Ankle Instability as a Global Concept.

The International Ankle Consortium (IAC), formed in 2004, is an international community of researchers and clinicians who seek to promote and improve the progression and dissemination of information related to conditions affecting the ankle complex, particularly lateral ankle sprains (LASs) and chronic ankle instability (CAI), among physically active populations. We are a collegial network that strives to support the ongoing growth of scientific and clinical evidence to elucidate the mechanisms and characteristics of ankle injuries in an effort to optimize interventions and improve the lives of affected patients.The primary venue by which the IAC disseminates the work of its collegial network is the International Ankle Symposium (IAS). This meeting has been hosted every 2 to 3 years by selected members of the IAC in an effort to present and discuss the most contemporary theories and research related to acute and chronic ankle sprains and instability.Another focus of the IAC is to endorse standards of clinical research on ankle injuries. These endorsements exist as isolated statements of standards (eg, patient inclusion criteria for studies of CAI, best practices for the evaluation of ankle instability), as well as summary statements from each IAS meeting that present the major findings and updates from the scientific discourse.The IAC was an idea that arose in 2004. Four years earlier, a small group of international researchers met in Ulm, Germany, to convene the first IAS. Athletic training researchers Jay Hertel, PhD, ATC, FNATA, FACSM, and Thomas W. Kaminski, PhD, ATC, FNATA, FACSM, attended this meeting. They decided to perpetuate the idea and hosted the second IAS at the University of Delaware in 2004. The concluding town hall–style session led to the idea that a consortium of international experts should be established to maintain the momentum from the first 2 IAS meetings, and Drs Hertel and Kaminski became the first codirectors of the IAC. Along with international researchers and clinicians, they guided the growth of the IAC over the next several years through subsequent symposia held in Dublin, Ireland, in 2006 and Sydney, Australia, in 2009.Before the fifth IAS meeting held in Lexington, Kentucky, in 2012, a group of individuals led by Drs Hertel and Kaminski, who had been involved in the IAS meetings since 2004, held a retreat to review the progress and discuss the trajectory of the IAC. Plans were formalized for the group to serve as the executive committee of the IAC. Drs Hertel and Kaminski recommended that they pass the leadership on as the group transitioned into a consortium, and we were asked to assume the new roles of IAC codirectors.The IAC Executive Committee believed that the influence of this international group could extend beyond organizing successful research meetings. Other similar organizations had been successful in promoting their disciplines by creating position statements to help guide research in their field and the day-to-day practice of clinicians. We determined that clarity was needed to improve the quality and consistency of studies involving patients with CAI. Much of the work presented at the IAS meetings and in the published literature1 demonstrated a lack of consistency regarding the inclusion criteria for CAI cohorts. Therefore, we produced the first consensus statement from the IAC to address this topic. This position statement outlined a recommended minimum set of standard inclusion criteria for enrolling participants with CAI as well as recommendations to improve the reporting of their characteristics in research studies. We envisioned that this initiative would enhance the ability of the international community to more consistently compare and share information about these patients. The Journal of Orthopedic and Sports Physical Therapy (JOSPT) agreed to publish our work as the primary source in 2013.2 As a testament to the editors of JOSPT and the reputation of our group of authors, JOSPT agreed to a publication in partnership with the Journal of Athletic Training (JAT)3 and the British Journal of Sports Medicine (BJSM).4 To date, the consensus statement published in these 3 journals has been cited 313 times (unpublished data, Scopus, accessed May 14, 2019).After the first consensus statement was published, the executive committee determined the next topic area that needed addressing was to inform the research and clinical communities of the long-term consequences of ankle sprains. The phrase “it's not just an ankle sprain” had become very common at the IAS meetings. Patients who sustain an LAS early in life are likely to develop lingering joint instability and pain and high rates of reinjury, which lead to reductions and interruptions in physical activity and the early onset of ankle osteoarthritis. The long-term effects of an ankle sprain create a substantial public health care burden. This document was presented in 2016 as a 2-part publication in BJSM: a consensus statement5 and accompanying comprehensive evidence-informed literature review.6 In that short time, these 2 articles have been cited 83 times (unpublished data, Scopus, accessed May 14, 2019).Most recently, a third statement from the IAC was published in 2018 in BJSM to present an evidence-informed consensus on the clinical assessment of patients with acute LASs.7 Using a Delphi method, the executive committee and selected clinicians from around the world arrived at recommendations for undertaking a structured clinical assessment of acute lateral ankle sprains. This consensus yielded the Rehabilitation-Oriented ASessmenT (ROAST) statement, which guides clinicians in objectively identifying mechanical and sensorimotor impairments after acute LAS that are associated with CAI. The message conveyed in ROAST has also been summarized in an accompanying infographic.8 We expect that these resources will help clinicians to use the objective outcomes of their structured clinical assessment to guide the treatment they administer to patients with acute LASs.The IAC Executive Committee has been very active since 2013 in producing consensus statements. These have been well received in the scientific community and appear to be influencing ankle research and clinical practice internationally. Our hope is that the IAC will continue to shape evidence that provides utility to clinicians and researchers interested in improving the condition of patients with ankle sprains and ankle instability.The eighth IAS will take place October 3–4, 2019, in Amsterdam, the Netherlands. As codirectors of the IAC, we are excited to have the opportunity to share the history and trajectory of the IAC in this special issue of JAT. At the upcoming meeting, we will present a plan to realign the leadership of the IAC to be more inclusive and to formalize membership. We hope this will begin the next important growth phase of the IAC. We are grateful to the many supporters of the IAC, including the current and past editors of JAT, JOSPT, and BJSM, who have provided a platform for the IAC to grow and become known to international researchers and clinicians. For those interested in patients with ankle sprains and instability, we invite you to attend the next IAS meeting and to consider becoming involved with the IAC as the organization continues to expand. More information is available at https://www.ias2019.amsterdam.

