Educational Administration: Theory and Practice

2024, 30(5), 12064-12068

ISSN: 2148-2403
https://kuey.net/ Research Article

Effects Of Short Foot Exercises On Kinesiophobia In

Patients With Functional Ankle Instability Using CAIT
Reshma Kadam1*, Lt Dr. Prathamesh Nikam (PT) 2, Prathamesh Dabade(PT)3, Achintya P R(PT)4, Vikas
Raghunath(PT)5
1*BpthIntern, D Y Patil University, School Physiotherpy, Navi Mumbai. ([email protected])
2AssistantProfessor, Department Of Sports-Physiotherpy, D Y Patil University, School Physiotherpy, Navi
Mumbai. ([email protected])
3Masters Of Sports Physiotherpy, D Y Patil University, School Physiotherpy, Navi

Mumbai. ([email protected])
4Masters Of Sports Physiotherpy, D Y Patil University, School Physiotherpy, Navi

Mumbai. ([email protected])
5Masters Of Cardiorespiratory And Integumentary System, D Y Patil University, School Physiotherpy, Navi

Mumbai. ([email protected])

*Corresponding Author: Reshma Kadam

*Bpth Intern, D Y Patil University, School Physiotherpy, Navi Mumbai.([email protected])

Citation: Reshma Kadam et al. (2024), Effects Of Short Foot Exercises On Kinesiophobia In Patients With Functional Ankle Instability
Using Cait, Educational Administration: Theory and Practice, 30(5), 12064-12068
Doi: 10.53555/kuey.v30i5.5064

ARTICLE INFO ABSTRACT

Short-Foot Exercise (SFE) Is A Widely Used Balance Training Intervention That Has
Been Developed Recently To Improve Ankle Proprioception And To Strengthen The
Intrinsic Foot Muscles (IFM) To Elevate And Support The Medial Longitudinal Arch
(MLA) Of The Foot And Improve Dynamic Standing Balance SFE Is Performed By
Attempting To Pull The Head Of The First Metatarsal Toward The Calcaneus,
Without Curling The Toes. Kinesiophobia, Also Called “Fear Of Movement Or
Activity,” Is Defined As An Excessive Fear Of Physical Movement, Expecting Or
Feeling Of Vulnerability To Painful Injury. Functional Ankle Instability (FAI) Is A
Condition That Causes Mechanical Alterations To The Ankle Joint And Leads To
Disability. The Main Purpose Of The Study Was To Evaluate FAI (Functional Ankle
Instability) Using CAIT (Cumberland Ankle Instability Tool).It Is Also Proven That
Kinesiophobia Is Present In Patients With Functional Ankle Instability
Discriminative Validity Was Tested To Determine Whether The CAIT Could
Discriminate Between Subjects With And Without Functional Ankle Instability. The
Study Assessment Was Done To See The Effects Of Short Foot Exercises In
Kinesiophobia With Patients With Functional Ankle Instability. 20 Males And 20
Females Were Included In This Study Who Had Functional Ankle Instability. The 20
Male Subjects Were Divided In A Group Of Two As In One For The Experimental
Study And The Other For The Control Group Study Same Procedure Was Followed
For The Females And They Were Further Divided Into Groups. The P-Value Of TSK-
11 Pre Male Compared To Post Male It Is Statistically Significant. The P-Value Of
TSK-11 Pre Female Compared To Post Female Indicates That The Data Is Statistically
Significant. The P-Value Of CAIT Post Male And Female Compared To TSK-11 Post
Male And Female Suggests The Result Is Statistically Significant. The P-Value Of
CAIT Pre Male And Female Compared To TSK-11 Pre Male And Female Indicates
That The Data Is Statistically Significant. The P-Value Of CAIT Post Male And Female
Compared To TSK-11 Post Male And Female Indicates That The Data Is Statistically
Significant.

