A Prospective Study of Ankle Injury Risk Factors

Abstract

Many factors are thought to cause ankle ligament injuries. The purpose of this study was to examine injury risk factors prospectively and determine if an abnormality in any one or a combination of factors identifies an individual, or an ankle, at risk for subsequent inversion ankle injury. We examined 145 college-aged athletes before the athletic season and measured generalized joint laxity, anatomic foot and ankle alignment, ankle ligament stability, and isokinetic strength. These athletes were monitored throughout the season. Fifteen athletes incurred inversion ankle injuries. Statistical analyses were performed using both within-group (uninjured versus injured groups) data and within-subject (injured versus uninjured ankles) data. No significant differences were found between the injured (N = 15) and uninjured (N = 130) groups in any of the parameters measured. However, the eversion-to-inversion strength ratio was significantly greater for the injured group compared with the uninjured group. Analysis of the within-subject data demonstrated that plantar flexion strength and the ratio of dorsiflexion to plantar flexion strength was significantly different for the injured ankle compared with the contralateral uninjured ankle. Individuals with a muscle strength imbalance as measured by an elevated eversion-to-inversion ratio exhibited a higher incidence of inversion ankle sprains. Ankles with greater plantar flexion strength and a smaller dorsiflexion-to-plantar flexion ratio also had a higher incidence of inversion ankle sprains.

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

“…Concentric and eccentric strength deficits for the ankle evertors, invertors, and plantar flexors have been reported in the literature, both after acute injury and in patients with CAI, reinforcing the need to strengthen all muscles around the ankle after injury. [114][115][116][117][118][119] Muscle inhibition may also occur from joint and ligamentous trauma and effusion after a lateral ankle sprain. 118,120,121 The peroneal muscles may be injured with an inversion sprain, resulting in decreased motor recruitment initially after injury and leading to secondary loss of eversion strength.…”

Correlation between Mechanical Properties of the Ankle Muscles and Postural Sway during the Menstrual Cycle

“…The ankle plays a major role in posture and locomotion (Baumhauer et al 1995;Vieira et al 2013;Cattagni et al 2014;Duclos et al 2014;Pozzi et al 2015). Small changes in the center of gravity are corrected by the position of the knee, hip and ankle to maintain the center of gravity in the basal plane (Page et al 2010).…”

Isokinetic strength of fully operational U.S. Navy Seals with a previous history of shoulder and knee injury

“…This would indicate that the current group of subjects is also highly trained. Injuries to the knee and shoulder can compromise functional joint stability characteristics such as strength and can delay a return to sport and can result in subsequent or recurrent injury [25][26][27][28][29][30]. Forty-six individuals in the current study had a medical chart documented history of unilateral knee injury.…”

“…Strength, as measured by force production capability, is one of the most observable effects of injury and is justifiably targeted as part of rehabilitation prior to return to sport or return to duty [23]. Strength is essential to efficient and effective functional joint stability [24] with deficits influencing future injury [25][26][27][28][29][30]. Sapega suggested that bilateral strength deficits greater than 10% were possibly abnormal but strength deficits greater than 20% were almost certainly abnormal [31].…”