Related Experiment Video
Updated: Mar 6, 2026
A Mouse Model of Ankle-Subtalar Complex Joint Instability
Published on: October 28, 2022
Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported
Erik A Wikstrom1, Patrick O McKeon2
1Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
Context:
Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)-associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI.
Objective:
To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI.
Design:
Secondary analysis of a randomized controlled clinical trial.
Setting:
Sports medicine research laboratories.
Patients Or Other Participants:
Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations.
Intervention(S):
Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks.
Main Outcome Measure(S):
Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S).
Results:
Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients <22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made ≥2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with ≤53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS.
Conclusions:
Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and <5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.
