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MEDICINA DELLO SPORT
A Journal on Sports Medicine
Official Journal of the Italian Sports Medicine Federation
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,163
ORTHOPAEDIC AND TRAUMATOLOGICAL SECTION
Medicina dello Sport 2002 March;55(1):29-37
Ligament inversion injuries of the ankle in athletes: incidence of foot structure on recurrence
Verni E., Cucca G., Ensini A., Blasi A., Romagnoli M., Giannini S.
IX Divisione di Ortopedia e Traumatologia, Clinica Ortopedica dell’Università, Istituto Ortopedico Rizzoli, Bologna
Background. The purpose of this study is to examine the relationship between foot morphologic characteristics and inversion ankle sprains. The incidence of anterior cavo-varus foot was retrospectively investigated as a possible risk factor of recurrence after injuries.
Methods. Lateral ankle sprains related to sport injuries were collected in a retrospective 5-year study; 1493 patients were reexamined. The age at injury ranged from 16 to 45. Residual problems were registered within 18 months follow-up after the first sprain. All subjects were asked concerning the amount of time off after injury, the involvement in a rehabilitation program, the use of a prophylactic ankle support, the occurrence of reinjury, and residual sport-limiting symptoms. Clinic and functional assessments were focused on the examination of foot architecture. Lower leg-foot alignment and foot arch were investigated to determine the rate of cavo-varus feet. According to the method of Viladot and Coleman test, 3 progressive degrees of cavo-varus foot were identified. Anterior cavo-varus foot was identified by 2nd or 3rd degree longitudinal arch in combination with a positive test (plantar flexed 1st ray deformity).
Results. The incidence rate of cavo-varus foot was 51% of the first lateral ankle ligament injuries. The same tendency toward reinjury was observed in the 1st degree cavo-varus foot and the normal foot. An interesting finding was the high correlation of anterior cavo-varus foot structure and the occurrence of reinjury (66.3%). Rehabilitation protocols and ankle stabilizers were effective to prevent further sprains. Therefore rigid cavo-varus foot structure showed significant low compliance to ankle braces. At 18 months follow-up, only 38% of the competitive subjects regained full preinjury athletic level.
Conclusions. Possible risk factors for ankle inversion reinjuries include foot structure and alignment. Our study underlines the presence of anterior cavo-varus foot as directly implicated in the occurrence of reinjuries. Proper investigation on functional anatomy of the first ray and longitudinal arch is necessary to evaluate the relationship between foot morphologic characteristics and risk of sports-related injury. Recurrent inversion sprains in presence of anterior cavo-varus may be less likely to occur if an orthosis is used.