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Ankle Sprain

Original Editor - Dale Boren, Michael Kauffmann, Pieter Jacobs as part of the Vrije Universiteit Brussel Evidence-Based Practice Project

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Introduction

An ankle sprain is a common musculoskeletal injury that involves the stretch or tear (partial or complete) of the ligaments of the ankle joint. These injuries occur when the ankle moves outside of its normal range of motion which can be seen mostly in active and sports populations. [1]

Epidemiology

The ankle joint is the second joint that is most likely to be injured in sport and the ankle sprain is the most common injury in the ankle joint. [2]

The most common type of ankle sprains are the lateral ligament injuries making up approximately 85% of all ankle sprains and the least common are acute medial, and syndesmotic ankle sprains, with females having a higher risk of injury than of males.[3]

the highest rate of ankle sprain incidence than males and children. [3]

In the United States, the total cost of ankle sprains is approximately $2 billion. [4] According to a study conducted on 39,340 individuals with an ankle sprain over the period of 4 years in the United States Military Health System, results showed that poor and delayed rehabilitation after initial sprain increases the chance of injury recurrence and increases the occurrence of ankle-related medical visits. [5] [6]

A meta-analysis by Doherty et al, [3] found that indoor sports such as basketball carry the greatest risk of ankle sprain with an incidence of 7 per 1,000 cumulative exposures. Severe ankle sprains occur commonly in basketball players with recurrence rates amongst these players being greater than 70%. [7] According to a study on elite Australian basketball players, McKay et al, [8] reported that the rate of ankle injuries was 3.85 per 1000 participations which caused 37 ankle-injured athletes to miss 81.5 weeks of play. Athletes with chronic ankle instability tend to miss practices and competition, require ongoing care in order to remain physically active, and display sub-optimal performance.

Clinically Relevant Anatomy

For the lateral ankle ligament complex, the most frequently damaged ligament is the Anterior Talofibular ligament (ATFL). The mechanism of sprain injury of the ATFL and Calcaneofibular Ligament (CFL) is when a plantarflexed foot is forcefully inverted. In this case, this implies that the Calcaneofibular ligament (CFL) and Posterior Talofibular Ligament (PTFL) are less likely to sustain damaging loads. The PTFL is rarely injured unless its associated with a talus dislocation.[9]

As for the medial side, the strong deltoid ligament complex, consisting of posterior Tibiotalar (PTTL), Tibiocalcaneal (TCL), Tibionavicular (TNL) and Anterior Tibiotalar Ligaments (ATTL) are injured with forceful pronation and rotation movements of the hindfoot. [10]

The stabilising ligaments of the distal Tibiofibular syndesmosis are the anterior-inferior, posterior-inferior, and transverse tibiofibular ligaments, the interosseous membrane and ligament, and the inferior transverse ligament. A syndesmotic (high ankle) sprain occurs with combined external rotation of the leg and dorsiflexion of the ankle. [11]

Risk Factors

Key risk factors of ankle sprains include: :[12][13]

  • Female > Males. [3]
  • Younger age. [3]
  • History of previous lateral ankle sprain.
  • High BMI.
  • Weakness of hip muscles, especially hip extensor strength.[14]
  • Weakness of ankle muscles.
  • impaired balance.
  • Slow eccentric inversion strength.
  • Fast concentric plantar flexion strength.
  • Passive inversion joint position sense.
  • Reaction time of the peroneus brevis.

Mechanism of Injury/Pathological Process

Lateral ankle sprains usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear. When a ligament tears or is overstretched, it's previous elasticity and resilience rarely return back to normal. Some researchers have described situations where return to play is allowed too early, which compromise sufficient ligamentous repair.[15] Reports have proposed that the greater the level of plantar flexion, the higher the likelihood of sprain occurrence.[15]

Based on a study conducted on 94 Brazilian young competitive volleyball and basketball athletes, results showed that the likelihood of ankle sprains were 80.6% when the athlete had the left lower leg dominant, peroneus brevis electromyographic response time greater than 80ms, use of shoes without dampers, and playing positions.[16]

In addition to that, Yeung et al,[7] in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant leg.[6] A less common mechanism of injury involves forceful eversion movement at the ankle injuring the strong deltoid ligament.

