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Randomized Controlled Trial
. 2025 Aug 21;22(1):182.
doi: 10.1186/s12984-025-01721-w.

Individualized transcranial direct current stimulation combined with foot core exercise improves foot and ankle sensorimotor function and static postural control in individuals with chronic ankle instability

Chuyi Zhang  1 , Songlin Xiao  2 , Bin Shen  1 , Zhen Xu  1 , Jianglong Zhan  1 , Jingjing Li  1 , Junhong Zhou  3   4 , Weijie Fu  5
Affiliations
Randomized Controlled Trial

Individualized transcranial direct current stimulation combined with foot core exercise improves foot and ankle sensorimotor function and static postural control in individuals with chronic ankle instability

Chuyi Zhang et al. J Neuroeng Rehabil. .

Abstract

Objective: This study aimed to investigate the effects of four-week individualized transcranial direct current stimulation (tDCS) combined with foot core exercise (FCE) on foot and ankle sensorimotor function and postural control in individuals with chronic ankle instability (CAI).

Methods: Thirty-four CAI individuals were randomly assigned to a tDCS combined with FCE group (tDCS group, n = 17) and a sham stimulation combined with FCE group (control group, n = 17). All participants received individualized stimulation combined with FCE and sham stimulation combined with FCE, respectively, three times a week for 20 min per session over four weeks. Ankle strength, joint position sense, and static and dynamic postural control were assessed at baseline and post-intervention.

Results: Compared with the control group and baseline, individualized tDCS combined with FCE significantly increased the relative peak torque of plantarflexion, reduced the absolute error of ankle eversion position sense, and decreased the average sway velocity of the center of pressure during single-leg standing with eyes closed in CAI individuals (p values ranging from < 0.001 to 0.016).

Conclusion: Four weeks of individualized tDCS combined with FCE can effectively improve foot and ankle sensorimotor function and static postural control in CAI individuals.

Keywords: Ankle strength; Chronic ankle instability; Foot core exercise; Individualized transcranial direct current stimulation; Joint position sense; Postural control.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Shanghai University of Sport (No. 102772022RT049). All participants provided written informed consent prior to participation. Consent for publication: All participants in this study received instructions about the experimental procedures and content and provided written informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consolidated standards of reporting trials flow diagram
Fig. 2
Fig. 2
Electric field modeling pipeline. First, T1 structure images are acquired by structural MRI scanning. Second, different types of tissue are segmented for the T1 structural images. Third, the tissue segmentations are combined into tetrahedral head meshes to create an individualized head model. Fourth, electrode models are created, and the simulated stimulation parameters and standard conductivity values are set. Lastly, electric field simulation is performed and analyzed
Fig. 3
Fig. 3
Actual electric field intensity and individualized current dose for participants in the tDCS group (green) and the control group (blue). A Actual electric field intensity generated in the target region when applying 2 mA current for each individual; B Individualized current dose
Fig. 4
Fig. 4
Foot core exercise. A Inversion with resistance band; B Eversion with resistance band; C Short foot exercise; D Heel raising with ankle inversion; E Heel raising with ankle eversion; F Balance training
Fig. 5
Fig. 5
Effect of individualized tDCS combined with FCE on plantarflexion strength, eversion position sense and average sway velocity of CoP in single-leg standing with eyes closed. tDCS, transcranial direct current stimulation; FCE, foot core exercise; RPT, relative peak torque; CoP, center of pressure; SL_EC, single-leg standing with eyes closed. Different lowercase letters (i.e., a and b) denote significant differences determined by post-hoc comparisons following ANCOVA (p < 0.05)
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