Effects of Rehabilitation Incorporating Short Foot Exercises on Functional Outcomes for Chronic Ankle Instability

Context. A population with chronic ankle instability (CAI) have previously shown improvement in self-reported function and static and dynamic balance following a rehabilitation program. The incorporation of an exercise focusing on the intrinsic foot muscles, like the short foot exercise (SFE), into a rehabilitation program is thought to result in a greater improvement of postural stability and function as a more stable base of support is developed. The specific effects of a SFE have not been previously studied in individuals with CAI. Objective. (1) To compare static and dynamic balance outcome measures between CAI subjects in traditional and SFE rehabilitation groups before and after a 4-week rehabilitation program, and (2) to compare self-reported function as assessed by the Foot and Ankle Ability Measure (FAAM) between traditional and SFE rehabilitation groups before and after a 4-week rehabilitation program. Design. Double-blind randomized controlled trial. Setting. Athletic training laboratory. Patients or Other Participants. Thirty participants with CAI participated in the study. All were screened for eligibility according to injury history and self-reported function on the FAAM. Intervention(s). Subjects were randomly assigned to one of two rehabilitation groups: a traditional ankle rehabilitation program (CON) or the experimental group that participated in the same rehabilitation program that incorporated the SFE (EXP). Baseline and 4-week follow-up measures were taken on postural control, dynamic balance and self-reported function. Main Outcome Measures. Time-to-boundary (TTB) postural control measures were used to analyze the absolute minimum, mean of the minima and standard deviation of the minima in both the medial-lateral and anterior-posterior directions during static, single limb balance with eyes open and eyes 2 closed. Dynamic balance outcome measures were reach distance as a percentage of leg length in the anterior, posteromedial and posterolateral directions on the Star Excursion Balance Test (SEBT). A percentage score on both the FAAM- activities of daily living and FAAM-Sport subscales were self-reported function outcome measures. Additionally, all participants' intrinsic foot muscle function test (IFMT) was classified as 'poor,' 'fair,' and 'satisfactory.' Results. There was a significant time by group interaction for FAAM-Sport values where the EXP demonstrated significantly higher self-reported function at the follow-up measurement session. There were no other significant time by group interactions or any group main effects. Both groups improved on static balance measures following four weeks of rehabilitation; there was a significant main effect for time on TTBML and TTBAP- absolute minimum, and TTBAP SD outcome measures during balance with eyes open and a significant main effect for time on the TTBML and TTBAP- absolute minimum, TTBAP mean of minima and TTBAP SD variables during balance with eyes closed. There was a significant main effect for time during dynamic balance with the SEBT in anterior, posteromedial and posterolateral directions. There was a significant main effect for time on the FAAM-ADL self-reported function measures. There was not an association between IFMT performance for EXP and CON groups at baseline or followup. Conclusions. While there were not significant group by time interactions for the postural control outcome measures, an improvement in patient-reported outcomes with the incorporation of the SFE is an important and significant finding for patients and clinicians. Given this result, we recommend incorporation of the SFE into rehabilitation program for patients with CAI.

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