Aspect Mechanism of injury Ligaments
Lateral Inversion and plantarflexion Anterior Talofibular Ligament (ATFL)
Calcaneofibular Ligament (CFL)
Posterior Talofibular Ligament (PTFL)
Medial Eversion Posterior Tibiotalar Ligament (PTTL)
Tibiocalcaneal Ligament (TCL)
Tibionavicular Ligament (TNL)
Anterior Tibiotalar Ligament (ATTL)
High External rotation and dorsiflextion Anterior-Inferior Tibiofibular Ligament (AITFL)
Posterior-Inferior Tibiofibular Ligament (PITFL)
Transverse Tibiofibular Ligament (TTFL)
Interosseous Membrane (IM)
Interosseous Ligament (IL)
Inferior Transverse Ligament (ITL)

Clinical Presentation

The signs and symptoms of ankle sprains vary widely depending on the type and severity of the injury and include:

  1. Pain particularly with weightbearing on the affected foot.
  2. Tenderness upon palpation of the ankle joint.
  3. Swelling.
  4. Limited range of motion, and instability at the level of the joint [17][18]
  5. Inversion injury or forceful eversion injury to the ankle.
  6. Previous history of ankle injuries or instability.
  7. Special Tests: positive signs in Anterior Drawer, Talar Tilt, or Squeeze Test (depending on the structures involved)

Differential Diagnosis

The differential diagnosis of an ankle sprain includes tendon rupture, tendinopathy, fracture, tendon subluxation, and many other conditions. The diagnosis is based on the history of trauma and examination findings. With examination, the use of ultrasound can help to identify whether there is a tendon injury, and in chronic cases where the Ottawa Ankle Rules are not applicable, diagnostic imaging can be used to confirm the diagnosis. [19]

The Ottawa Ankle Clinical Prediction Rules are an accurate tool according to 27 studies conducted on 15,581 individuals [20] to exclude fractures within the first week after an ankle injury and to reduce the number of unnecessary radiographs. [21]

Additional differential diagnosis to assess, include: [9]

Classification of Ankle Sprain

Ankle sprains can be classified into 3 main categories:

  • Grade I represents slight stretching and damage to fibers of the ligament
  • Grade II represents partial tear of the ligament
  • Grade III represents complete rupture of the ligament [22]

As there are multiple ligaments across the ankle joint, it may not be always straightforward to use a grading system that is designed for describing the state of a single ligament unless it is certain that only a single ligament is injured. For this reason, another grading system is used to classify ankle sprains based on the number of ligaments injured. [23] It is, however, hard to determine the exact number of ligaments torn unless there is clear high quality radiographic imaging or surgical evidence.

A different system which can be adopted is based on the severity of sprain injury: [24]

  • Grade I: Mild impairment - Minimal swelling and tenderness with little impact on function
  • Grade II: Moderate impairment - Moderate swelling, pain, and tenderness with decreased range of motion and ankle instability
  • Grade III: Severe impairment - Significant swelling, tenderness, loss of function, and marked instability [25]

Outcome Measures

Clinical Examination

An ankle sprain involves multiple structures, therefore a full foot and ankle assessment is recommended. [24] The assessment of the injured ankle involves taking past medical history of the patient to note any previous similar injuries. This is crucial for aiding in the diagnosis. It is then important to observe the patient's gait pattern and posture and any deviations, note any deformities, malalignments, atrophy, and presence of oedema or ecchymosis. Palpating the affected structures is necessary to feel for any tenderness over bony prominences, muscles, or ligaments. Assessing the patient's passive and active range of motion is also necessary. [26]

[27]

Special Tests

  • Anterior Drawer Test - tests the Anterior Talofibular Ligament
  • Talar Tilt Test - tests the Calcaneofibular Ligament
  • Posterior Drawer Test - tests the Posterior Talofibular Ligament
  • Squeeze test - tests for a Syndesmotic sprain
  • External rotation stress test (Kleiger’s test) - tests for a Syndesmotic sprain

[28]

Physical Therapy Management

Physical therapy plays an important role in the treatment of ankle sprains, especially in athletes. In athletes, its important that there a distinct and different treatment that is prescribed for an acute or mild injury (lasting up to 4 weeks) compared to a chronic or more severe injury (lasting beyond 4 weeks), and considering the different stages of tissue healing. [29][30]

