Gait training for chronic ankle instability improves neuromechanics during walking

A novel gait-training device has been shown to improve gait patterns while patients with chronic ankle instability (CAI) are using the device and our current objective was to analyze the effect of structured gait training with the device on plantar pressure and surface electromyography (sEMG) following repeated gait training sessions. Sixteen CAI patients participated. Plantar pressure and sEMG were collected simultaneously during walking pre- and post-gait training. Plantar pressure (pressure time integral, peak pressure, time to peak pressure, contact area, contact time, and center of pressure trajectory) of the entire foot and nine specific regions of the foot were recorded concurrently with sEMG root mean square amplitudes from the anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius. Five gait training sessions were performed with each session lasting approximately 15 min. Pre- and post-gait training self-reported function, plantar pressure, and sEMG were compared using paired t-tests with a priori level of significance of p ≤ 0.05. Gait training improved self-reported function (FAAM-Sport scale: Pre = 75.1 ± 7.1%, Post = 85.7 ± 12.2%, p < 0.001) and caused a medial shift in the COP from 10% of stance through toe-off (p < 0.05 for all analyses). The medial shift in COP was driven by concurrent increases in peroneus longus muscle activity from 21% to 60% and 81% to 90% of stance (p < 0.05 for all analyses). There was a corresponding reduction in gluteus medius muscle activity during 71-100% of stance (p < 0.05 for all analyses). Overall, gait training with a device that targets the peroneus longus and gluteus medius throughout the gait cycle improved gait patterns in CAI patients. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:515-524, 2018.