Ankle sprains are one of the most common injuries in both athletes and the general population. A major problem accompanying ankle injury is the high rate of recurrence, with about 20% of acute ankle sprain patients developing chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability usually needs surgical intervention. Various anatomic reconstruction techniques using the ruptured ends of the ligaments to restore stability have gained popularity. The purpose of this study was to evaluate the functional results of the treatment of chronic lateral ankle instability with anatomic repair of the injured ligaments and reinforcement with polyester tape. A prospective study of 30 consecutive patients who underwent anatomic reconstruction of the lateral ligaments using transosseous suturing and augmentation using a polyester tape done at a single centre by a single surgeon from 2016 to 2017. All patients were assessed preoperatively and postoperatively at 6 weeks, 3, 6 and 12 months. The American Orthopaedic Foot and Ankle Score (AOFAS) and Free Online Foot and Ankle Ability Measure (FAAM) were recorded and used for results analysis. At 12 months' follow-up, the AOFAS had improved from mean 52.47 ± 2.06 to 91.0 ± 6.03 (p< 0.001) .The FAAM mean score had improved from mean 55.21± 1.9 to 90.43 ± 4.02 Conclusion. The ankle ligament reconstruction with additional polyester tape augmentation is an effective technique in treating chronic ankle instability with a satisfactory surgical outcome.

