Managing ankle sprains and chronic ankle instability with bracing

An ankle sprain is one of the most common injuries experienced in physically active populations1 and one of the most frequent sport-related injuries,2 with indoor/court sports having the highest incidence.3

Such injuries can result in the ankle joint becoming abnormally loose, which can then lead to chronic ankle instability (CAI). The pain, stiffness, and loss of confidence associated with CAI can be a major hindrance to physical activity, and the condition may require surgery to remedy.

However, functional ankle braces offer patients a conservative way to manage both acute and chronic ankle injuries. This article examines the evidence for these products.

What is an ankle sprain?

Lateral ankle sprains can occur due to forceful ankle plantarflexion and inversion,4 when the foot suddenly rolls inward, resulting in damage to the ligaments of the ankle. In addition to pain, the patient may experience swelling, bruising, and additional discomfort when attempting to put weight on the foot.

There are three categories of sprain, increasing in seriousness:

  • Grade I (Mild):  Features slight stretching and microscopic tearing of the ligament fibers, resulting in mild tenderness and swelling around the ankle
  • Grade II (Moderate): Partial tearing of the ligament occurs, resulting in moderate tenderness and swelling around the ankle. When the ankle moves in certain ways, there is an abnormal looseness of the ankle joint
  • Grade III (Severe): The ligament is completely torn, resulting in significant tenderness and swelling around the ankle. When the ankle moves in certain ways, substantial instability occurs

What is chronic ankle instability?

40% of those who experience an ankle sprain go on to develop chronic ankle instability (CAI) and complain of chronic symptoms.5,6 This is a condition characterized by the feeling, or the actual occurrence, of the ankle giving way.7

Grades of ankle sprain

Individuals with CAI often experience persistent swelling, pain, weakness, reduced ankle range of motion (ROM), ankle instability, diminished self-reported function, and recurrent ankle sprains.7,8

CAI has been identified as a precursor for ankle osteoarthritis (OA), and onset usually occurs a decade earlier than knee or hip OA.9

Chronic ankle sprains may require surgery in the form of arthroscopic ligament reconstruction. Individuals with CAI have been identified as having mechanical instability, relating to structural changes around the ankle, and functional instability which has been associated with a reduction in sensorimotor and neuromuscular control.10

Bracing for chronic ankle instability

An ankle brace is a garment designed to stabilize the ankle before or after injury. Available in soft or semi-rigid types, these braces are designed to perform some or all of the following functions:

  • Improve ankle stiffness and thus mechanical stability11
  • Improve neuromuscular control12
  • Improve grounding of the foot12
  • Decrease excessive ROM11
  • Enhance proprioceptive acuity (the body’s ability to sense its own location, movement, and actions)13

Several clinical studies have been carried out to determine the effectiveness of ankle bracing in these areas.

Hals et al.’s 2000 study showed the Aircast® Sport Stirrup® significantly improved shuttle-run performance in subjects with post-acute, unilateral, mechanically stable but functionally unstable ankle sprains.14

Habadi et al. (2014), demonstrated that soft and semi-rigid ankle orthoses are beneficial for dynamic balance of individuals with functional ankle instability.15

In their 2020 systematic review, Reyburn and Powden found that the current literature supports a strong effect of ankle braces on the dynamic balance of those with CAI.16

In 1998, Vaes et al. discovered the Aircast Air-Stirrup® brace significantly decreased talar tilt of unstable ankles in static and dynamic test conditions and slowed down the simulated sprain speed.17

A randomized controlled trial by Janssen et al. (2014), including 384 athletes who had sustained a lateral ankle sprain, revealed that bracing with an Aircast A60 brace was superior to neuromuscular training for reducing the incidence of ankle sprain recurrence.18

Introducing ActyFoot by Aircast® – the ankle support putting patients in control of stability

The latest ankle support from Aircast, ActyFoot™ provides a functional, modular management option to help protect existing ankle injuries or prevent them from occurring in the first place.

