Effects of Ankle Evertor Fatigue on Perturbed Gait

University of Ljubljana

Status: Enrolling

Conditions: Chronic Ankle Instability, CAI

Treatments: Other: Muscle fatigue

Study type: Observational

Funder types: Other

Identifiers

NCT07273097

0120-197/2023/3/gait

Details and patient eligibility

About

This study will investigate the effects of ankle evertor muscle fatigue on gait stability during treadmill walking with mechanical perturbations. Participants will walk at two speeds (0.4 m/s and 1.0 m/s) while random medial and lateral perturbations (<10% body weight) are applied to the pelvis. Surface EMG from ankle muscles and center of pressure (COP)-based gait parameters (e.g., step length, step width, single support duration, COP trajectory) will be analyzed before and immediately after an isotonic fatigue protocol of the ankle evertors.

Full description

The purpose of this study is to examine how ankle evertor muscle fatigue affects gait stability and neuromuscular responses during treadmill walking with mechanical perturbations. Perturbations will be applied randomly in the medial or lateral direction, but always shortly after initial foot contact, to specifically challenge ankle stabilization in stance.

The study will include individuals with chronic ankle instability (CAI) and matched healthy controls. In the CAI group, the symptomatic side will be targeted with the fatigue protocol, whereas in healthy controls the tested side will be assigned to match the distribution of sprain laterality in the CAI group.

Walking and perturbation protocol:

Participants will first complete familiarization at 1.0 m/s, including both normal and perturbed walking. After familiarization, the measurements will consist of 2 minutes of unperturbed walking followed by 3 minutes of perturbed walking. The same procedure will then be repeated at 0.4 m/s, with familiarization (normal and perturbed walking) preceding the measurement block.

The fatigue protocol will be applied immediately after these baseline blocks. Following fatigue, participants will immediately perform perturbed walking at 1.0 m/s. The fatigue protocol will then be repeated, followed by perturbed walking at 0.4 m/s.

Fatigue protocol:

Ankle evertor muscles will be fatigued using elastic resistance bands through repeated concentric and eccentric eversion contractions. The task will be paced using a metronome at a rate of one repetition per second, and will continue until the active eversion range of motion decreases by 50% compared to baseline.

Enrollment: 40 estimated patients

Sex: All

Ages: 18 to 45 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria for the healthy control group (no CAI):

• Age between 18 and 45 years,
• No history of injuries or surgical procedures to the lower limbs,
• No peripheral or central neurological impairments.

Inclusion criteria for the chronic ankle instability (CAI) group:

• Age between 18 and 45 years,

• No history of major surgical procedures on the lower limbs

• No peripheral or central neurological impairments,

• Diagnosed chronic ankle instability:

  • First ankle sprain occurred at least one year prior to testing,
  • At least three months since the most recent ankle sprain,
  • Subjective feeling of ankle instability - CAIT (Cumberland Ankle Instability Tool) score < 24.

Exclusion criteria for the CAI group:

• Other pathologies of the ankle joint.
• Acute pain

Trial design

40 participants in 2 patient groups

Healthy group

Description:

Healthy participants without a history of ankle sprain or self-reported ankle instability. Participants in this group will complete the same experimental protocol as Chronic ankle instability group, which includes treadmill walking at two speeds (0.4 m/s and 1.0 m/s) with and without mechanical perturbations, performed before and after an ankle evertor fatigue protocol. For this group, the fatigued limb will be assigned based on the laterality of ankle sprains observed in the CAI group.

Treatment:

Other: Muscle fatigue

Chronic ankle instability group

Description:

Participants with chronic ankle instability, defined by a history of recurrent ankle sprains and self-reported instability. Participants in this group will complete the same experimental protocol as Healthy group, which includes treadmill walking at two speeds (0.4 m/s and 1.0 m/s) with and without mechanical perturbations, performed before and after an ankle evertor fatigue protocol. For this group, the fatigued limb will be the symptomatic side.

Treatment:

Other: Muscle fatigue