Risk factors for ankle injuries
by Gail McKay
(Gail McKay is the physiotherapist to the Bulleen Boomers team in the Women’s National Basketball League and has 17 years’ experience as a player in the WNBL. She works at Alphington Sports Medicine Clinic in Melbourne.)

Ankle injuries are common injuries in sport, particularly in sports that involve jumping and change of direction. Understanding the risk factors for ankle injury is an important step in planning injury prevention strategies.

The most common risk factor identified was a history of ankle injury (DuRant, Pendergrast, Seymore, Gaillard, & Donner, 1992; Ekstrand & Tropp, 1990; Garrick & Requa, 1973; McKay, Goldie, Payne, & Oakes, 2001; Milgrom et al., 1991). Therefore, ankle-injured athletes tend to face the downward spiral of recurrent ankle injuries.

Recent research has shown that basketball players wearing the most expensive shoes that had air cells in the heel were 4.83 times more likely to injure their ankle than those wearing the least expensive shoes (McKay et al., 2001).

Two theories can be suggested to explain this finding.

The first theory is that the air cells located in the heel of the basketball shoes may decrease rear foot stability which may, in turn, increase the risk of ankle injury.

The second theory is based on the findings of Robbins and Waked (1998) and Waddington and Adams (2001) who report impaired ankle movement discrimination when subjects wear shoes compared to bare feet.

The thickest and softest soles caused the greatest errors (Robbins, Waked, & Rappel, 1995). Robbins and Waked (1998) suggest that shoes may impair the awareness of foot position by impairing the tactile feedback from the plantar aspect of the foot. The air cells in the sole of the shoe could make the sole thick and soft and therefore may decrease the awareness of foot position. This in turn may increase the risk of ankle injury.

Further research would be required to explore these two theories.

Basketball players who did not stretch during the warm-up period were 2.7 times more likely to injure their ankle than players who performed stretches (McKay et al., 2001). Although the role of stretching as an injury prevention strategy has been recently questioned by Pope, Herbert, Kirwan, & Graham (2000), this finding supports the traditional clinical beliefs about the benefits of stretching.

The relationship between ankle injury and some other potential risk factors remains unclear. Whether being female rather than male increases the risk of ankle injury appears equivocal. The role of the cut of shoe worn in preventing ankle injuries (high versus low cut) is also debatable, although recent evidence suggests high cut shoes may not have a protective role.

With recurrent ankle injuries being a major issue for athletes, ways in which the rate of ankle injuries can be decreased must be considered.

The literature reports that the risk of ankle injury can be decreased by the use of external ankle support, particularly ankle braces (Handoll, Rowe, Ouinn, & de Bie, 2001; Quinn, Parker, de Bie, Rowe, & Handoll, 2000; Verhagen, van Mechelen, & de Vente, 2000).

There is some evidence to suggest that the role of ankle tape remains unclear.

Functional ankle rehabilitation programs have also been shown to reduce the risk of ankle injury (Thacker et al., 1999; Verhagen et al., 2000).

Hence, ankle-injured athletes should be encouraged to use external ankle support and undertake comprehensive ankle rehabilitation programs.