Auswirkungen des Trainings der intrinsischen Fußmuskulatur bei Patienten*innen mit Sprunggelenkinstabilität – ein narrativer Review

Zusammenfassung

Hintergrund Sprunggelenkdistorsionen stellen eine der häufigsten Verletzungen im Sport dar und können sich als chronische Sprunggelenkinstabilität manifestieren. In der Therapie und Prävention hat sich ein sensomotorischer Trainingsansatz der sprunggelenkumgebenden Strukturen als wirksam erwiesen. Es gibt Hinweise, dass auch ein Training der intrinsischen Fußmuskulatur beispielsweise die Balance verbessern kann.

Ziel Ziel dieses narrativen Reviews ist die Darstellung der Evidenz eines Trainings der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität.

Methode Im Januar 2022 wurde in den Datenbanken PubMed, Cochrane Library, EBSCOhost, PEDro, SPONET und BISp-Surf eine systematische Literaturrecherche durchgeführt, die durch eine Freihandsuche ergänzt wurde. Dabei sollten Metaanalysen, Systematic Reviews und Interventionsstudien inkludiert werden, die Effekte einer Trainingsform der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität untersuchten. Die qualitative Bewertung der Literatur und Evidenz erfolgte anhand des Risk-of-Bias-Tools (RoB-Tool) des Cochrane Handbook sowie angelehnt an das GRADE-System.

Ergebnisse Fünf randomisierte kontrollierte Studien mit insgesamt 150 Proband*innen wurden inkludiert. Vier Studien nutzten die Short-Foot Exercise (SFE), eine Studie die Towel-Curl Exercise (TCE) und eine wandte ein Training der Zehen an. Drei Studien wiesen einen großen, signifikant positiven Effekt (p<0,05) der SFE auf die subjektive Instabilität auf. Die SFE und das Zehentrainingsprogramm hatten signifikant positive Effekte (p<0,05) auf die Balance, wobei die Einbeziehung der SFE in ein Trainingsprogramm zu keinem Vorteil führte. Eine Studie stellte signifikant positive Auswirkungen (p<0,05) der SFE auf die Somatosensibilität fest. Alle 3 Trainingsformen führten zu deutlichen, signifikanten (p<0,05) Verbesserungen funktioneller Aspekte.

Schlussfolgerung Es zeigen sich positive Effekte durch das Training der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität auf die subjektive Instabilität, Balance, Somatosensibilität sowie auf funktionelle Aspekte. Effektive Trainingsformen scheinen die SFE und ein Zehentraining zu sein, diese könnten eine sinnvolle Ergänzung zur konventionellen Therapie darstellen. Die Qualität der Evidenz ist jedoch zu gering, um eine klare Empfehlung aussprechen zu können.

Abstract

Background Ankle sprains are among the most common injuries in sports and can result in chronic ankle instability. In therapy and prevention, a sensorimotor training approach on the structures surrounding the ankle joint has proven to be effective. There is evidence that training the intrinsic foot muscles can also improve balance, for example.

Objective/Aim The aim of this narrative review is to present evidence regarding intrinsic foot muscles training in patients with ankle instability.

Methods In January 2022, a systematic literature search was conducted in the databases PubMed, Cochrane Library, EBSCOhost, PEDro, SPONET and BISp-Surf and was complemented by a freehand search. We searched for meta-analyses, systematic reviews and intervention studies that examined the effects of a form of intrinsic foot muscle training on patients with ankle instability. The qualitative evaluation of the literature and evidence was based on the risk-of-bias tool (RoB tool) of the Cochrane Handbook and the GRADE system.

Main Results Five randomised controlled trials involving 150 participants were included. Four trials used the Short-Foot Exercise (SFE), one trial used the Towel-Curl Exercise (TCE) and a toe-training program. The results of three studies showed a significant positive effect (p<0,05) on self-reported instability. Significant positive effects (p<0.05) on balance were shown for the SFE and the toe-training program, although the inclusion of the SFE in a training program did not result in any benefits. One study found significant positive effects (p<0.05) of the SFE on somatosensory function. All three forms of training led to significant (p<0.05) improvements in functional aspects.

Conclusion The results of this narrative review show positive effects of training the intrinsic foot muscles in patients with ankle instability on self-reported instability, balance, somatosensory function and on functional aspects. SFE and toe training seem to be effective forms of training and could be a useful addition to conventional therapy. However, the quality of evidence is too low and further research is needed to make a clear recommendation.

Schlüsselwörter

Sprunggelenk - Sprunggelenkinstabilität - Distorsionstrauma - Supinationstrauma - intrinsische Fußmuskulatur - Training

Keywords

ankle - ankle injuries - ankle instability - inversion injury - intrinsic foot muscles - exercise

Publication History

Received: 11 February 2022

Accepted after revision: 29 June 2022

Article published online:
29 November 2022

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