Instabilité chronique de la cheville, analyse dynamique de la marche et semelles de posture

Mellie Lavenant , sous la direction de Pierre-Olivier Morin enseignant à Connaissance & Evolution à soutenue au congrès de l’ISPGR 2017 à Fort Lauderdale en floride ses travaux sur l’ instabilité chronique de la cheville (ICC).

L’entorse chronique de cheville est une blessure fréquente du membre inférieur.
Certains auteurs suggèrent que le contrôle moteur en feed back n’est pas suffisant pour les prévenir.
L’analyse de l’équilibre s’effectuant dans de bonnes conditions en feed forward.

Ci dessous un extrait de l’introduction du mémoire présenté et soutenu le Vendredi 5 Mai 2017 par Mellie LAVENANT en en vue de l’obtention du diplôme de Posturologie-Posturopodie Délivré  par Connaissance  & Evolution
JURY : Christian Chotar Vasseur, François-Xavier Grandjean, Thierry Mulliez, Philippe Villeneuve

Instabilité chronique de la cheville

ISPGR Amazing effect of neurosensory insoles on plantar pressure in people withe chronic ankle instability soutenu par Mélie Lavenant et dirigé par Pierre Olivier Morin.

 

 

 » L’entorse de cheville est la blessure la plus fréquente des membres inférieurs lors d’activités sportives ou de la vie quotidienne (Beynnon et AL, 2002). 9 millions de cas sont décrit chaque année aux Etats-Unis (American College of Sports Medicine).

Un déficit de proprioception, une instabilité posturale et une limitation de la flexion dorsale de cheville font partis des facteurs de risque de l’instabilité chronique de cheville (ICC). (Noronha et Al, 2006)

L’ICC est définie par Bonnomet (2004) comme étant « une répétition de plus en plus fréquente d’entorse externe de la cheville, d’une sensation d’insécurité à la course ou à la marche sur terrain accidenté ou plat. Il peut même y avoir des douleurs hors épisode d’entorse. »  »

 

 

Instabilité chronique de la cheville

ISPGR 2017 poster , Amazing effect of neurosensory insoles on plantar pressure in people withe chronic ankle instability, soutenu par Mélie Lavenant et dirigé par Pierre Olivier Morin.

 

AMAZING EFFECTS OF NEUROSENSORY INSOLES ON PLANTAR PRESSURE IN PEOPLE WITH CHRONIC ANKLE INSTABILITY

Mellie Lavenant ˡ, Pierre-olivier Morinˡ ˡConnaissance & Evolution

Mellie Lavenant
et Pierre-Olivier Morin

Background and purpose

The practice of podiatry reveals that ankle sprains are the most common injuries of the lower extremity area, more than nine million each years in the United States (ACSM).

Some authors suggests that feed-back control may not be sufficient to prevent them (Pop & al, 1979; Forestier & al, 2014; Kiers & Al, 2012).

In stable conditions, the gait analysis is known to reveal the feed-forward control mechanism (Zhang et al, 2013).

This study was conducted to determine whether neurosensory insoles can improve feed-forward motor control for people suffering from chronic single-ankle instability by analyzing plantar pressure under both feet.

Methodologies

7 participants: 6 females, 1 male, Average age 44 years, Average height 168 cm, with unilateral ankle instability are evaluated in the aftermaths of 8 weeks of treatment.

2 tests were used:

Plantar pressure were measured by selecting an area of interest under the six areas of the foot: toes, medial, central and lateral forefoot, midfoot and heel.

In order to study the modifications of the motor control, plantar pressures were recorded barefoot. The foot lift test: It is a single leg stance (30 seconds trial) where each foot wobbles is recorded as an

error. But individuals are required to touch their non-weight-bearing foot to the weight-bearing leg at

calf level, with the arms relaxed at the sides. A foot wobble is defined as lifting of the anterior, posterior, medial, or lateral portion of the foot. A point is added when the non-weight-bearing foot touches the ground, and an additional point is recorded for every second that the non-weight-bearing foot remains on the floor.

The location of the plantar inserts on the insoles was determined by the practicing podiatrist following clinical examination of the patient. The inserts did not exceed 3 millimeters in thickness.

Results

The relative time of pressure under the central forefoot and toes is extended under both feet after treatment (p<0.015). Under the healthy lower limb, the relative time of pressure under the lateral forefoot is increased (p=0.029)

In addition, there is a statistically significant increase in relative pressure under the medial forefoot and the toes of the unstable foot after 8 weeks of wearing insoles (p<0.02).

The foot lift test is enhanced after treatment on the pathological side (p=0.004) and shows statistical trend on the healthy side (p=0.051).

Conclusion

The novelty of this study is that neurosensory insoles contribute to modify the feed-forward motor control in participants suffering from chronic ankle instability on both the pathological and healthy sides.

It would be interesting to compare those neurosensory insoles with the physiotherapy treatment in terms of efficiency but also cost for the health system.

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