Keywords: Short Foot Exercises, Kinesiophobia, CAIT, Functional Ankle

Instability,

Copyright © 2024 by Author/s and Licensed by Kuey. This is an open access article distributed under the Creative Commons Attribution
License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
12065 Reshma Kadam et al. / Kuey, 30(5), 5064

1. Introduction

Short-Foot Exercise (SFE) Is A Widely Used Balance Training Intervention That Has Been Developed Recently
To Improve Ankle Proprioception And To Strengthen The Intrinsic Foot Muscles (IFM) To Elevate And
Support The Medial Longitudinal Arch (MLA) Of The Foot And Improve Dynamic Standing Balance SFE Is
Performed By Attempting To Pull The Head Of The First Metatarsal Toward The Calcaneus, Without Curling
The Toes. 1
The Feet Occupy Only 5% Of The Areas Of The Human Body, They Control Postures Through Afferent
Information Obtained Through The Sense Of The Soles, Provide Stability For Maintenance Of Balance, And
Absorb Impacts. The Deformation Into Flatfoot Is Induced When The Medial Longitudinal Arch (MLA) Has
Descended Because The Arch Had Been Excessively Relaxed To The Extent That The Arch Cannot Be
Maintained And Causes The Feet To Be Excessively Pronated Compared To Normal Feet So That Heel Eversion
Appears And The Weight Load Is Shifted Inward To Compress The ( MLA) 5
To Correct Flatfoot Issues, Short Foot Workouts And Arch Support Insoles Were Used, And It Was Evident
That As The Medial Longitudinal Arch Was Strengthened, So Too Was The Subject's Capacity For Dynamic
Balance. Additionally, It Was Evident That Sensory-Motor Training, Such As Quick Foot Exercises,
Outperformed Traditional Therapy Options Like Arch Support Insoles. Additionally, It Was Clear That
Employing Arch Support Insoles Would Not Be Enough To Improve The Medial Longitudinal Arch Throughout
The Six-Week Intervention Period. It Is Required To Conduct Thorough Comparison Studies Integrating
Sensory-Motor Foot Training, Arch Support Insoles, And Longer Intervention Periods. 5 Other Intervention
Techniques Include SFE, Which Uses Sensory-Motor Training To Amplify The Intrinsic And Extrinsic Foot
Muscles.
A Condition Known As Functional Ankle Instability (FAI) Affects The Ankle Joint Mechanically And Results
In Impairment. Understanding The Association Between Physical Causes And Fear Of Movement Is Essential
When Assessing And Treating People With FAI. The Current Study Sought To Determine If Kinesiophobia Can
Predict JPS And Postural Control In FAI Participants As Well As. 1 The Effect Of Kinesiophobia On Ankle Joint
Position Sense (JPS) And Postural Control. [ Kinesiophobia, Commonly Known As "Fear Of Movement Or
Activity," Is Described As An Excessive Fear Of Physical Movement, Anticipating, Or Feeling Vulnerable To
Unpleasant Damage]. When Rehabilitating Individuals With FAI, It Is Important To Take Into Account
Kinesiophobia Because It Can Greatly Affect Ankle JPS And Postural Control.
The Study's Primary Goal Was To Assess The Effects Of Short Foot Exercises On Kinesiophobia In Patients
With Functional Ankle Instability (FAI) Using The Cumberland Ankle Instability Test (CAIT). Functional
Ankle Instability Isn't Just Brought On By One Thing, Like Ligament Elasticity, Muscular Weakness,
Decreased Proprioception, Or Postural Control Issues. Ankle Instability, A Complex Neuromuscular Disease
That Commonly Occurs In People With Lateral Ankle Sprain, Affects A Substantial Percentage Of Patients.
Uncertainty Surrounds The Neuromuscular Mechanism Causing The Pathophysiology Of Ankle Instability. It
Is Probable That A Number Of Factors, Including Deficiencies In Open And Closed Loop Regulatory Systems,
Contribute To The Development Of Ankle Instability. Freeman First Identified Functional Instability In 1965,
Attributing Poor Balance In People With Lateral Ankle Sprains To Damaged Mechanoreceptors In The Lateral
Ankle Ligaments That Led To Proprioceptive Deficits.11
In Those With Chronic Pain, The Tampa Scale For Kinesiophobia (TSK) Has Proven To Be A Reliable Predictor
Of Physical Functioning And Disability. Both Exploratory Factor Analysis (EFA) And Confirmatory Factor
Analysis (CFA) Have Been Used To Analyze The TSK.12
Ankle Joint Functional Assessment Tool (AJFAT) And The Functional Ankle Instability Questionnaire
(FAIQ)8 Are Two Such Instruments. After A Simple Ankle Sprain, People Continue To Experience Discomfort
And Instability. Functional Ankle Instability, Mechanical Ankle Instability, And Recurring Sprains Are All
Examples Of Chronic Ankle Instability. Mechanical Ankle Instability Occurs When A Primary Mechanical
Restraint Is Lost. Ankle Joint Functional Assessment Tool (AJFAT) And The Functional Ankle Instability
Questionnaire (FAIQ)8 Are Two Such Instruments. Validity By Comparing A Scale To The Benchmark For The
Condition Being Investigated, Concurrent Validity Is Often Assessed. To See If The CAIT Could Distinguish
Between Participants With And Without Functional Ankle Instability, The Discriminative Validity Of The Test
Was Put To The Test. The Test-Retest Reliability Of The CAIT Was Assessed By Giving It To 18 People From
The General Population Twice, Two Weeks Apart.8