With a mild ankle sprain, the goals of physical therapy include decreasing pain and swelling, and protecting the joint and its ligaments from further injury. The duration for a patient to recover from an acute ankle sprain ranges from 5 to 14 days. With a chronic ankle sprain, the goals of physical therapy focus on reducing pain and oedema, and restoring functional movement and stability. The duration for a patient to recover from a chronic ankle sprain is between 3 to 12 weeks or more. [31]

The common treatment protocol followed is the PRICE (Protect, Rest, Ice, Compress, Elevate) treatment. It involves resting the injured ankle for the first 72 hours and if necessary protecting the ankle joint through the use of crutches. Applying ice can then help with the swelling and pain. A compress such as a bandage or a brace can be used to stabilise the joint. Elevating the ankle and leg can help with reducing pain and oedema. [9][32]

First-time lateral ligament sprains can be innocuous injuries that resolve quickly with minimal intervention, and some approaches suggest that only minimal intervention is necessary. The NICE guidelines 2016 recommend advice and analgesia, instead of routine physiotherapy referrals. [33] However, it is also highlighted that the recurrence rate of first time lateral ankle sprains is 70%. [34] With the recurrence rate being so high and the guidelines not recommending any rehabilitation, this approach has been questioned. [32]

The healing process is divided into 3 phases, the Inflammatory phase, the Proliferation phase, and the Remodeling or Maturation phase. The inflammatory phase is the first phase in the healing process. It occurs immediately after an injury and lasts for a period that ranges between 2 to 4 days. The main goals during this phase include the reduction of pain and oedema and providing support for the foot. [35] The PRICE protocol is used during this phase and involves protection of the ankle from reaggravation of further injury, resting after the injury, applying ice at intervals of 15 minutes, applying a compression bandage to reduce swelling and oedema, and elevating the ankle to further reduce swelling.

Despite its widespread clinical use, the precise physiologic responses to ice application have not been fully proven. Moreover, the rationales for its use at different stages of recovery are quite distinct. There is insufficient evidence available from randomised control trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. However, there isn't any evidence against the RICE protocol. [36] The use of non-steroidal anti-inflammatory drugs (NSAIDs) for the initial treatment of ankle sprains is supported according to a meta-analysis involving 22 studies. [37]

To increase ankle stability and provide support for the ankle joint during the inflammatory phase, active and passive mobilisation of the foot and ankle is done to reduce pain and prevent venous stasis, and improve local circulation allowing resorption of oedema. These mobilisation techniques involve subtalar distraction to reduce pain, medial subtalar glide, and lateral subtalar glide to increase eversion and inversion. [38]

Although widely known, these previous acronyms focus on acute management, unfortunately ignoring subacute and chronic stages of tissue healing. The contemporary acronyms encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE). PEACE and LOVE outline the importance of educating patients and addressing psychosocial factors to enhance recovery. While anti-inflammatories show benefits on pain and function, the acronyms flag their potential harmful effects on optimal tissue repair. It is suggested that they may not be included in the standard management of soft-tissue injuries. [39][40]

PEACE & LOVE

P - Protection - The injured tissue must be unloaded for 1-3 days after injury and movement is avoided. This is important to protect the injury in the first few days and prevent aggravation. Be careful and avoid prolonged rest as that can cause loss og strength and quality of the tissue.

E - Elevation - Elevation of the limb higher than the heart helps reduce the swelling by promoting flow of interstitial fluid from the limb towards the heart.

A - Avoid Anti-Inflammatories - The phases of inflammation play an important role in recovery of the tissue. Use of anti-inflammatories and cryotherapy should be avoided as it may interfere with long-term tissue repair by reducing the inflammation.

C -Compression - Using bandages and tape to compress the injured limb helps to minimize bleeding and edema.

E - Education - It is vital to educate the patient about importance of active recovery which includes encouraging movement within pain-free ranges, continuing daily activities within the limits of pain and avoiding prolonged rest. Avoiding use of passive modalities like analgesics and ice as it may interfere with the natural recovery process.

L - Load- The tissue should receive the ideal load without experiencing more discomfort. In order to continue regular activities, this encourages tissue remodeling, healing, and tolerance.

O - Optimism- Patients with optimistic expectations tend to have better prognoses and outcomes. Recovering is hampered by catastrophizing, fear, and sadness.

V - Vasculariasation- Pain-free aerobic activity and prompt mobilization enhance bodily functions, facilitate a return to work, and lessen the need for painkillers.

