5. CAI Pathobiomechanics
Tibialis Ant activation
greater in CAI from 15-
30% and 45-70% of
gait
Peroneus Longus
activation greater
in CAI at initial
heel contact and
toe off
(3)
7. CAI Pathobiomechanics
Eccentric peak torque DF/PF ratio
of CAI was higher due to
decreased eccentric strength of PF
Eccentric peak torque
eversion/inversion of CAI was
lower due to decreased eccentric
strength of evertors
Eccentric weakness of invertors,
evertors,and plantarflexors may
lead to repeated injury.
(5)
9. Medial Longitudinal Arch (MLA)
Calcaneal tuberosity and
head of first metatarsal
Navicular - highest point
Talus, cuneiforms, six
ligaments stabilize the arch
Plantar fascia provides
majority of stabilization
Unlock = Shock absorption
Lock = Rigid Lever
Static vs. Dynamic (7,8)
10. MLA
(+) correlation
between low arches
and acute and
recurrent ankle
sprains - possible risk
factor.
Low MLA increase
fatigue and
weakening of
peroneal muscles:
decreases
proprioceptive
function -
predisposing factor
(7)
11. MLA
Rearfoot pronation accompanied
with Tibial Int Rot = Normal
Arch support decreases eversion
angle in dynamic trials
p= 0.0002
Restores normal eversion
2.058 (95% CI=0.99-3.128)
Decreased mean wt. peak impact
load
9% BW (95% CI=1-18%)
Decreases Peak Tibial Int
Rotation (PTIR)
Insufficient evidence in control
over proximal segments (8,9,10)
13. Clinical Prediction Rule
● Symptoms worse when standing
● Symptoms worse in the evening
● Navicular drop > 5 mm
● Distal Tibiofibular Jt. Hypomobility
3 out of 4 variables = 5.9 +LR Success
(11)
14. Jt Mobs and Kinematics
Task: Jump landing
Angle of jt plantarflexion premobilization 34.89 (+/- 4.8)
Angle of jt plantarflexion postmobilization 31.90 (+/- 5.89)
P < 0.05
Mean 2.98 (95% CI 0.54 - 5.43)
(12)
15. Manipulation in Isolation
Jt manipulation of prox or distal tibiofibular jt performed in isolation is unlikely to
have an impact on jt function in individuals with CAI
(13)
29. Reference List
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