Poster 258: A New Treatment for the Ankle Sprain Outcomes

Objective: The authors want to evaluate if specific alterations of ankle retinacula can be evidenced in patients with functional ankle instability (3 months) and if treatment focused on the fascia could restore normal function to the retinacula. Design: An in vivo radiologic study by MRI was performed on 20 patients to evaluate possible damage to the ankle retinacula. Setting: In those subjects (11 cases) with an evident alteration of at least one of the retinacula, static posturography was quantitatively measured and painful symptoms were recorded using a specific questionnaire. Interventions: These subjects were treated by the same practitioner, according to the methodology of Fascial Manipulation for 3 treatment sessions. Main Outcome Measures: Evaluation with static posturography and the questionnaire was repeated after treatment and at the 1, 3, 6 months. Results:: By MRI, the retinacula were clearly visible and easily evaluated. They appeared as low signal intensity bands with a mean thickness of 1 mm. In all patients, 4 types of retinacular alterations were identified. After treatment, a mean pain reduction of 32.2% was recorded (mean value of VAS prior: 41/100; after 3: 8.8/100), together with a good recovery of movement. The initial benefit was generally maintained (mean value of VAS: 13/100) at a short-term follow-up. Static posturography showed a significant difference (P.05) in sway path between the first and the last evaluation: initial mean sway path (msp) was 7.9 mm/sec and final msp was 6.9 mm/sec, coinciding with patients’ reports of an improved sense of balance. Conclusions: Retinacula could be seen as a specialization of the fascia for local, spatial proprioception of foot and ankle movements. Their damage, during ankle sprains, could modify the lines of forces within the fascia of the foot and leg, altering the role of the fascial system in peripheral control of articular motility. Restoring normal tension to the fascia could improve proprioceptive activity of receptors.