Thanks to its modular design, ActyFoot allows patients to control the level of stability their ankle needs. By simply adding the attachable lateral stay, patients can receive the benefit of increased immobilization and protection to aid recovery following injury or for added confidence during activity.

Without the stay, the unique strap system provides sufficient support for sports and daily activities while allowing greater freedom of movement.

ActyFoot ankle support from Aircast

How ActyFoot helps to provide ankle stability

The brace’s three integrated straps provide proprioceptive feedback and work together with semi-rigid elements to stabilize the ankle and restrict excessive range of movement.

How ActyFoot helps to provide ankle stability

References

  1. Hootman, J.M., Dick, R. & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of athletic training, 42(2): 311.
  2. Fong, D.T.P., Hong, Y., Chan, L.K., Yung, P.S.H. & Chan, K.M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1): 73-94.
  3. Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J. & Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports medicine, 44(1): 123-140.
  4. Hubbard, T.J. & Wikstrom, E.A. (2010). Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access Journal of Sports Medicine, 1: 115.
  5. Anandacoomarasamy, A. & Barnsley, L. (2005). Long term outcomes of inversion ankle injuries. Br J Sports Med, 39(3): e14; discussion e14.
  6. Konradsen L., Bech L., Ehrenbjerg M. & Nickelsen T. (2002). Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports, 12(3): 129-135.
  7. Hertel, J. & Corbett, R.O. (2019). An updated model of chronic ankle instability. Journal of athletic training, 54(6): 572-588.
  8. Ahn, C. S., Kim, H. S., & Kim, M. C. (2011). The Effect of the EMG Activity of the Lower Leg with Dynamic Balance of the Recreational Athletes. The Journal of Physical Therapy Science. 579–583.
  9. Saltzman, C.L., Zimmerman, M.B., O’Rourke, M., Brown, T.D., Buckwalter, J.A. & Johnston, R. (2006). Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis. J Bone Joint Surg Am., 88(11): 2366-2372.
  10. Hertel, J., (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of athletic training, 37(4): 364.
  11. Zinder, S.M., Granata, K.P., Shultz, S.J. & Gansneder, B.M. (2009). Ankle bracing and the neuromuscular factors influencing joint stiffness. Journal of Athletic Training, 44(4): 363-369.
  12. Kobayashi, T., Saka, M., Suzuki, E., Yamazaki, N., Suzukawa, M., Akaike, A., Shimizu, K. & Gamada, K. (2014). The effects of a semi-rigid brace or taping on talocrural and subtalar kinematics in chronic ankle instability. Foot & Ankle Specialist, 7(6): 471-477.
  13. Raymond, J., Nicholson, L.L., Hiller, C.E. & Refshauge, K.M. (2012). The effect of ankle taping or bracing on proprioception in functional ankle instability: a systematic review and meta-analysis. Journal of Science and Medicine in Sport, 15(5): 386-392.
  14. Hals, T. M., Sitler, M. R., & Mattacola, C. G. (2000). Effect of a semi-rigid ankle stabilizer on performance in persons with functional ankle instability. The Journal of orthopaedic and sports physical therapy, 30(9), 552–556.
  15. Hadadi, M., Mousavi, M. E., Fardipour, S., Vameghi, R., & Mazaheri, M. (2014). Effect of soft and semirigid ankle orthoses on Star Excursion Balance Test performance in patients with functional ankle instability. Journal of science and medicine in sport, 17(4): 430–433.
  16. Reyburn, R. J., & Powden, C. J. (2020). Dynamic Balance Measures in Healthy and Chronic Ankle Instability Participants While Wearing Ankle Braces: Systematic Review With Meta-Analysis. Journal of sport rehabilitation, 30(4): 660–667.
  17. Vaes, P. H., Duquet, W., Casteleyn, P. P., Handelberg, F., & Opdecam, P. (1998). Static and dynamic roentgenographic analysis of ankle stability in braced and nonbraced stable and functionally unstable ankles. The American journal of sports medicine, 26(5): 692–702.
  18. Janssen, K. W., van Mechelen, W., & Verhagen, E. A. (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British journal of sports medicine, 48(16): 1235–1239.

