Introduction: Functional Foot Orthoses (FFO’s) have been shown to improve one element of balance, postural sway, when prescribed for patients with ankle injuries. Little is known, however, about the effect of these devices on ankle stability/proprioception, or the changes which might occur as the patient becomes habituated to using the device. We studied these effects from the time of initial application of the FFO through to regular usage at six weeks.

Methods: Patients with musculoskeletal conditions affecting the lower limb that required custom made FFO’s were evaluated. A standardised protocol, using the Biodex stability system (a balance platform), to assess several stability indices was performed. Patients were assessed before fitting the orthosis, at the time of fitting and six weeks later. The American Orthopaedic Foot and ankle Society (AOFAS) score was also used to evaluate the progress of these patients.

Results: There were 13 male and seven female patients, aged 10 to 64 years. Patients had a range of orthopaedic conditions and all been assessed by orthopaedic specialist and podiatrist as having correctable foot biomechanics. In 6 patients, proprioception deteriorated on initial application of FFO’s. However, all patients exhibited improved over-all stability by a mean of 2.5 points (Normal range 0.82–3.35) at 6 weeks evaluation. The mean AOFAS on presentation was 72 and the final mean score was 97, both of which were clinically and statistically significant (t test, p< 0.05). Eighteen patients had complete resolution of symptoms of pain and instability.

Conclusions: FFO’s alter foot biomechanics, and in doing so appear also to improve balance and proprioception. Proprioception deteriorated in 30% of cases on initial application of orthotics, but pain and instability improved in more than 90% of patients on extended use of foot orthotics, with this improvement becoming manifest by 6 weeks after starting use of the device.

The “Knot of Henry” was dissected in 16 embalmed cadaveric feet to reveal the complex interconnections between flexor hallucis longus (FHL) and flexor digi-torum longus (FDL) tendons. Three distinct anatomical patterns were observed.

Tension was applied manually to FHL or FDL proximal to the Knot. Digit movement was different depending on the anatomical pattern.

FHL or FDL tendon transfer is an accepted technique to prevent progression of acquired plano-valgus deformity. In order to minimise donor deficit, we suggest the use of either FHL or FDL should be based on assessment of the anatomical pattern at the time of surgery.

The rehabilitative phase of ankle injury management often involves the use of an ankle brace. The aim of this study was to ascertain the effects of such braces on the forces through the foot and the timing of peak loads in the gait cycle, in the recovering ankle and the uninjured ankle, in order to understand better the mechanism by which such braces enhance ankle stability.

Twenty four adults with recurrent ankle injuries and an aspiration to return to sporting activity were studied. Each was in the rehabilitation phase of recovery from ankle injury. Controls were 17 adults who regularly took part in sporting activity, without ankle injury. Assessment of peak force in three orthogonal axes (% body weight) during walking was carried out using the Kistler foot plate; the times taken to reach the maxima were recorded. Subjects were assessed in bare feet, training shoes and wearing one of two types of commonly available stirrup-type ankle braces.

Results showed that the ankle braces did not alter peak loads compared to training shoes alone (one-way analysis of variance, p< 0.05) and were consistent in both the injured and un-injured subjects. There were no significant differences between the two braces tested (p< 0.05). The time to reach peak load was not significantly different between the braced or non-braced ankles in either the injured or control groups.

Conclusions are that stirrup type ankle braces do not alter the peak forces through the foot during walking. The effectiveness of stirrup-type ankle braces appears not to depend on their modification of medial forces during gait.

The rehabilitative phase of ankle injury management often involves braces. Our aim was to ascertain the effect of both a brace on both ankle range of movement and the timing of peak loads in the gait cycle, to understand better the mechanisms by which such braces enhance ankle stability.

We recruited 24 adults who were in the rehabilitation stage following ankle injuries, and in whom there was an aspiration to return to sport.

Controls were 17 adults who regularly played sport, but had no recent history of injury.

Assessment of range of movement was carried out using the Biodex isokinetic dynamometer to measure inversion, eversion, flexion and extension of the foot, with the subject in training shoes, and wearing one of two common stirrup-type ankle braces. Assessment of peak force in three orthogonal axes (% body weight) was performed using the Kistler footplate. The subjects were observed in bare feet, trainers and stirrup braces.

Results showed that the ankle braces restricted inversion (mean reduction 9 degrees, SD 8 degrees) compared to training shoes alone in both the injured and non-injured sunjects, but the restriction in range of movement in inversion /eversion was not significantly different between the braced injured and un-injured ankles (t test p< 0.05).The ankle braces did not alter peak loads compared to training shoes alone (one way analysis of variance, p< 0.05);these findings were consistent in both groups. The time to reach peak load was not significantly different between the braced or un-braced ankles in either the injured or control groups.

We conclude that stirrup type braces reduce the range of inversion/eversion in the normal and injured ankle, reducing the movement by a similar amount in both of these groups, but they do not alter peak forces through the foot during walking.

It is not clear to what extent the normal active stabilisers of the ankle, primarily the peroneii, are affected by fatigue, during or after sporting activity. The aim of this study was to ascertain the effects of fatigue on ankle stability in the active sportsman.

20 adults who regularly took part in sporting activity, and who had no recent history of ankle injury were recruited. Assessment of ankle stability and function consisted of a static test (one legged stance, ‘stork test’) and dynamic tests (time taken to hop 6-limbed star), testing each leg. Test time were recorded (3 attempts with the best result counting) before and after exercise which consisted of a 2km treadmill run, run at the subject’s best pace.

Our results showed an overall improvement in both static and dynamic stability after exercise. The differences reached statistical significance (one-tailed analysis of variance, p< 0.05).

We therefore conclude that moderate exercise improves static and dynamic ankle stability in the normal ankle; this demonstrates a beneficial warm up effect, rather than a fatigue effect.

The functionally unstable ankle with giving way or with lack of confidence in the ankle, without major ligamentous laxity, is a common problem in sportsmen and women. The aim of this study was to record the arthroscopic findings in patients with ankle problems, a history of ankle injury, and continuing functional instability.

We reviewed the findings of 90 consecutive ankle arthroscopies in patients suffering from ankle problems interfering with sport. All complained of a combination of pain on sporting activity (38%), a lack of trust in the ankle (30%), or the ankle letting them down when running or turning (22%).

Results showed that isolated lesions identified at arthroscopy were uncommon (7%). 40% had synovitis, often associated with scarring or thickening around the anterior talo-fibular ligament (ATFL). Anterior tibial osteophytes were found in 45% and chondral or osteochondral talar lesions were present in 53%. The majority (80%) also had a lesion in the inferior tibiofibular joint (ITFJ). The ITFJ lesions were often firm, impinging within the ankle joint, and were associated with synovitis. All ankle lesions were arthroscopically resected.

The importance of ATFL impingement lesions, sometimes called meniscoid lesions, has previously been described. We would draw attention to the IFTJ lesions, which were common in our series of unstable ankles, and which we believe are part of the pathology of this condition.