E - Exercise- Early after an injury, exercise reduces recurrence and restores proprioception, strength, and mobility. In order to guarantee the best possible repair during the subacute phase of recovery, pain should be avoided and utilized as a benchmark for increasing the intensity of activity.

The proliferative phase begins after inflammation has been minimised and lasts for 4 to 6 weeks. During this phase, the scar tissue begins to form adapting the initial physical properties of the normal tissue. The goals of physical therapy during this phase include retrieving ankle function, improving weight bearing capacities on the affected foot, and increasing range of motion, while protecting the joint from recurrence of the injury. It is important to begin early with the rehabilitation of the ankle. Exercises during the first week should produce significant improvements to ankle function. [41] A brace or tape can also be applied, at the beginning of this phase, to protect the joint. It should be applied as soon as swelling decreases, and depends on the patient's preference. According to a randomised control trial on 50 patients, results showed that the use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at both 10 days and one month compared with standard management with an elastic support bandage. [42]

Here are two videos, which show examples taping techniques for ankle sprain. There are many other techniques that can be used.

[43]
[44]

The remodeling and maturation phase is a long-term process and represents the final phase of the healing process. The goals of rehabilitation during this phase involves improving muscle strength, active stability, foot and ankle motion and mobility. In addition to that, improve load-carrying capacity, walking skills and improve the skills needed during activities of daily living as well as work and sports. The rehabilitation programme during this phase consists of practicing balance, muscle strength, ankle/foot motion and mobility (walking, stairs, running), looking for a symmetric walk patterns, working on dynamic stability as soon as load -bearing capacity allows, focusing on balance and coordination exercises. Then gradually progress the loading, from static to dynamic exercises, from partially loaded to fully loaded exercises and from simple to functional multi-tasking exercises and use different types of surfaces to increase the level of difficulty. The patient should be encouraged to pursue practicing the exercises given during the sessions at home. The patient is also advised to wear tape or a brace during physical activities until the patient is able to confidently perform static and dynamic balance and motor coordination exercises. [45][46]

The remodeling and maturation phase is the final stage of tissue healing, which is a long-term process. The goals of rehabilitation during this phase involve improving muscle strength, active stability, and foot and ankle motion and mobility. In addition, improved load-carrying capacity, walking skills, and improved skills for activities of daily living and work and sports, are developed. The rehabilitation program involves muscle strength, ankle/foot motion and mobility (walking, stairs, running), looking for a symmetrical gait patterns, working on dynamic stability as soon as load-bearing capacity permits, and focusing on balance and coordination exercises. The intensity of the exercises is gradually progressed, from static to dynamic, partially loaded to fully weightbearing, and from simple to functional multi-tasking exercises, with the use of different types of surfaces (different friction, different levels of evenness) to increase the level of difficulty. The patient needs to be encouraged to practice the exercises at home. The patient is also advised to wear tape or a brace during physical activities until they are able to confidently perform static and dynamic balance, and motor coordination exercises. [47][48].

Return to Activities after Ankle Sprain

It is often thought that ankle sprain is a harmless injury, but we have previously seen that it can be the cause of subsequent pathologies such as osteoarthritis or chronic ankle instability.

Some protocols and standardisations for Return-to-Sport have been used for situations such as post-ACL operation or hamstring injury, but still does not have generalisable findings. Evidence-based research is needed concerning areas related to foot and ankle injuries, to assist in the assessment and treatment decision making process for athlete to Return to Sport. According to a recent systematic review by Tessigol et al, [49] there are currently no published evidence-based criteria to inform Return-to-Work decisions for patients with a lateral ankle sprain injury.

Despite the minimal criteria that is present when guiding return-to-sport after an ankle sprain , the athlete still needs to be assessed and treated after injury.

Tests and Criteria

  • Ankle Mobility: knee to wall test
  • Lower Limb Strength: A typical load level during a single leg vertical jump landing is approximately 1.5 your own weight corporeal. [50] In order to perform certain dynamic activities, capacity to generate (and absorb) force equal to 1.5x bodyweight would be required. Using the data previously outlined, Lee Herrington et al. [51] introduced the ability to perform 10 reps of single leg press (1.5x bodyweight) as a criterion for return to run after a cruciate ligament injury. While it is not transferrable to an ankle sprain, it is helpful in helping an athlete return to running.

