Background A history of ankle injury is known to be associated with an increased risk of future injuries. Prevention of a first-time injury to an ankle will also prevent subsequent re-injury; yet these participants are often overlooked in reports of preventive testing. Determining the functional deficits which promote injury risk in all ankles, through studies inclusive of previously injured and never injured ankles, will enable training to be directed at improving known deficits in all sports participants. Objective To review studies investigating the measurement of intrinsic functions in healthy ankles and assess their predictive value for injury. Method Systematic review and meta-analysis of journal articles from selected electronic databases. Using all papers that included sufficient data for extraction in any paradigm, the authors pooled results for measures of strength, postural control, proprioception, muscle reaction time in response to perturbation, range of movement and ligament stability. Results Thirteen papers were found with adequate data reporting to allow calculation of pooled standardised mean difference (SMD) or pooled RR. The following are all associated with an increased risk of ankle injury: higher postural sway (SMD=0.693, 95% CI=0.151 to 1.235, p=0.012), being in the lower postural stability group (RR=2.06, 95% CI=1.364 to 3.111, p=0.001), lower inversion proprioception (0.573, 0.244 to 0.902, <0.001), higher concentric plantar flexion strength at faster speeds (0.372, 0.092 to 0.652, 0.009) and lower eccentric eversion strength at slower speeds (0.337, 0.117 to 0.557, 0.003). Conclusion There is a set of intrinsic functional and structural ankle deficits associated with significantly increased risk of ankle injury. These findings will enable clinicians and sports trainers to measure and train specific deficits in sports people for the prevention of ankle injury.

Peer reviewed article authored by (Newman P, Witchalls J, Waddington G, Adams R). Read article or submit your manuscript for publishing.

Context: Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. Objective: To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Design: Descriptive laboratory study. Setting: University clinical laboratory. Patients or Other Participants: Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Intervention(s): Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Main Outcome Measure(s): Difference in scores between groups with stable and unstable ankles and between test repeats. Results: Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). Conclusions: The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.