Using External Visual Feedback Techniques to Improve Chronic Ankle Instability: A Critically Appraised Topic

Lateral ankle sprains are common orthopedic injuries and often result in chronic ankle instability (CAI). Studies have shown that the CAI population typically has decreased ankle proprioception and possibly a greater reliance on visual feedback when compared to healthy controls. However, little is known about how the postural control characteristics change in those with and without CAI when external visual feedback is manipulated. PURPOSE: To compare postural control characteristics of persons with CAI, Copers and healthy adults when performing a single leg balance test with and without external feedback. METHOD: The definition for CAI used for this study includes persons who have experienced recurrent ankle sprains, in addition to self-reported “feelings of instability” and “giving way,” and a score on the Identification of Functional Ankle Instability (IdFAI) of 11 or greater. 18 participants with CAI, 15 Copers, and 18 healthy controls (mean age of all groups: 22 years) performed the Athlete Single Leg Test on the Biodex Balance System (BBS) at Level 4, which involved a high degree of platform instability. All participants completed 2 trials without and with feedback in that order. Center of pressure position was recorded and the two trial mean was used for further analysis. Overall stability index (OSI) defined as the mean distance of the center of pressure from the center of the platform was obtained from the system. Sway area was calculated using custom Matlab script. Separate 3 (Group) x 2 (Feedback) mixed ANOVAs were run using overall stability index (OSI), and sway area as dependent variables. RESULTS: Significant feedback main effect showed participants had significantly lower (better) OSI value with feedback (1.4±0.1) compared to without feedback (2.6±0.2; P < 0.001) but sway area with feedback (8.61±2.33cm2) was similar to without feedback (10.94±2.43 cm2). There was no significant group main effect or interaction observed for either of the variables. CONCLUSION: Results suggest that external visual feedback may not play a significant role in helping persons with CAI improve their postural control.

Introduction: Chronic Ankle Instability (CAI) is an injury that presents persistent instability and “giving way” symptoms. The higher rate of reinjury following an initial Lateral Ankle Sprain (LAS) is associated with the development of CAI, which affects athletic and functional performance. Impairment of musculotendinous receptors following an initial ankle sprain may result in recurrent ankle instability. Some studies have suggested an association between CAI and issues with static and dynamic balance. Comparisons of static balance between recreational badminton and volleyball players and dynamic balance between recreational badminton and volleyball players with CAI are required to provide athletes with the proper balance training exercises. Aim: To analyse the static balance of badminton and volleyball recreational players with CAI using the Balance Error Scoring System (BESS) and a Plantar Pressure Analysis System (PPAS), as well as the dynamic balance of those players using the Y Balance Test (YBT). Materials and Methods: A cross-sectional study was conducted where recreational players with CAI who play badminton and volleyball were screened using the Cumberland Ankle Instability Tool (CAIT), and 46 participants were selected based on inclusion and exclusion criteria. The study was conducted in the indoor and outdoor stadiums of NITTE (Deemed to be University), Mangaluru, Karnataka, India. The study duration was from March 2023 to March 2024. Ethical clearance was obtained from the same university for the study. Following this, static and dynamic balance of each group was assessed using BESS (number of errors), PPAS (sway velocity), and YBT (distance reached by the limb). The static balance between the groups and dynamic balance between the groups were analysed in Jamovi software using independent sample t-test. Results: Following the analysis, static balance between badminton and volleyball recreational players using BESS showed a non significant difference with a p-value of 0.282, while PPAS showed non significant differences with p-values of 0.174 for double leg stance and 0.063 for single leg stance. Similarly, dynamic balance between badminton and volleyball recreational players using YBT showed non significant differences with p-values of 0.467, 0.768, and 0.299 for anterior, posteromedial, and posterolateral directions, respectively. Conclusion: The study concluded that there was no significant difference in static as well as dynamic balance between badminton and volleyball recreational players with CAI. However, it is important to evaluate the static and dynamic balance of recreational players to enhance performance and prevent injuries.

BackgroundThe lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI.MethodsBetween 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus.ResultsThe overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1–3 recurrent sprains or 4–5 recurrent sprains (p < .001).ConclusionsFemales over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.

