Effects of gait training with auditory biofeedback on biomechanics and talar cartilage characteristics in individuals with chronic ankle instability: A randomized controlled trial

Background: Altered walking gait is a typical impairment following ankle sprains which may increase susceptibility to recurring injuries and development of posttraumatic osteoarthritis at the ankle. There is a lack of targeted gait training interventions focusing on specific modifications in individuals with chronic ankle instability (CAI). Additionally, there is a need to focus on cartilage health changes following gait training to mitigate osteoarthritis progression. Research question: To determine the immediate and retention effects of gait training using auditory biofeedback (AudFB) in patients with chronic ankle instability (CAI) on biomechanics and talar cartilage characteristics. Methods: Eighteen participants with CAI were randomly assigned into Control (n = 7) or AudFB (n = 11) groups. Each group completed 8-sessions of 30-minute treadmill walking. The AudFB group received biofeedback through a pressure sensor fashioned to the lateral foot and instructions to walk while avoiding noise from the sensor. The Control group did not receive instructions during sessions. An in-shoe insole system measured peak pressure, maximum force, and center of the pressure gait line (COP) during walking. Ultrasonography captured talar cartilage thickness and echo intensity before and after walking. Biomechanics and ultrasound were measured at baseline, immediately, and 1-week after the intervention. Repeated measures mixed-methods analysis of variance assessed changes within groups across time. Results: The AudFB group significantly reduced pressure and force in the lateral foot and medially shifted their COP at Immediate and 1-week Post. There were no observed changes in the Control group. In addition, neither group demonstrated changes in ultrasound measures at follow-up. Significance: Implementation of auditory biofeedback during gait training can be a valuable tool for clinicians treating patients with CAI.