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. The initial form of treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered. To compare different treatments, both conservative and surgical, for chronic lateral ankle instability. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to July 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 3), and MEDLINE (1966 to April 2006), EMBASE (1980 to April 2006), CINAHL (1982 to April 2006) and reference lists of articles. All randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included. Two review authors independently assessed methodological quality and extracted data. Where appropriate, results of comparable studies were pooled. Seven randomised trials were included and divided into three groups: surgical interventions; rehabilitation programs after surgical interventions; and conservative interventions. None of the studies were methodologically flawless. Only one study described an adequate randomisation procedure. Only two studies, both about rehabilitation programs after surgery, had a moderate risk of bias; all other studies had a high risk of bias. Due to clinical and methodological diversity, extensive pooling of the data was not possible. Surgical interventions (four studies): one study showed more complications after the Chrisman-Snook procedure compared to an anatomical reconstruction, whereas another study showed greater mean talar tilt after an anatomical reconstruction. Subjective instability and hindfoot inversion was greater after a dynamic than after a static tenodesis in a third study. The fourth study showed that the operating time for anatomical reconstructions was shorter for the reinsertion technique than for the imbrication method. Rehabilitation after surgical interventions (two studies): both studies provided evidence that early functional mobilization leads to an earlier return to work and sports than immobilisation. Conservative interventions: the only study in this group showed better proprioception and functional outcome with the bi-directional than with the uni-directional pedal technique on a cyclo-ergometer. In view of the low quality methodology of almost all the studies, this review does not provide sufficient evidence to support any specific surgical or conservative intervention for chronic ankle instability. However, after surgical reconstruction, early functional rehabilitation was shown to be superior to six weeks immobilisation regarding time to return to work and sports.

Chronic ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. In case of severe joint laxity, surgical treatment with reconstruction of the lateral ligamental complex is recommended. The aim of this study was to evaluate the functional outcome of patients treated with lateral ligament reconstruction with allograft for severe chronic lateral ankle instability. We performed a retrospective cohort study of ten patients who underwent allograft external non-anatomic ligamentoplasty for severe chronic lateral ankle instability between 2009 and 2011, with an average follow-up of 16.3 months (SD 8.2). Median age at surgery was 29 years (range 25-35). All patients presented both ATFL and CFL lesion. Patients were evaluated using American Orthopaedic Foot and Ankle Society score, Karlsson-Peterson score, Tegner activity level, Sefton stability scale, and objective examination comprehending range of motion, anterior drawer sign and talar tilt test. Telos stress equipment was used for pre- and post-operative radiographic laxity testing. Follow-up examination at an average of 16.3 months (SD 8.2) after surgery showed significant improvement of all variables compared to pre-operative values (p < 0.001). Most patients rated their outcome as good/excellent. Telos stress radiographs documented improvement in joint stability. Lateral ligament reconstruction with allograft represents a valid treatment option in patients with severe chronic lateral ankle instability.

Chronic ankle instability (CAI) is a clinical sequela that causes the recurrence of ankle sprain by inducing ankle sensorimotor dysfunction. Animal models of CAI have recently shown that ankle ligament injuries mimicking an ankle sprain result in chronic loss of ankle sensorimotor function. However, the underlying mechanisms determining the pathogenesis of CAI remain unclear. Ankle instability after an ankle sprain leads to the degeneration of the mechanoreceptors, resulting in ankle sensorimotor dysfunction and the development of CAI. Controlled laboratory study. Four-week-old male Wistar rats (N = 30) were divided into 2 groups: (1) the ankle joint instability (AJI) group with ankle instability induced by transecting the calcaneofibular ligament (n = 15) and (2) the sham group (n = 15). Ankle instability was assessed using the anterior drawer test and the talar tilt test at 4, 6, and 8 weeks after the operation (n = 5, for each group at each time point), and ankle sensorimotor function was assessed using behavioral tests, including ladder walking and balance beam tests, every 2 weeks during the postoperative period. Morphology and number of mechanoreceptors in the intact anterior talofibular ligament (ATFL) were histologically analyzed by immunofluorescence staining targeting the neurofilament medium chain and S100 proteins at 4, 6, and 8 weeks postoperatively (n = 5 per group). Sensory neurons that form mechanoreceptors were histologically analyzed using immunofluorescence staining targeting the mechanosensitive ion channel PIEZO2 at 8 weeks postoperatively (n = 5). Ankle sensorimotor function decreased over time in the AJI group, exhibiting decreased ankle instability compared with the sham group (P = .045). The number of mechanoreceptors in the ATFL was reduced (P < .001) and PIEZO2 expression in the sensory neurons decreased (P = .008) at 8 weeks postoperatively. The number of mechanoreceptors was negatively correlated with ankle sensorimotor dysfunction (P < .001). The AJI model demonstrated degeneration of the mechanoreceptors in the ATFL and decreased mechanosensitivity of the sensory neurons, which may contribute to CAI. Ankle instability causes degeneration of mechanoreceptors and decreases the mechanosensitivity of sensory neurons involved in the development of CAI. This finding emphasizes the importance of controlling ankle instability after ankle sprains to prevent recurrence and the onset of CAI.

