From the Guidelines
Chronic ankle sprain risk factors include a history of previous ankle injuries, incomplete rehabilitation, ligament laxity, muscle weakness, poor balance and proprioception, and participation in high-risk activities, as identified in recent studies 1. The most significant risk factors for chronic ankle sprain can be categorized into several key areas:
- History of previous ankle injuries and incomplete rehabilitation after initial sprains
- Ligament laxity and muscle weakness, particularly in the peroneal muscles
- Poor balance and proprioception
- Anatomical abnormalities such as hindfoot varus or forefoot valgus
- Participation in high-risk activities like basketball, soccer, or volleyball
- Being overweight or obese, which increases stress on the ankle joint
- Wearing inappropriate footwear without proper support, contributing to instability
- Hypermobility syndromes, which increase risk due to inherently loose ligaments
- Training errors, such as sudden increases in activity intensity or duration, which can overload the ankle structures
- Poor neuromuscular control and coordination deficits, affecting the ability to stabilize the ankle during movement
- Environmental factors like uneven surfaces or poor field conditions, which also increase risk, as noted in studies 1. Understanding these factors is crucial because chronic ankle instability develops when the initial injury is followed by repeated sprains, creating a cycle of instability that weakens the supporting structures and proprioceptive mechanisms around the ankle joint, as discussed in 1. Recent evidence-based clinical guidelines recommend addressing these risk factors early in the treatment process to prevent future injury recurrence 1. Exercise therapy, including coordination and balance training, has been shown to prevent recurrent ankle sprains, with a positive effect towards prevention of lateral ankle sprains, as demonstrated in studies 1.
From the Research
Risk Factors for Chronic Ankle Sprain
The risk factors for chronic ankle sprain can be identified through various studies, including:
- History of acute ankle sprain: Approximately 20% of acute ankle sprain patients develop chronic ankle instability 2.
- Failure of functional rehabilitation: Inadequate rehabilitation after an acute ankle sprain can lead to chronic ankle instability 2.
- Residual symptoms: Pain, episodes of giving way, compromised proprioception, and neuromuscular control can contribute to chronic ankle instability 3.
- Proprioception and balance deficits: Deficits in foot proprioception, static and dynamic balance can predispose individuals to recurrent injury and instability 3.
- Anatomical and functional insufficiencies: Understanding the normal clinical course and risk factors is essential for devising a comprehensive rehabilitation program to improve functional performance and prevent recurrent sprains 3.
Contributing Factors
Other contributing factors to chronic ankle sprain include:
- Lateral ankle sprains: Up to 40% of individuals who experience a first-time lateral ankle sprain may develop chronic ankle instability 4.
- Primary injury to the lateral ankle ligaments: This can lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence clinical outcome 4.
- Age and activity level: Ankle sprains can occur in people of all ages, with four in every 10 first-time ankle sprains occurring during sports activities 5.
Prevention and Management
Prevention and management strategies for chronic ankle sprain include:
- Proprioceptive training: This has been shown to be effective in reducing the incidence and recurrence rates of ankle sprains in sporting populations 6.
- Comprehensive rehabilitation programs: These should focus on mechanical and functional insufficiencies to improve functional performance and prevent recurrent sprains 3.
- Updated clinical practice guidelines: These provide guidance on diagnosing, managing, and preventing acute ankle sprains and chronic ankle instability 5.