Chronic Ankle Instability

Ongoing issues following a lateral ligament injury within the ankle are reported in 19-72% of patients. An inability to complete certain movement tasks, evidence of deficits during the Star Excursion Balance Test, and self-reported loss of function as quantified using the Foot and Ankle Ability Measure can be utilised as predictive measures of a Chronic Ankle Instability (CAI) outcome in the clinical setting for patients with a first time lateral ankle sprain injury. [32] Around 20% of people develop CAI and this has been attributed to a delayed muscle reflex of stabilising lower leg muscles, deficits in lower leg muscle strength, deficits in kinaesthesia, or impaired postural control. [52][53]

Chronic ankle instability has been described as a combination of mechanical (pathological laxity, arthrokinematic restrictions, and degenerative and synovial changes) and functional (impaired proprioception and neuromuscular control, and strength deficits) deficiencies.[54] A holistic treatment program must adhere to both mechanical and functional insufficiencies.

It is recommended that all patients undergo conservative treatment to improve stability and improve the muscle reflex and strength of the lower limb stabilising muscles. Although this will help some individuals, it cannot compensate for the deficit of the lateral ligament complex, and surgery may be indicated. [52]

Sample taping technique used for lateral ankle sprain

Ankle Bracing and Taping

Ankle bracing and taping is often used as a preventative measure, which has gained increasing interest. Ankle taping may be used to help stabilise the joint by limiting motion and proprioception. Ankle taping is said to have a greater effect in preventing recurrent strains rather than an initial sprain. [55] A study on basketball players detailed the effectiveness of ankle taping on reducing the risk of reinjury in athletes who have a history of ankle-ligament sprains. The large sample size of the study (n=10,393) and identification of 40 ankle injuries adds reliability to the results expressed. Tropp et al. [56] undertook a study in soccer players who wore an ankle brace. The subjects in the brace group experienced a significant decrease in the incidence of ankle sprains when compared to no intervention. Surve et al (1994), described similar effects in their prospective study with bracing but noted there was no difference in the ankle sprain severity in the braced and unbraced groups. [57]

Reports are inconclusive on the effective of ankle taping. Several reports have suggested the ineffectiveness of taping. [55][58] It’s effectiveness is also affected by the experience of the taper. Some of the advantages of bracing over taping are; cost [59], reusability, experience not required, and no risk of an allergic reaction. [60]

Resources

  • The Sprained Ankle from the Connecticut Centre for Orthopedic Surgery contains a range of resources on Ankle Sprains including patient resources and surgical techniques.

Coordinated Health TV Ankle Sprain Video Series

[61]
[62]
[63]


Denver-Vail Orthopedics, P.C Ankle Sprain Video Series

[64]
[65]
[66]
[67]

