From the Guidelines
Risk factors for chronic ankle sprain include a history of previous ankle injuries, inadequate rehabilitation, anatomical factors, muscle weakness, poor proprioception, and participation in high-risk sports, as identified in the most recent and highest quality study 1. These factors contribute to the development of chronic ankle instability (CAI) by compromising the ankle's dynamic stabilization and increasing the risk of recurrent sprains.
Key Risk Factors
- History of previous ankle injuries, which can lead to residual ligament laxity and proprioceptive deficits 1
- Inadequate rehabilitation following an initial sprain, resulting in incomplete healing and failure to restore strength and balance 1
- Anatomical factors, such as hindfoot varus, forefoot varus, or cavus foot structure, which create biomechanical disadvantages and place additional stress on the lateral ankle ligaments 1
- Muscle weakness, particularly in the peroneal muscles, which compromises dynamic stabilization 1
- Poor proprioception and balance deficits, which impair the body's ability to detect and correct ankle positioning during movement 1
- Participation in high-risk sports, such as basketball, volleyball, and soccer, which increases exposure to injury mechanisms 1
- Body weight and height, which can contribute to increased forces on the ankle joint during activity 1
- Wearing inappropriate footwear without proper ankle support, especially during athletic activities, which fails to provide necessary external stabilization 1
- Generalized ligamentous laxity or hypermobility syndromes, which predispose individuals to joint instability throughout the body, including the ankles 1
Prevention and Treatment
Exercise regimens and external ankle supports can help prevent ankle sprains, with a 47% relative reduction in ankle sprains in persons who use an external ankle support and participate in high-risk sporting activities 1. Coordination and balance training have also been shown to prevent recurrent ankle sprains 1. Supervised exercise-based programs are preferred over passive modalities, as they stimulate the recovery of functional joint stability 1. Ankle braces should be considered as an efficacious option for the prevention of recurrent lateral ankle sprains 1. Early attention to the patient's current level of pain, workload, and level of sports participation is crucial in addressing these factors and preventing future injury recurrence 1.
From the Research
Risk Factors for Chronic Ankle Sprain
The risk factors for chronic ankle sprain can be understood by examining the causes and characteristics of chronic ankle instability (CAI). Some key points to consider include:
- History of acute ankle sprain: Individuals who have experienced an acute ankle sprain are at risk of developing CAI, with up to 40% of individuals who experience a first-time lateral ankle sprain developing CAI 2.
- Recurrent ankle sprains: Athletes who have experienced multiple ankle sprains are more likely to develop CAI, with recurrent sprains leading to chronic symptoms such as pain, swelling, and limited motion 3.
- Functional and anatomical instability: Differentiation between functional and anatomical ankle instability is essential to guide proper treatment, with subtalar instability being an important pathology that is commonly overlooked 4.
- Neuromuscular control dysfunction: CAI has been associated with neuromuscular control dysfunction, particularly of the peroneal musculature, with individuals with CAI showing specific sensorimotor impairments in evertor force sense accuracy and peroneus longus latency 5.
- Proprioception and balance deficits: Athletes with chronic ankle sprain have been shown to have deficits in foot proprioception, static and dynamic balance, which can predispose to recurrent injury and instability 3.
Key Characteristics of Chronic Ankle Instability
Some key characteristics of CAI include:
- Persistent symptoms: CAI is characterized by persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function 2.
- Recurrent ankle sprains: Individuals with CAI are more likely to experience recurrent ankle sprains, with frequent episodes or perceptions of the ankle giving way 2.
- Functional limitations: CAI can lead to functional limitations, with individuals experiencing difficulties with tasks such as walking or playing sports 6.
- Neuromuscular dysfunction: CAI has been associated with neuromuscular dysfunction, particularly of the peroneal musculature, which can contribute to the development and maintenance of CAI 5.