踝關節扭傷，是一種常見的運動傷害，其中嚴重的足踝扭傷，常因而形成慢性踝關節不穩定，若傷及韌帶軟組織，就更容易導致功能性踝關節不穩定以及機械性踝關節不穩定的形成。其中，由脛骨、腓骨與距骨所構成之踝關節，主要動作為背屈(dosiflexion)及蹠屈(plantarflexion)，而距骨與跟骨之間的距骨關節(subtalar joint)，主要動作為外翻(eversion)與內翻(inversion)動作。舞者經常需要做大角度踝關節蹠屈時，較容易發生踝關節內翻扭傷。然而，至今仍缺乏利用逆向工程(reverse engineering)來探討長期進行大角度的背屈及蹠屈之舞者，於足踝部之骨頭間的相對關係，是否存在著對位上的改變因素，也並沒有人去探討關於腳踝扭傷以及慢性踝關節不穩定之芭蕾舞患者，小腿遠端的肌肉與肌腱的肌肉肌腱截面積。
本研究目的，希望透過影像與幾何方法學，對於接受長時間訓練之腳踝扭傷年輕女性芭蕾舞者，在正中與蹠屈時，進行足踝部骨頭排序關係及結構分析。並且於軟組織部分，針對小腿遠端肌肉肌腱截面積做分析。分析數據用以探討這些幾何參數於腳踝扭傷以及慣用及非慣用腳間之變化。研究結果顯示，踝關節不穩定之芭蕾舞者，其腓骨在前後平移方向上，相較於健康人是較為往後平移的，其餘骨頭在排序與結構分析，是與健康人相同的。本研究的主要結論為，根據結果比較，先天上的慣用側與非慣用側因素，相較於踝關節不穩定因素，造成的影響還要來的大。

Ankle sprain is a common sports injury. Repeated lateral ankle sprain may lead to chronic ankle instability (CAI). If the ligament and soft tissue are injuried, functional ankle instability and mechanical ankle instability may occur. The ankle, being consist of the tibia, fibula, talus and calcaneus, mainly performed dorsiflexion and plantarflexion; while the subtalar joint, contribute mostly to eversion and inversion. Because of the shape of the talus, its anterior part is narrower and the posterior is wider so that a large amount of plantarflexion with inversion often cause ankle sprain. However, until now evidence using reverse engineering to investigate whether the alignement and structural among the bones in the foot and ankle would be altered in both neutral and plantarflexion of sound and affected limbs in dancers with ankle sprain or CAI remain unclear. In addition, cross section area (CSA) in the distal leg muscles and tendons in patients with ankle sprain or CAI remain unexplored.
The purpose of this study was to perform the foot-ankle bones alignment and structure analysis of affected and un-affected limbs in young female ballet dancer with CAI during neutral and plantarflexion. The issue of limb dominance was also taken into consideration. For the possible changes of soft tissue morphology, CSA of distal leg muscle and tendon were also obtained. The results of current study indicated that the bone in ballet dancer with chronic ankle instability, compared with healthy groups, fibula was positioned more posterior in translation, but other bones alignment and structural analysis was similar to those in healthy group. In conclusion, the factor of dominant and non-dominant limbs was greater than that of ankle instability

Bozkurt, M., N. Apaydin, E. Tonuk, C. Isik, N. Cay, G. Kartal, H. I. Acar and S. R. Tubbs (2014). "Impact of fibular torsion and rotation on chronic ankle instability." Foot Ankle Surg 20(2): 125-129.
[2] Caputo, A. M., J. Y. Lee, C. E. Spritzer, M. E. Easley, J. K. DeOrio, J. A. Nunley, 2nd and L. E. DeFrate (2009). "In vivo kinematics of the tibiotalar joint after lateral ankle instability." Am J Sports Med 37(11): 2241-2248.
[3] Ebraheim, N. A., J. Lu, H. Yang and J. Rollins (1998). "The fibular incisure of the tibia on CT scan: a cadaver study." Foot Ankle Int 19(5): 318-321.
[4] Eren, O. T., M. Kucukkaya, Y. Kabukcuoglu and U. Kuzgun (2003). "The role of a posteriorly positioned fibula in ankle sprain." Am J Sports Med 31(6): 995-998.
[5] Fleiss, J. (1986). The Design and Analysis of Clinical Experiments, Taylor & Francis.
[6] Fong, D. T., Y. Hong, L. K. Chan, P. S. Yung and K. M. Chan (2007). "A systematic review on ankle injury and ankle sprain in sports." Sports Med 37(1): 73-94.
[7] Forbes, S. C., D. J. Lott, R. S. Finkel, C. Senesac, B. J. Byrne, H. L. Sweeney, G. A. Walter and K. Vandenborne (2012). "MRI/MRS evaluation of a female carrier of Duchenne muscular dystrophy." Neuromuscul Disord 22 Suppl 2: S111-121.
