Top

Journal of Foot and Ankle Research

Published in:

01-12-2021 | Review

The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

Authors: Chiao-I Lin, Sanne Houtenbos, Yu-Hsien Lu, Frank Mayer, Pia-Maria Wippert

Published in: Journal of Foot and Ankle Research | Issue 1/2021

Abstract

Background

Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.

Methods

An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.

Results

After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.

Conclusions

The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.

Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association Sports. Am J Sports Med. 2016;45(1):201–9. https://doi.org/10.1177/0363546516660980.CrossRefPubMed

Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40. https://doi.org/10.1007/s40279-013-0102-5.CrossRefPubMed

Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. Evidence review for the 2016 international ankle consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–505. https://doi.org/10.1136/bjsports-2016-096189.CrossRefPubMed

Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and cost of ankle sprains in United States emergency departments. Sports Health. 2016;8(6):547–52. https://doi.org/10.1177/1941738116659639.CrossRefPubMedPubMedCentral

Whalan M, Lovell R, McCunn R, Sampson JA. The incidence and burden of time loss injury in Australian men’s sub-elite football (soccer): a single season prospective cohort study. J Sci Med Sport. 2019;22(1):42–7. https://doi.org/10.1016/j.jsams.2018.05.024.CrossRefPubMed

Knowles SB, Marshall SW, Miller T, Spicer R, Bowling JM, Loomis D, et al. Cost of injuries from a prospective cohort study of North Carolina high school athletes. Inj Prev. 2007;13(6):416–21. https://doi.org/10.1136/ip.2006.014720.CrossRefPubMedPubMedCentral

Owoeye OBA, Palacios-Derflingher LM, Emery CA. Prevention of ankle sprain injuries in youth soccer and basketball: effectiveness of a neuromuscular training program and examining risk factors. Clin J Sport Med. 2018;28(4):325–31. https://doi.org/10.1097/Jsm.0000000000000462.CrossRefPubMed

Attenborough AS, Hiller CE, Smith RM, Stuelcken M, Greene A, Sinclair PJ. Chronic ankle instability in sporting populations. Sports Med. 2014;44(11):1545–56. https://doi.org/10.1007/s40279-014-0218-2.CrossRefPubMed

Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):e14; discussion e. https://doi.org/10.1136/bjsm.2004.011676.CrossRefPubMedPubMedCentral

10.

Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty C, Fourchet F, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48(13). https://doi.org/10.1136/bjsports-2013-093175.

11.

Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54(6):572–88. https://doi.org/10.4085/1062-6050-344-18.CrossRefPubMedPubMedCentral

12.

Wikstrom EA, Song K, Tennant JN, Dederer KM, Paranjape C, Pietrosimone B. T1ρ MRI of the talar articular cartilage is increased in those with chronic ankle instability. Osteoarthr Cartil. 2019;27(4):646–9. https://doi.org/10.1016/j.joca.2018.12.019.CrossRef

13.

Terada M, Pietrosimone B, Gribble PA. Individuals with chronic ankle instability exhibit altered landing knee kinematics: potential link with the mechanism of loading for the anterior cruciate ligament. Clin Biomech. 2014;29(10):1125–30. https://doi.org/10.1016/j.clinbiomech.2014.09.014.CrossRef

14.

Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med. 2005;39(6):324–9. https://doi.org/10.1136/bjsm.2005.018341.CrossRefPubMedPubMedCentral

15.

Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46(2):133–41. https://doi.org/10.4085/1062-6050-46.2.133.CrossRefPubMedPubMedCentral

16.

Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LOP. What are the main running-related musculoskeletal injuries? a systematic review. Sports Med (Auckland, NZ). 2012;42(10):891–905. https://doi.org/10.1007/BF03262301.CrossRef

17.

Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479–501. https://doi.org/10.1007/s40279-016-0575-0.CrossRefPubMed

18.

Schmitt M, Marchi J, Jouvion A, Trappier T, Reyes-Rivet L, De Brier G, et al. Prevalence of chronic ankle instability in French paratroopers. Mil Med. 2020;185(3–4):477–85. https://doi.org/10.1093/milmed/usz323.CrossRef

19.

Donovan L, Hetzel S, Laufenberg CR, McGuine TA. Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes. Orthop J Sports Med. 2020;8(2):Artn 2325967119900962. https://doi.org/10.1177/2325967119900962.CrossRef

20.

Koshino Y, Samukawa M, Murata H, Osuka S, Kasahara S, Yamanaka M, et al. Prevalence and characteristics of chronic ankle instability and copers identified by the criteria for research and clinical practice in collegiate athletes. Phys Ther Sport. 2020;45:23–9. https://doi.org/10.1016/j.ptsp.2020.05.014.CrossRefPubMed

21.

Holland B, Needle AR, Battista RA, West ST, Christiana RW. Physical activity levels among rural adolescents with a history of ankle sprain and chronic ankle instability. PLoS One. 2019;14(4):e0216243-e. https://doi.org/10.1371/journal.pone.0216243.CrossRef

22.

Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Clinical tests have limited predictive value for chronic ankle instability when conducted in the acute phase of a first-time lateral ankle sprain injury. Arch Phys Med Rehabil. 2018;99(4):720–5. https://doi.org/10.1016/j.apmr.2017.11.008.CrossRefPubMed

23.

Attenborough AS, Sinclair PJ, Sharp T, Greene A, Stuelcken M, Smith RM, et al. A snapshot of chronic ankle instability in a cohort of netball players. J Sci Med Sport. 2016;19(5):379–83. https://doi.org/10.1016/j.jsams.2015.04.010.CrossRefPubMed

24.

Simon J, Hall E, Docherty C. Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study. J Dance Med Sci. 2014;18(4):178–84. https://doi.org/10.12678/1089-313x.18.4.178.CrossRefPubMed

25.

Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Spec. 2013;7(1):37–44. https://doi.org/10.1177/1938640013509670.CrossRefPubMed

26.

Kobayashi T, Takabayashi T, Kudo S, Edama M. The prevalence of chronic ankle instability and its relationship to foot arch characteristics in female collegiate athletes. Phys Ther Sport. 2020;46:162–8. https://doi.org/10.1016/j.ptsp.2020.09.002.CrossRefPubMed

27.

Nauta J, Martin-Diener E, Martin BW, van Mechelen W, Verhagen E. Injury risk during different physical activity Behaviours in children: a systematic review with Bias assessment. Sports Med. 2015;45(3):327–36. https://doi.org/10.1007/s40279-014-0289-0.CrossRefPubMed

28.

Pourkazemi F, Hiller CE, Raymond J, Black D, Nightingale EJ, Refshauge KM. Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study. Physiotherapy. 2018;104(4):430–7. https://doi.org/10.1016/j.physio.2017.10.004.CrossRefPubMed

29.

Mandarakas M, Pourkazemi F, Sman A, Burns J, Hiller CE. Systematic review of chronic ankle instability in children. J Foot Ankle Res. 2014;7(1):21. https://doi.org/10.1186/1757-1146-7-21.CrossRefPubMedPubMedCentral

30.

Hershkovich O, Tenenbaum S, Gordon B, Bruck N, Thein R, Derazne E, et al. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg. 2015;54(2):183–7. https://doi.org/10.1053/j.jfas.2014.06.001.CrossRefPubMed

31.

Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113–25. https://doi.org/10.1136/bjsports-2016-096178.CrossRefPubMed

32.

Rivera MJ, Winkelmann ZK, Powden CJ, Games KE. Proprioceptive training for the prevention of ankle sprains: an evidence-based review. J Athl Train. 2017;52(11):1065–7. https://doi.org/10.4085/1062-6050-52.11.16.CrossRefPubMedPubMedCentral

33.

Rozzi SL, Lephart SM, Sterner R, Kuligowski L. Balance training for persons with functionally unstable ankles. J Orthop Sports Phys Ther. 1999;29(8):478–86. https://doi.org/10.2519/jospt.1999.29.8.478.CrossRefPubMed

34.

Hubbard-Turner T. Lack of medical treatment from a medical professional after an ankle sprain. J Athl Train. 2019;54(6):671–5. https://doi.org/10.4085/1062-6050-428-17.CrossRefPubMedPubMedCentral

35.

Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med. 2016;44(4):995–1003. https://doi.org/10.1177/0363546516628870.CrossRefPubMed

36.

Bielska IA, Brison R, Brouwer B, Janssen I, Johnson AP, Day AG, et al. Is recovery from ankle sprains negatively affected by obesity? Ann Phys Rehabil Med. 2019;62(1):8–13. https://doi.org/10.1016/j.rehab.2018.08.006.CrossRefPubMed

37.

Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Brit J Sport Med. 2009;43(13):966–72. https://doi.org/10.1136/bjsm.2009.066936.CrossRef

Title: The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review
Authors: Chiao-I Lin
Sanne Houtenbos
Yu-Hsien Lu
Frank Mayer
Pia-Maria Wippert
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Journal of Foot and Ankle Research / Issue 1/2021
Electronic ISSN: 1757-1146
DOI: https://doi.org/10.1186/s13047-021-00480-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Foot care practice and associated factors among patients with lymphoedema in Boreda district, Gamo zone, southern Ethiopia, 2020. Implications for elimination of podoconiosis and lymphatic filariasis

Evidence for foot orthoses for adults with flatfoot: a systematic review

‘Green podiatry’ - reducing our carbon footprints. Lessons from a sustainability panel

Comparison of 3D scanning versus traditional methods of capturing foot and ankle morphology for the fabrication of orthoses: a systematic review

Semi-automatic measurements of foot morphological parameters from 3D plantar foot scans

Utilisation of the 2019 IWGDF diabetic foot infection guidelines to benchmark practice and improve the delivery of care in persons with diabetic foot infections