2. Methodology

We Designed An Intervention-Based Study Over A Period Of 6 Months Among Patients With Ankle Instability
.Demographic Questionnaire And Informed Consent Form Was Obtained From The Participants Before
Recruitment Of Patients To The Study.
The Study Recruited Patients With Ankle Instability With An Age Group Of Young Adults (19-29 Years) Both
Genders. Those Who Had A History Of Recurrent Ankle Sprains And Ankle Instability Were Included In The
Study.
The Patients With Neurological Conditions, Balance And Co-Ordination Issues, Lower Limb Surgery And
12066 Reshma Kadam et al. / Kuey, 30(5), 5064
Related Pathology, Associated Fractures In The Study Were Excluded. The Outcome Measures Assessed Were
Tampa Scale Of Kinesiophobia (TSK-11). The TSK Is One Of The Most Well-Known Instruments For Measuring
Fear Of Movement/ (Re)Injury. Cumberland Ankle Instability Tool (CAIT). The Cumberland Ankle Instability
Tool (CAIT) Is A 9-Item 30-Point Scale That Measures The Severity Of Functional Ankle Instability. Using A
Numeric Value, The CAIT Has The Ability To Discriminate Between Stable And Unstable Ankles. This Self-
Report Questionnaire Allows Patients To Rate Their Perceived Degree Of Difficulty In Performing Different
Physical Activities. The CAIT Is Filled Out For Both The Left And Right Ankle, Making It Possible To Assess
Both Ankles Individually.
Patients Were Evaluated For Kinesiophobia Using The TSK-11 Scale And CAIT Questionnaire For Ankle
Instability According To The Inclusion Criteria And Exclusion Criteria And Were Recruited For The Study. The
Male And Female Groups Were Further Divided Into Experimental And Control Groups.

3. Results

TABLE: 1The CAIT Scale Pre Male And Pre Female Compared To TSK-11 Scale Pre Male And Pre Female
CAIT AND MEAN STANDARD T- P-
TSK-11 DEVIATION VALUE VALUE

Pre Male 19.7 5.5 -4.8 <0.001

(Experimental
And Control)

Pre Female 26.0 4.7

(Experimental
And Control)

TABLE: 2The CAIT Scale Post Male And Post Female Compared To TSK-11 Scale Post Male And Post
Female.
CAIT AND MEAN STANDARD T- P-
TSK-11 DEVIATION VALUE VALUE

Pre Male 19.5 5.6 -2.0 0.05

(Experimental
And Control)

Pre Female 22.4 6.4

(Experimental
And Control)

According To Table 1 Shows The CAIT Scale Pre Male And Pre Female Comparison To TSK-11 Scale Pre Male
And Pre Female Which Gave A P-Value Of <0.001 Shows That It Is Statistically Significant, The Mean For Pre
Male (Experimental And Control Group) Was 19.7 And Pre Female (Experimental And Control Group) Was
26.0 Also The Standard Deviation Was 5.5 And 4.7 For The Following Groups And The T-Value Was -4.8
Tab 2 Shows That The CAIT Scale Post Male And Post Female Comparison To TSK-11 Scale Post Male And
Post Male Which Gave A P-Value Of 0.05 Shows That It Is Statistically Significant, The Mean For Post Male
(Experimental And Control Group) Was 19.5 And Post Female (Experimental And Control Group) Was 22.4
Also The Standard Deviation Was 5.6 And 6.4 For The Following Groups And The T-Value Was -2.0

