving postural stability regardless of group
• During bilateral stance, postural stability was initially worse for the
malaligned group with and without orthoses when compared with the
control group; however, improvements were seen by week 2 and
continued throughout the remainder of testing.
• Clinically, the application of orthoses appears to improve postural
control in people with rearfoot malalignment, particularly when vision is
removed
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