How a Splint can Help Relieve Bunion Pain.

Hallux Valgus – or bunion – is one of the most common foot deformities, especially for women, who are 15 times more likely to have corrective surgery for the condition than men. Because of its weaker connective tissue, the big toe can become misaligned, resulting in an unsightly and painful protrusion from the foot.

As well as being unattractive and making it harder to choose shoes, bunions also cause painful pressure points and inflammation. Without corrective action, they can lead to functional disability, foot pain, impaired gait patterns, poor balance and falls in older adults.

TREATMENT OPTIONS FOR BUNIONS

While only surgery can fully correct a bunion, a range of conservative treatment options has been shown to be effective in helping correct misalignment and provide pain relief, including after surgery1. These include hinged splints, rigid splints, foot braces, toe separators, and foot cushions.

Rigid Bunion Splints

A rigid bunion splint, or night splint, is attached to the affected side of the foot to help provide immobilization and support. While night splints can help relieve pain² and correct malpositioning3, their rigid construction means they are only suitable to be worn during rest periods and at night.

Hinged bunion splints

A hinged bunion splint works on the same principle as a rigid splint, but adds a hinged joint to allow the patient to move while wearing it. This makes hinged splints convenient for bunion patients looking for correction and pain relief while continuing their normal daily activities. 3

Soft braces

Soft braces aim to provide support and pain relief without the inclusion of rigid elements. They may take the form of an elasticated strap or even a supported sock, and offer a low profile to allow them to be comfortably worn with footwear.

Foot cushions

Along with insoles that can be worn inside shoes, small toe and foot cushions are available to help provide comfort and soft protection for bunions and other toe and forefoot conditions. These products can include foot pads and toe spacers and are usually made of soft rubber-like materials.

INTRODUCING THE NEW RANGE OF BUNION SPLINTS AND FOOT CARE PRODUCTS

Medical device manufacturer Aircast® has provided patients with innovative healthcare solutions for over 30 years, and now it’s launching a comprehensive portfolio of hallux valgus and foot protection products. Designed to address bunions and other foot disorders, together they help provide patients with correction, protection and pain relief.

The range comprises of three splints and nine SofToes™ foot protection products:

ActyToe

A low-profile, lockable hinged bunion splint, ActyToe™ can be worn with shoes for active use, as well as during rest and throughout the night. Whether you’re on the go or on the mend, the adjustable and versatile ActyToe hinged splint helps provide functional pain relief and correction for bunions.

ActyToe Night

A rigid bunion splint for use during rest and throughout the night. For patients with bunions, ActyToe™ Night combines rigid support with adjustability to help provide comfortable pain relief and correction during rest.

ActyToe Lift

A mid-foot bunion and splay foot brace with pad. Thanks to its low-profile design and comfortable arch pad, the ActyToe™ Lift mid-foot brace helps provide adjustable pain relief during activity and rest for a range of foot conditions.

SofToes™

The innovative Aircast® SofToes range helps provide solutions for a variety of needs in the toe area. These ergonomic cushions help provide gentle protection, soft comfort and secure support, while a subtle hint of menthol helps maintain a fresh, airy smell.

References

  1. Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Hallux valgus: immediate operation versus 1 year of waiting with or without orthoses: a randomized controlled trial of 209 patients. Acta Orthop Scand. 2003 Apr;74(2):209-15.
  2. du Plessis M, Zipfel B, Brantingham JW, Parkin-Smith GF, Birdsey P, Globe G, Cassa TK. Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomised clinical trial. Foot (Edinb). 2011 Jun;21(2):71-8.
  3. Moulodi N, Kamyab M, Farzadi M. A comparison of the hallux valgus angle, range of motion, and patient satisfaction after use of dynamic and static orthoses. Foot (Edinb). 2019 Dec;41:6-11.