References

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  18. ↑ Pachana M, Kukuła P, Ziomek M, Piersiak M, Sawczuk H, Tomasiewicz A, Zabierowski J, Marschollek J. Ankle Sprains: Clinical Practice and Guideline-Based Treatment Strategies. Quality in Sport. 2025 Jul 12;43:62354-.
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  32. ↑ 32.0 32.1 32.2 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 Apr;44(4):995-1003.
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  37. ↑ van den Bekerom MPJ, Sjer A, Somford MP, Bulstra GH, Struijs PAA, Kerkhoffs GMMJ. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events. Knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(8):2390-399.
  38. ↑ Edmond S. Joint Mobilization/Manipulation, Extremity and Spinal Techniques. 3rd Edition. Amsterdam: Elsevier, 2016.
  39. ↑ Dubois B, Esculier J Soft-tissue injuries simply need PEACE and LOVE.British Journal of Sports Medicine 2020;54:72-73.https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf
  40. ↑ Pachana M, Kukuła P, Ziomek M, Piersiak M, Sawczuk H, Tomasiewicz A, Zabierowski J, Marschollek J. Ankle Sprains: Clinical Practice and Guideline-Based Treatment Strategies. Quality in Sport. 2025 Jul 12;43:62354-.
  41. ↑ Bleakley CM, O'Connor SR, Tully MA, Rocke LG, Macauley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010 May 10;340:c1964.
  42. ↑ Boyce SH, Quigley MA, Campbell S. Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. Br J Sports Med. 2005 Feb;39(2):91-6.
  43. ↑ Finest Physio. Finest Physio: Ankle Taping. Available from: http://www.youtube.com/watch?v=d_XlzZMSV8E [last accessed 09/12/12]
  44. ↑ itherapies. Mulligan Taping Techniques: Inversion Ankle Sprain. Available from: http://www.youtube.com/watch?v=TEjKhf-qDJU [last accessed 09/12/12]
  45. ↑ Stojanović E, Terrence Scanlan A, Radovanović D, Jakovljević V, Faude O. A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial. Phys Sportsmed. 2023 Oct;51(5):463-71.
  46. ↑ Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D; National Athletic Trainers' Association. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013 Jul-Aug;48(4):528-45.
  47. ↑ Stojanović E, Terrence Scanlan A, Radovanović D, Jakovljević V, Faude O. A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial. Phys Sportsmed. 2023 Oct;51(5):463-71.
  48. ↑ Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D; National Athletic Trainers' Association. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013 Jul-Aug;48(4):528-45.
  49. ↑ Tassignon B, Verschueren J, Delahunt E, Smith M, Vicenzino B, Verhagen E, Meeusen R. Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med. 2019 Apr;49(4):601-19.
  50. ↑ Cleather DJ, Goodwin JE, Bull AM. Hip and knee joint loading during vertical jumping and push jerking. Clin Biomech (Bristol, Avon). 2013 Jan;28(1):98-103.
  51. ↑ Herrington L, Myer G, Horsley I. Task based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: a clinical commentary. Phys Ther Sport. 2013 Nov;14(4):188-98.
  52. ↑ 52.0 52.1 Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna journal of medicine. 2016 Oct;6(4):103.
  53. ↑ Eechaute C, Vaes P, Van Aerschot L, Asman S, Duquet W. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review. BMC Musculoskeletal Disorders. 2007 Jan 18;8(1):1.
  54. ↑ Hertel J. Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. J Athl Train. 2002 Dec;37(4):364-75.
  55. ↑ 55.0 55.1 McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001 Apr;35(2):103-8.
  56. ↑ Tropp H, Ekstrand J, Gillquist J. Stabilometry in functional instability of the ankle and its value in predicting injury. Med Sci Sports Exerc. 1984;16(1):64-6.
  57. ↑ Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994 Sep-Oct;22(5):601-6.
  58. ↑ Rovere GD, Clarke TJ, Yates CS, Burley K. Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med. 1988 May-Jun;16(3):228-33.
  59. ↑ Olmsted LC, Vela LI, Denegar CR, Hertel J. Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis. J Athl Train. 2004 Mar;39(1):95-100.
  60. ↑ Callaghan MJ. Role of ankle taping and bracing in the athlete. Br J Sports Med. 1997 Jun;31(2):102-8.
  61. ↑ Coordinated Health TV. Ankle Sprains Part 1: Anatomy. Available from: https://www.youtube.com/watch?v=PDFbZFNtPfs[accessed 9/9/2024]
  62. ↑ Coordinated Health TV. Ankle Sprains Part 2: Symptoms & Evaluation. Available from: https://www.youtube.com/watch?v=dP17ZY3zxa4 [ accessed 9/9/2024]
  63. ↑ Coordinated Health TV. Ankle Sprains Part 3: Rehab & Protection. Available from: https://www.youtube.com/watch?v=dznWBbwLq6k[ accessed 9/09/2024]
  64. ↑ Denver-Vail Orthopedics. Ankle Sprains Part 1 How they occur, what ligaments are injured and initial treatment. Available from: https://www.youtube.com/watch?v=B0-n-ndTAX0[accessed 9/9/2024]
  65. ↑ Denver-Vail Orthopedics. Ankle Sprains Part 2 Stretching and Range of Motion Exercises. Available from: https://www.youtube.com/watch?v=YHJbvf4TW2Y[accessed 9/9/2024]
  66. ↑ Denver-Vail Orthopedics. Ankle Sprains Part 3 Stretching and Range of Motion Exercises. Available from: https://www.youtube.com/watch?v=u6xRWb9dFbU[accessed 9/9/2024]
  67. ↑ Denver-Vail Orthopedics. Ankle Sprains Part 4 Proprioception - Balance. Available from: https://www.youtube.com/watch?v=AsEV5OYghSQ [accessed 9/9/2024]


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