4. Discussion

The Ankle Joint Is A Congruent Synovial Joint With A Single Oblique Axis That Transfers Weight To The
Proximal Joints And Allows Smooth Movements During Functional Activities.2 A Common Injury That May
Be Assessed Using Proms Is Ankle Sprains, Which Are The Most Common Sports Injury. Up To 30 % Of People
Who Suffer From An Initial Ankle Sprain Experience Persisting Symptoms, Which Can Progress To Chronic
Ankle Instability (CAI).3 Ankle Sprains Are A Common Injury Among Physically Active Populations That Can
Cause Lasting Damage To The Lateral Ligaments And In Some Cases Chronic Functional Instability. In The
United States, Ankle Sprains Occur With An Incidence Of Around 2.15 Per 1000 Person-Years.4 It Has Been
Shown That Ankle Sprains Can Lead To Chronic Ankle Instability Thereby Affecting The Function Of The
Ankle.7
Ankle Instability Is A Complex Neuromuscular Disorder, Which Affects A Large Percentage Of Individuals
Who Have Lateral Ankle Sprain. The Neuromuscular Mechanism Behind The Pathology Of Ankle Instability
Remains Unclear. 11 Chronic Ankle Instability Describes A Combination Of Mechanical And Functional
Instability With Residual Ankle-Sprain Symptoms2,3: Pain, Swelling, Weakness, Instability, And Repeated
Episodes Of ‘‘Giving Way”.8 Functional Ankle Instability (FAI) Is A Condition That Causes Mechanical
Alterations To The Ankle Joint And Leads To Disability.2 Up To 70% People Have Persisting Symptoms Of
12067 Reshma Kadam et al. / Kuey, 30(5), 5064

Pain And Instability After A Simple Ankle Sprain.1-3 Chronic Ankle Instability, Among The Most Common
Symptoms, Is Debilitating And Can Lead To A Wide Spectrum Of Disability.
Chronic Ankle Instability Can Include Recurrent Sprain, Mechanical Instability In Which A Primary
Mechanical Restraint Is Lost, And Functional Ankle Instability.9 Functional Ankle Instability Is Not Merely A
Result Of A Single Factor Such As Ligament Laxity, Muscle Weakness, Diminished Proprioception, Or Postural
Control Deficits. Rather, CAI Has Been Found To Be Associated With All These Factors, As Well As Altered
Arthrokinematics And Joint Structure At The Talocrural Joint.11
Kinesiophobia, Also Called “Fear Of Movement Or Activity,” Is Defined As An Excessive Fear Of Physical
Movement, Expecting, Or Feeling Of Vulnerability To Painful Injury.2 Fear Of Movement Can Significantly
Influence Physical Factors, And Understanding Their Relationship Is Crucial In Assessing And Managing
Individuals With FAI.2 It May Well Appear As A Fear Of Physiological Symptoms Of Fatigue Or Exhaustion
Or, Even More Comprehensively, Fear Of Physical Or Mental Discomfort Psychotherapeutic Intervention.10
Taking Into Consideration All Remarks Mentioned Above, A New Diagnostic Tool Was Developed And Is
Proposed In This Article, Named Kinesiophobia Causes Scale (KCS). It Is Devised For An Adult Population
And Aims To Diagnose Original Causes Of Motor Passivity. Such A Construct Allows To Diagnose Individual
Causes Of Kinesiophobia And Their Intensity In The Two Domains Separately, As Well As To Calculate The
Total Score Of KCS.10 The Fear Avoidance Model Has Contributed Greatly To Our Understanding Of The Role
Of Pain-Related Fear In Chronic Pain And Pain-Related Disability. Within This Conceptual Framework, Fear
Of Movement/ (Re)Injury, As Measured By The Tampa Scale For Kinesiophobia (TSK) Has Been A Robust
Predictor Of Physical Functioning And Disability In Individuals With Chronic Pain.12 TSK Have Been
Investigated Using Both Exploratory Factor Analysis (EFA) And Confirmatory Factor Analysis (CFA). 12
Hiller Et Al. Designed The Cumberland Ankle Instability Tool (CAIT). It Was Originally Developed In English
And Proved To Be Of High Content Validity And Good Reliability. The Main Advantage Of The Questionnaire
Is That It Consists Of Only 9 Items, Minimizing Patient Burden And Increasing Reliability. The Precision Of
The Instrument Is Increased As It Is A Multiple Answer Option Instrument. The CAIT Is Filled Out For Both
The Left And Right Ankle, Making It Possible To Assess Both Ankles Individually.3
Short-Foot Exercise (SFE) Is A Widely Used Balance Training Intervention That Has Been Developed Recently
To Improve Ankle Proprioception And To Strengthen The Intrinsic Foot Muscles (IFM) To Elevate And
Support The Medial Longitudinal Arch (MLA) Of The Foot And Improve Dynamic Standing Balance.1 SFE Is
Performed By Attempting To Pull The Head Of The First Metatarsal Toward The Calcaneus, Without Curling
The Toes.1 The Short Foot Exercises Training Significantly Improves Proprioception And Dynamic Balance In
Patients With CAI Who Have Experienced Recurrent Ankle Sprains, And It Was More Effective Than PSE
Training. Inclusion Of Sfes Could Accelerate Recovery From Ankle Sprains And Prevent The Development Of
CAI, As Well As Facilitating A Faster Return To Activities Of Everyday Life And Sports.1
The Study Assessment Was Done To See The Effects Of Short Foot Exercises In Kinesiophobia With Patients
With Functional Ankle Instability. 20 Males And 20 Females Were Included In This Study Who Had
Functional Ankle Instability. The 20 Male Subjects Were Divided In A Group Of Two As In One For The
Experimental Study And The Other For The Control Group Study Same Procedure Was Followed For The
Females And They Were Further Divided Into Groups. The Age Group Included In The Study Was 19 To 29
Years. The Mean Age For Females Were 22.9 And For Males Were 24. The Comparison Between The Two Sex
Groups Male And Female In Experimental Group Was Highly Significant. The BMI Classification Had Patients
With Different Weight Categories As Well. In This Study The Functional Ankle Instability Was Mostly Seen On
Left Side As Compared To The Right Side.
The Results Of CAIT Scale Post Compared To TSK-11 Scale Post The Results Are Statistically Significant. Thus,
Docherty And Arnold Argued That Proprioceptive Sensory Training Should Be Considered As An Essential
Component Of The Rehabilitation Of Patients Following An Ankle Injury. Zang Et Al. Argued That Deficits In
Ankle Proprioception Could Impair The Functional Stability Of The Ankle Joint, As Well As Playing A Role In
Impairment Of The Somatosensory Control Of Balance. For These Reasons, We Sought To Evaluate The
Relative Efficacy Of SFE And PSE In Improving The Sensory Function Of The Ankle In Patients With CAI.1 In
The Present Study Patients With Functional Ankle Instability Were Evaluated With The Help Of CAIT AND
TSK-11for Kinesiophobia. When CAIT Pre Male Was Compared To Post Male It Indicated It Is Statistically Not
Significant (P=0.8). The Results Of CAIT Pre Female Compared To Post Female It Indicated It Is Statistically
Not Significant (P=0.8). When TSK-11 Pre Male Was Compared To Post Male It Is Statistically Significant
(P=<0.001). When TSK-11 Pre Female Compared To Post Female It Indicates It Is Statistically Significant
(P=0.05). When CAIT Post Male And Female Compared To TSK-11 Post Male And Female Suggests The Result
Is Statistically Significant (P=0.05). The Patients With FAI Had Kinesiophobhia And Inculcating One Of The
Treatments Such As Short Foot Exercises To Treat Functional Ankle Instability Does Increase Stability And
Reduces Instability And Reduces Effects Of Kinesiophobia.