Category: Ankle, Hindfoot, Imaging, Ankle Instability Introduction/Purpose: Varus hindfoot deformity may increase the risk of chronic ankle instability (CAI).Weightbearing CT (WBCT) semi-automated measurements and built-in databases may contribute to investigate the relationship between clinical and radiographic data. The objective of this study was to analyze hindfoot alignment (HA) in relation with CAI in a series of patients using these new tools. We hypothesized that there would be a positive correlation between a varus morphotype and a history of CAI. Methods: This is a Level 3 retrospective comparative study of a continuous series of 124 feet (63 patients) referred from July to December 2016. and subsequently assessed by WBCT (PedCAT®, CurveBeam LLC). The measurement software (Talas®, Curvebeam LLC), gave HA as a value of Foot and Ankle Offset (FAO). This measures the offset between the center of the ankle joint and the median line of the foot joining the centers of the calcaneus and forefoot weight bearing surfaces. Data was prospectively saved in a database (CubeView®, CurveBeam, PA, USA). The definition of CAI was a history of at least 3 ankle sprains during a 6 months period. Exclusion criteria were medial instability and syndesmotic injuries (2 cases).A univariate analysis was conducted to study CAI against the following variables: gender (Fisher), BMI and FAO (Kurskal-Wallis). The significant variables were subsequently included in a multivariate logistic model. Results: Nineteen feet had CAI, in 12 patients. Gender (p=0.0467 –the proportion of women for patients with CAI was 72.3%, compared to 33.3% without CAI) and FAO (p=0 .0002) were significant in the univariate analysis. The mean FAO was respectively -1.40 (SD: 5.50) and 3.56 (SD: 5.31) with and without a history of CAI. No significant difference of age or BMI was shown. After verification of log-linearity between odds of CAI and FAO, the multivariate logistic regression adjusted for gender demonstrated a 15% increase of odds of CAI per unit increase of varus (adjusted Odds Ratio (CI95%): 0.858 (0.771-0.943) p=0.003), and no more significant effect of gender after adjustment on FAO (Odds ratio (CI95%) Female versus Male: 0.548 (0.185 -1.669) p=0.277). Conclusion: A positive linear relationship was found between Varus Hindfoot Alignment measured using a semi-automatic tool in WBCT and the odds ratio for Chronic Ankle Instability, thus confirming and quantifying previous findings. The recent development of semi-automatic measurements and prospective databases opens future perspectives for big data and multivariate analysis in foot and ankle pathology.

Objetive Chronic ankle instability is generally associated with ankle sprain. Its consequences can be measured by means of patient-reported outcome measures (PROMs). The aim of this review is to identify the PROMs specifically available for chronic ankle instability and to evaluate their methodological quality and that of the cross-cultural adaptations made. Data Sources Papers were retrieved from PubMed, Embase, Scopus and Google Scholar databases, with no time limit applied, based on the following inclusion criteria: (1) type of participants: patients with chronic ankle instability, over 18 years of age; (2)type of study: those specifically focused on this pathology, using PROMs specific to chronic ankle instability and published in English; (3) type of outcome: measurement properties based on COSMIN criteria in patient-reported outcomes associated with chronic ankle instability. Methods This systematic review, following the COSMIN checklist, was conducted to determine the methodological quality of PROMs specific to foot and ankle pathologies, for patients presenting chronic ankle instability. Results Of the 576 studies identified in the initial search, 34 were included in the final analysis of measurement properties. Four – the Ankle Instability Instrument, the Chronic Ankle Instability Scale, the Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability – were original questionnaires, and the remaining 30 were cross-cultural adaptations. Conclusion The Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability questionnaires can be useful instruments for evaluating chronic ankle instability, both in patients with this condition and also in non-pathological patients.

