Effects of chronic ankle instability on cutaneous reflex modulation during walking

Chronic ankle instability (CAI) is characterized by persistent giving way at the ankle following an acute lateral ankle sprain and is associated with an early onset of osteoarthritis. Researchers have reported that the cutaneous afferent pathway from certain leg muscles is modified in people with CAI while in a seated position. However, we do not know if these reflex modulations persist during functional activities. The purpose of this study was to further explore sensorimotor function in patients with CAI by analyzing cutaneous reflex modulation during gait. CAI (n = 11) and uninjured control (n = 11) subjects walked on a treadmill at 4 km/h and received non-noxious sural nerve stimulations at eight different time points during the gait cycle. Net electromyographic responses from four lower leg muscles were quantified 80-120 ms after stimulation for each phase of the gait cycle and compared between groups. We found that cutaneous reflex responses between groups were largely similar from the late stance to late swing phases, but uninjured control subjects, and not CAI subjects, experienced significant suppression in the medial gastrocnemius and lateral gastrocnemius muscles during the early stance phase of the gait cycle. Our results indicate that people with CAI lack a protective unloading response in the triceps surae following high-intensity sural nerve stimulation during the early stance phase of the gait cycle. Evaluating cutaneous reflex modulations may help to identify neural alterations in the reflex pathways that contribute to functional deficits in those with CAI.