5. Conclusion

It Can Be Concluded From This Study That Kinesiophobia Is Present In People Having Functional Ankle
Instability, It Is One Of The Cardinal And Residual Symptoms Present In People Having Functional Ankle
12068 Reshma Kadam et al. / Kuey, 30(5), 5064
Instability. Inculcating Short Foot Exercises As One Of The Treatments To Treat Functional Ankle Instability
Can Gradually Reduce Functional Ankle Instability And Have A Better Impact On Effects Of Kinesiophobia.
Short Foot Exercises Can Reduce Kinesiophobia And It Is Effective For Managing Functional Ankle Instability.

6. Acknowledgement

I Take This Opportunity To Thank All The Hands That Have Joined Together To Make This Thesis A Success.
It Is A Great Pleasure And Privilege To Express Deep-Felt Gratitude To My Guide Lt. Dr. Prathamesh Nikam
(PT) Who Rendered His Knowledge To Enlighten Me On This Subject. He Provided Constant Encouragement
And Support To Accomplish This Thesis Project. I Also Thank The Ethical Committee For Providing The
Approval To Execute This Study. Also, I Would Like To Thank All The Department Staff For The Help They
Rendered During The Data Collection Phase.
Financial Support And Sponsorship
Not Applicable.

Conflicts Of Interest
There Are No Conflicts Of Interest So Far.

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