Background Lateral ankle sprains occur at a high rate in competitive athletics. Following an ankle sprain, residual symptoms and recurrent injuries often persist. This can lead to chronic ankle instability (CAI) and eventually osteoarthritis. Therefore, understanding the magnitude of these long term issues is critically important to healthcare providers. Objective To determine the prevalence of CAI in Division I college athletes and any potential relationship between the presence of CAI and subsequent ankle sprain occurrence. Design Case-control study. Setting Division I Athletics Department. Participants A total of 462 college athletes participated in this study (184 males, 278 females, age = 19.5 ± 1.3 years, height = 178.4 ± 0.7 cm, body mass = 73.7 ± 10.5 kg). All participants completed the Identification of Functional Ankle Instability (IdFAI) survey to determine presence of CAI. Individuals scoring ≥11 on the IdFAI were classified as having CAI, and those scoring Interventions Frequency of ankle injury along with descriptive information (e.g. side, grade, etc…) was tracked for all participants for an academic year. Main outcome measurements Frequency of ankle sprains. A non-parametric c 2 test of independence was used to determine the presence of an association between CAI status and subsequent ankle sprain occurrence. A priori alpha was set a p Results Of the athletes included in this study, 40.5% (n = 187) had CAI. Of all 462 athletes there were 58 athletes who sustained an ankle sprain during the academic year; of those 58 ankle sprains 35 (60.3%) were identified as having CAI at the beginning of the study. There was a significant association between CAI status and the presence of sustaining an ankle injury during the academic year (c 2 (1) = 10.9, p = 0.001). Conclusions Similar to previously published results, there is a high prevalence of CAI in collegiate athletes. These data provide support that athletes with CAI have a significant association with sustaining an ankle sprain during the athletic season.

Background Comparisons of talar cartilage and the anterior talofibular ligament (ATFL) profiles in individuals with different levels of chronic ankle instability (CAI) provide insight into early adaptation of tissue morphology. Purpose This study compared morphologic response and recovery of the talar cartilage and ATFL before and after 30-min of self-paced treadmill running between individuals with CAI, coper (full recovery from a first-time ankle sprain), and healthy controls. Methods Sixty young males (24.8 years, 176.9 cm, 75.7 kg) were allocated into the CAI, coper, and healthy control group by their number of ankle sprains and scores on the self-reported ankle instability questionnaires (Cumberland Ankle Instability Tool, and Foot and Ankle Ability Measure-Activities of Daily Living). Ultrasonographic images in the cross-sectional area (CSA; overall, lateral, and medial) and ATFL length (unstressed and stressed and position) before and after treadmill running were recorded and analyzed. Results There were no group by time interactions in the talar cartilage CSA (F14,399 <1.09, p > .36 for all tests) and ATFL length (F14,399< .69, p > .79 for all tests). Regardless of time, CAIs had the largest overall (F2,399 = 42.68, p < .001), lateral (F2,399 = 37.16, p < .001), and medial (F2,399 = 36.57, p < .001) CSA of talar cartilage and the longest stressed-ATFL length (F2,399 = 54.42, p < .001), followed by copers and healthy controls. Conclusion Morphologic features of the talar cartilage and ATFL appear to depend on the level of ankle instability (e.g. a history of recurrent ankle sprain).

