Effects of Midfoot Joint Mobilization on Perceived Ankle–Foot Function in Chronic Ankle Instability: A Crossover Clinical Trial

Abstract

Context: To investigate the effects of midfoot joint mobilization and a 1-week home exercise program, compared with a sham intervention, and home exercise program on pain, patient-reported outcomes, ankle–foot joint mobility, and neuromotor function in young adults with chronic ankle instability. Design: Crossover clinical trial. Methods: Twenty participants with chronic ankle instability were instructed in a stretching, strengthening, and balance home exercise program and were randomized a priori to receive either midfoot joint mobilizations (forefoot supination, cuboid glide, and plantar first tarsometatarsal) or a sham laying of hands on the initial visit. Changes in foot morphology, joint mobility, strength, dynamic balance, and patient-reported outcomes assessing pain, physical, and psychological function were assessed pre to post treatment and 1 week following post treatment. Participants crossed over to receive the alternate treatment and were assessed pre to post treatment and 1 week following. Linear modeling was used to assess changes in outcomes. Results: Participants demonstrated significantly greater perceived improvement immediately following midfoot mobilization in the single assessment numeric evaluation (sham: 5.0% [10.2%]; mobilization: 43.9% [26.2%]; β: 6.8; P < .001; adj R2: .17; Hedge g: 2.09), and global rating of change (sham: −0.1 [1.1]; mobilization: 1.1 [3.0]; β: 1.8; P = .01; adj R2: .12; Hedge g: 0.54), and greater improved 1-week outcomes in rearfoot inversion mobility (sham: 4.4° [8.4°]; mobilization: −1.6° [6.1°]; β: −6.37; P = .01; adj R2: .19; Hedge g: 0.81), plantar flexion mobility (sham: 2.7° [6.4°]; mobilization: −1.7° [4.3°]; β: −4.36; P = .02; adj R2: .07; Hedge g: 0.80), and posteromedial dynamic balance (sham: 2.4% [5.9%]; mobilization: 6.0% [5.4%]; β: 3.88; P = .04; adj R2: .10; Hedge g: 0.59) compared to the sham intervention. Conclusion: Greater perceived improvement and physical signs were observed following midfoot joint mobilization.