Tiantan Xiaotangshan Rehabilitation Center, Beijing Xiaotangshan Hospital, Beijing, 102200, China.
Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
J Orthop Surg Res. 2024 Oct 26;19(1):692. doi: 10.1186/s13018-024-05178-w.
BACKGROUND: Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI. OBJECTIVE: The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI. METHODS: A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period. RESULTS: After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment. CONCLUSION: Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability.
背景：慢性踝关节不稳（CAI）患者常出现反复肿胀和疼痛，这会妨碍他们的长距离步行能力。新出现的证据表明，关节松动术可以增强 CAI 患者的踝关节功能。
目的：本研究旨在探讨距下关节松动术对增强踝关节稳定性、缓解踝关节疼痛以及改善 CAI 患者步行能力的影响。
方法：对 2022 年 4 月至 2023 年 10 月期间接受治疗的 46 例患者进行回顾性分析，将其随机分为两组：治疗组 23 例，接受常规治疗加距下关节松动术治疗；对照组 23 例，仅接受常规治疗。治疗持续 8 周。在治疗前后评估疼痛程度和步行能力。
结果：治疗 8 周后，治疗组患侧单腿提踵次数（NLHSL）增加，星状偏移平衡测试（SEBT）改善，美国矫形足踝协会（AOFAS）评分高于对照组，休息时疼痛（RVAS）和行走时疼痛（WVAS）评分明显降低。然而，两组间单腿站立时间（SLT）无统计学差异。对照组治疗后动态平衡和控制测量（SLT、NLHSL、SEBT）显著改善，但疼痛水平（RVAS、WVAS）或后足功能（AOFAS）无显著变化。相比之下，治疗组治疗后所有测量参数（RVAS、WVAS、SLT、NLHSL、SEBT 和 AOFAS）均显著改善。
结论：距下关节松动术通过增强踝关节稳定性，有效减轻 CAI 患者的踝关节疼痛，提高步行能力。观察到的步行能力改善可能源于减轻跟骨内翻和踝关节不稳定相关的代偿机制。
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