[8] Freeman, M. (1965). "Instability of the foot affer injuries to the lateral ligament of the ankle." Journal of Bone & Joint Surgery, British Volume 47(4): 669-677.
[9] Gerber, J. P., G. N. Williams, C. R. Scoville, R. A. Arciero and D. C. Taylor (1998). "Persistent disability associated with ankle sprains: a prospective examination of an athletic population." Foot Ankle Int 19(10): 653-660.
[10] Hiller, C. E., K. M. Refshauge, R. D. Herbert and S. L. Kilbreath (2008). "Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study." Clin J Sport Med 18(1): 44-48.
[11] Hopkinson, W. J., P. St Pierre, J. B. Ryan and J. H. Wheeler (1990). "Syndesmosis sprains of the ankle." Foot Ankle 10(6): 325-330.
[12] Hubbard, T. J. and J. Hertel (2008). "Anterior positional fault of the fibula after sub-acute lateral ankle sprains." Man Ther 13(1): 63-67.
[13] Hubbard, T. J., J. Hertel and P. Sherbondy (2006). "Fibular position in individuals with self-reported chronic ankle instability." J Orthop Sports Phys Ther 36(1): 3-9.
[14] Kobayashi, T., Y. No, K. Yoneta, M. Sadakiyo and K. Gamada (2013). "In vivo kinematics of the talocrural and subtalar joints with functional ankle instability during weight-bearing ankle internal rotation: a pilot study." Foot Ankle Spec 6(3): 178-184.
[15] Kobayashi, T., M. Saka, E. Suzuki, N. Yamazaki, M. Suzukawa, A. Akaike, K. Shimizu and K. Gamada (2014). "In vivo kinematics of the talocrural and subtalar joints during weightbearing ankle rotation in chronic ankle instability." Foot Ankle Spec 7(1): 13-19.
[16] Kobayashi, T., E. Suzuki, N. Yamazaki, M. Suzukawa, A. Akaike, K. Shimizu and K. Gamada (2014). "Fibular malalignment in individuals with chronic ankle instability." J Orthop Sports Phys Ther 44(11): 872-878.
[17] Mavi, A., H. Yildirim, H. Gunes, T. Pestamalci and E. Gumusburun (2002). "The fibular incisura of the tibia with recurrent sprained ankle on magnetic resonance imaging." Saudi Med J 23(7): 845-849.
[18] McKay, G. D., P. Goldie, W. R. Payne and B. Oakes (2001). "Ankle injuries in basketball: injury rate and risk factors." British Journal of Sports Medicine 35(2): 103-108.
[19] Monforte, M., E. Mercuri, F. Laschena, E. Ricci and G. Tasca (2014). "Calf muscle involvement in Becker muscular dystrophy: When size does not matter." Journal of the neurological sciences 347(1): 301-304.
[20] Nielsen, A. B. and J. Yde (1989). "Epidemiology and traumatology of injuries in soccer." Am J Sports Med 17(6): 803-807.
[21] Procter, P. and J. P. Paul (1982). "Ankle joint biomechanics." J Biomech 15(9): 627-634.
[22] Sattler, M., T. Dannhauer, S. Ring-Dimitriou, A. Sänger, W. Wirth, M. Hudelmaier and F. Eckstein (2014). "Relative distribution of quadriceps head anatomical cross-sectional areas and volumes—Sensitivity to pain and to training intervention." Annals of Anatomy-Anatomischer Anzeiger 196(6): 464-470.
[23] Scranton, P. E., J. E. McDermott and J. V. Rogers (2000). "The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs." Foot & Ankle International 21(8): 657-664.
[24] Snyder, A. R., J. T. Parsons, T. C. Valovich, R. C. Bay, L. A. Michener and E. L. Sauers (2008). "Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part I: Disablement models." Journal of Athletic Training 43(4): 428-436.
[25] Wokke, B. H., J. C. van den Bergen, M. J. Versluis, E. H. Niks, J. Milles, A. G. Webb, E. W. van Zwet, A. Aartsma-Rus, J. J. Verschuuren and H. E. Kan (2014). "Quantitative MRI and strength measurements in the assessment of muscle quality in Duchenne muscular dystrophy." Neuromuscul Disord 24(5): 409-416.
[26] Yamaguchi, S., T. Sasho, H. Kato, Y. Kuroyanagi and S. A. Banks (2009). "Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities." Foot Ankle Int 30(4): 361-366.
[27] Yeung, M. S., K. M. Chan, C. H. So and W. Y. Yuan (1994). "An epidemiological survey on ankle sprain." Br J Sports Med 28(2): 112-116.