Lateral ankle sprains have been shown to be one of the most common musculoskeletal injuries in both athletes and the recreationally active population. Moreover, it is estimated that approximately 30% of people who incur a lateral ankle sprain will ssustain recurrent ankle sprains and experience symptoms of pain and instability that last > 1 year. Chronic ankle instability (CAI) is the term used to describe cases involving repetitive ankle sprains, multiple episodes of the ankle “giving way,“ persistent symptoms, and diminished self-reported function for > 1 year after the initial ankle sprain. The optimal conservative treatment for CAI is yet to be determined; however, comparison between patients with CAI and individuals showing no history of ankle sprain has revealed several characteristic features of CAI. These include diminished range of motion, decreased strength, impaired neuromuscular control, and altered functional movement patterns. We propose a new treatment paradigm for conservative management of CAI with the aim of assessing and treating specific deficits exhibited by individual patients with CAI.

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.

External feedback during walking improves measures of plantar pressure in individuals with chronic ankle instability

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.

Lateral ankle sprains are a common consequence of physical activity. If not managed appropriately, a cascade of negative alterations to both the joint structure and a person's movement patterns continue to stress the injured ligaments. These alterations result in an individual entering a continuum of disability as evidenced by the ~30 % of ankle sprains that develop into chronic ankle instability (CAI) and up to 78 % of CAI cases that develop into post-traumatic ankle osteoarthritis (OA). Despite this knowledge, no significant improvements in treatment efficacy have been made using traditional treatment paradigms. Therefore, the purpose of this review is to (1) provide an overview of the consequences associated with acute lateral ankle sprains, CAI and post-traumatic ankle OA; (2) introduce the patient-, clinician-, laboratory (PCL)-oriented) model that addresses the lateral ankle sprains and their consequences from a constraints perspective; and (3) introduce the dynamic systems theory as the framework to illustrate how multiple post-injury adaptations create a singular pathology that predisposes individuals with lateral ankle sprains to fall into a continuum of disability. The consequences associated with lateral ankle sprains, CAI and ankle OA are similar and encompass alterations to the structure of the ankle joint (e.g. ligament laxity, positional faults, etc.) and the sensorimotor function responsible for proper ankle joint function (e.g. postural control, gait, etc.). Further, the impairments have been quantified across a range of patient-oriented (e.g. self-report questionnaires), clinician-oriented (e.g. bedside measures of range of motion and postural control), and laboratory-oriented (e.g. arthrometry, gait analysis) outcome measures. The interaction of PCL-oriented outcomes is critically important for understanding the phenomenon of CAI across the continuum of disability. Through the integration of all three sources of evidence, we can clearly see that an ankle sprain is more than just a peripheral musculoskeletal pathology with only local consequences. The dynamic systems theory illustrates that the organization of human movement/function is shaped by the interaction of (1) organismic constraints (health of the person); (2) task constraints; and (3) environmental constraints. However, ankle sprains increase the organismic constraints (i.e. changes in joint structure and sensorimotor function) that significantly hinder an individual's function and may be the underlying cause for the continuum of disability associated with CAI. To treat and/or prevent an individual from entering the continuum of disability, greater protection of the ankle ligaments is needed immediately after injury. Subsequent rehabilitation should then focus on goal-oriented rehabilitation (i.e. quality of the movement pattern) rather that task-oriented rehabilitation (i.e. do these exercises). When evaluating patients with ankle inversion trauma and/or instability, it is imperative to remember that an ankle sprain is not simply a local joint injury; it can result in a constrained sensorimotor system that leads to a continuum of disability and life-long consequences such as high injury recurrence and decreased quality of life if not managed properly.

To answer the following clinical questions: (1) Is poor postural control associated with increased risk of a lateral ankle sprain? (2) Is postural control adversely affected after acute lateral ankle sprain? (3) Is postural control adversely affected in those 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 postural control measures in participants on a stable force plate performing the modified Romberg test were included. To be included, a study had to address at least 1 of the 3 clinical questions stated above and provide adequate results for calculation of effect sizes or odds ratios where applicable. We calculated odds ratios with 95% confidence intervals for studies assessing postural control as a risk factor for lateral ankle sprains. Effect sizes were estimated with the Cohen d and associated 95% confidence intervals for comparisons of postural control performance between healthy and injured groups, or healthy and injured limbs, respectively. Poor postural control is most likely associated with an increased risk of sustaining an acute ankle sprain. Postural control is impaired after acute lateral ankle sprain, with deficits identified in both the injured and uninjured sides compared with controls. Although chronic ankle instability has been purported to be associated with altered postural control, these impairments have not been detected consistently with the use of traditional instrumented measures. Instrumented postural control testing on stable force plates is better at identifying deficits that are associated with an increased risk of ankle sprain and that occur after acute ankle sprains than at detecting deficits related to chronic ankle instability.