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. Initial treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered. To compare different treatments, conservative or surgical, for chronic lateral ankle instability. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and reference lists of articles, all to February 2010. All identified randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included. Two review authors independently assessed risk of bias and extracted data from each study. Where appropriate, results of comparable studies were pooled. Ten randomised controlled trials were included. Limitations in the design, conduct and reporting of these trials resulted in unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting. Only limited pooling of the data was possible.Neuromuscular training was the basis of conservative treatment evaluated in four trials. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool (AJFAT): mean difference (MD) 3.00, 95% CI 0.3 to 5.70; 1 trial, 19 participants; Foot and Ankle Disability Index (FADI) data: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, 56 participants). The fourth trial (19 participants) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.Four studies compared surgical procedures for chronic ankle instability. One trial (40 participants) found more nerve injuries after tenodesis than anatomical reconstruction (risk ratio (RR) 5.50, 95% CI 1.39 to 21.71). One trial (99 participants) comparing dynamic versus static tenodesis excluded 17 patients allocated dynamic tenodesis because their tendons were too thin. The same trial found that dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77, 82 participants). One trial comparing techniques of lateral ankle ligament reconstruction (60 participants) found that operating time was shorter using the reinsertion technique than the imbrication method (MD -9.00 minutes, 95% CI -13.48 to -4.52). Two trials (70 participants) compared functional mobilisation with immobilisation after surgery. These found early mobilisation led to earlier return to work (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial). Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.

Chronic lateral ankle pain and instability can be associated with a split in the peroneus brevis tendon. This case reports a peroneus brevis split that was centered over the sharp posterior edge of the fibula and was associated with laxity of the superior peroneal retinaculum, and chronic ankle instability. The mechanism of the split was easily demonstrated during surgery by everting the foot and pulling longitudinally on the peroneus longus tendon. The interrelationship of lateral ankle instability with superior retinacular laxity and resultant peroneus brevis splits can account for posttraumatic lateral ankle pain. Surgical treatment must identify and correct the underlying pathology and should attempt to repair or debride the peroneus brevis tendon, reconstruct the superior peroneal retinaculum, flatten the posterior edge of the fibula by removing the sharp bony prominence, and address any associated lateral ankle instability with either a modified Chrisman-Snook, Anderson, or modified Brostrom-Gould procedure.

To answer the following clinical questions: (1) Can prophylactic balance and coordination training reduce the risk of sustaining a lateral ankle sprain? (2) Can balance and coordination training improve treatment outcomes associated with acute ankle sprains? (3) Can balance and coordination training improve treatment outcomes in patients with chronic ankle instability? PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway. Only studies assessing the influence of balance training on the primary outcomes of risk of ankle sprain or instrumented postural control measures derived from testing on a stable force plate using the modified Romberg test were included. Studies had to provide results for calculation of relative risk reduction and numbers needed to treat for the injury prevention outcomes or effect sizes for the postural control measures. We calculated the relative risk reduction and numbers needed to treat to assess the effect of balance training on the risk of incurring an ankle sprain. Effect sizes were estimated with the Cohen d for comparisons of postural control performance between trained and untrained groups. Prophylactic balance training substantially reduced the risk of sustaining ankle sprains, with a greater effect seen in those with a history of a previous sprain. Completing at least 6 weeks of balance training after an acute ankle sprain substantially reduced the risk of recurrent ankle sprains; however, consistent improvements in instrumented measures of postural control were not associated with training. Evidence is lacking to assess the reduction in the risk of recurrent sprains and inconclusive to demonstrate improved instrumented postural control measures in those with chronic ankle instability who complete balance training. Balance training can be used prophylactically or after an acute ankle sprain in an effort to reduce future ankle sprains, but current evidence is insufficient to assess this effect in patients with chronic ankle instability.

ObjectivesThe evaluation of health-related quality of life and physical function is important for determining therapeutic strategies following ankle injuries. The Anglo-American Foot and Ankle Ability Measure (FAAM) is a valid...

Recalibration and Validation of the Cumberland Ankle Instability Tool Cutoff Score for Individuals With Chronic Ankle Instability

The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study