Blog Post Author Biography: Patrick Rowe is a Physiotherapist, Lecturer & PhD Candidate in the College of Sport, Health & Engineering at Victoria University and the Centre of Health, Exercise & Sports Medicine at the University of Melbourne. Patrick has research expertise in the biomechanics of lateral ankle sprains and chronic ankle instability by using musculoskeletal modeling to explore how footwear and external ankle supports influence the lateral ankle ligament complex.
Citation: Rowe, P. L., Bryant, A. L., Egerton, T. & Paterson, K. L. External ankle support effects on ankle biomechanics in chronic ankle instability: systematic review and meta-analysis. Journal of Athletic Training (2022) doi:10.4085/1062-6050-0208.22.
Take-to-the-clinic message: This review found that ankle supports (taping and bracing) reduce inward motion but not inward position at ground contact in people with unstable ankles during landing. This may help prevent ankle sprains or lessen injury severity by limiting excessive inward movement. However, while ankle supports also reduce forward ankle motion, this could shift forces to the knee and hip, potentially increasing injury risk at these joints.
Background: Lateral ankle sprains are common among youth and adolescent athletes in high-demand, multidirectional sports, with up to 70–80% experiencing repeated sprains and chronic ankle instability (CAI). Biomechanical alterations in CAI, such as reduced plantarflexion and higher ground reaction forces during landing, contribute to instability. Athletes often use ankle supports (taping and bracing) to reduce sprain risk, but research is limited to non-randomized studies and lower-demand tasks. Therefore, we must explore whether external ankle supports influence ankle biomechanics during higher demand tasks (running, landing, and cutting), particularly in athletes at higher risk of sustaining a lateral ankle sprain and CAI.
Purpose: This systematic review aimed to compare the effects of external ankle supports compared to no support on ankle biomechanics in individuals with CAI during sports-related tasks.
Methods: This systematic review followed the Cochrane Handbook, PICOT framework, and PRISMA 2020 guidelines and was registered with PROSPERO in August 2020. A comprehensive search of MEDLINE, SPORTDiscus, and CINAHL in November 2021 identified randomized controlled or crossover studies on ankle biomechanics in individuals with CAI using external supports during landing, running, and directional changes. Studies were independently assessed for eligibility, appraised using the Cochrane risk-of-bias tool, and analyzed using random-effects meta-analysis with 95% confidence intervals.
Results: The literature search identified 162 studies, with 13 meeting inclusion criteria, totaling 248 CAI participants. Most studies had low to moderate risk of bias and examined various ankle supports, including non-elastic taping, semi-rigid bracing, soft bracing, and elastic taping. Landing (7 studies) and running (5 studies) were most commonly investigated, while change of direction tasks lacked homogenous data for meta-analysis. External ankle supports did not reduce inversion angle at initial contact during landing or running but showed very low-grade evidence of reducing frontal-plane and sagittal-plane excursion. These findings suggest ankle supports may influence some biomechanical aspects but with limited evidence supporting their overall effectiveness.
Rolling the field forward: This novel review provides further insight into how external ankle supports influence ankle biomechanics during high demand tasks, and the current literature suggests that external ankle support do not influence ankle inversion position prior to ground contact during running and landing. This challenges the current perception of the mechanical function of external ankle supports which is traditionally thought to adjust ankle inversion position during the pre-landing phase. In contrast, frontal plane excursion was found to be significantly reduced, which may be an important consideration for a typical lateral ankle sprain mechanism by limiting excessive inversion kinematics. Another major finding was the significant reduction in sagittal plane kinematics during running and landing. This may be considered either beneficial or detrimental due changes in ankle position (close-packed) or proximal loading at the hip and knee joints. However, it is difficult to determine this effect based on the limited evidence currently available. Future research should consider validated musculoskeletal, multi-segmental foot and ankle models to accurate measures to quantify joint kinematics, kinetics, joint contact, muscle, and ligament forces during high-demand sporting tasks. Adopting more sophisticated laboratory-based biomechanical approaches for CAI research will provide better translation to clinical and sporting environments and assist in reducing the burden of lateral ankle sprains.
Question for researchers: Based on the kinematic alterations of external ankle supports, does this lead to changes in tissue-based strains and forces at the lateral ankle ligament complex? In turn, do ankle-spanning musculotendinous structures perform differently during higher demand tasks when frontal and sagittal plane kinematics are limited? As a consequence of sagittal plane restrictions, do external ankle supports have negative implications to proximal structures (ie. knee) such as joint contact (tibiofemoral) and ligament (ACL) forces?
International Ankle Consortium 