Copious research exists regarding ankle instability, yet lateral ankle sprains (LAS) persist among the most common recurrent musculoskeletal injuries. Key anatomical structures, necessary to subtalar joint (STJ) stability, have been potentially overlooked. The functional STJ complex is comprised of 2 compartments – the talocalcaneal joint (posteriorly) and the talocalcaneonavicular joint (anteriorly). Stability is provided by extrinsic ligaments (calcaneofibular and deltoid ligaments) and a series of broad intrinsic ligaments situated in the tarsal canal. These intrinsic ligaments, separating the 2 compartments, are a crucial source of mechanical stability and proprioceptive information. The specific stabilising direction of the STJ complex is controversial; there is likely a multiplanar function, similar to the ACL. Damage to the STJ complex occurs in approximately 25%–80% all LAS injuries, especially when the lateral ligaments are also involved. STJ complex disruption allows non-physiologic anterolateral rotary displacement, especially in weight-bearing. Patients with STJ instability present similarly to those with chronic ankle instability (CAI), including a history of acute LAS, recurrent ‘giving way’ episodes, insecurity on unstable surfaces, recurrent swelling, stiffness, and diffuse hindfoot pain that is aggravated by activity or uneven ground. Persistent pain over the sinus tarsi is common. Few special tests for STJ instability exist. Imaging with stress radiograph, diagnostic ultrasound, and MRI all have varying degrees of effectiveness of visualising soft tissue damage within the STJ complex. Laboratory-oriented evidence supports the vital role of ankle intrinsic ligaments for ankle instability, yet clinically-relevant research on evaluating and treating the STJ complex lags. This critical review summarises the literature, providing model to support further investigations into the role of the STJ complex in CAI. Future research should focus on identifying the clinical population overlap of CAI patients and those with concurrent STJ complex instability, and the best practices for clinical action when the intrinsic ankle ligaments are involved.

Comparison of talar cartilage thickness between those with and without chronic ankle instability: a ultrasonography study

Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking. The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability. PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956. Twenty articles were included, of which only one investigated individuals whoexperienced alateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 whoexperienced alateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability. The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.

Lateral ankle sprains are common musculoskeletal injuries, especially in active individuals, with up to 70% cases leading to chronic ankle instability (CAI). CAI is characterized by recurrent ankle sprains, persistent dysfunction, and an increased risk of long-term joint degeneration. Strength deficits at the ankle are one of the hallmark symptoms of CAI, directly impacting joint stability and functional performance. Does incorporating blood flow restriction (BFR) training, either applied passively without concurrent exercise or combined with rehabilitation exercises, enhance ankle strength in individuals with CAI compared with traditional rehabilitation methods? (1)Three studies were reviewed to evaluate the effects of BFR training on ankle strength in individuals with CAI. (2)Results showed that although BFR alone did not result in consistent improvements in ankle strength, significant improvements in ankle strength across all 4 directions (plantarflexion, dorsiflexion, eversion, and inversion) were found when combined with rehabilitation or other therapeutic modalities. BFR training might be most effective when incorporated into a comprehensive rehabilitation plan aimed at improving ankle strength. Although passive BFR (applied without concurrent exercises) demonstrates limited effectiveness, combining BFR with traditional rehabilitation or therapeutic exercises significantly enhances muscle strength at the ankle joint in individuals with CAI. Grade B evidence supports the inclusion of BFR in rehabilitation programs for individuals with CAI to enhance muscle strength.

T1rho MRI of the subtalar articular cartilage is increased in those with chronic ankle instability

<h3>Study Design</h3> Case-Control Study. <h3>Objectives</h3> To investigate the position of the distal fibula in individuals with unilateral chronic ankle instability (CAI) and healthy individuals. <h3>Background</h3> CAI is classified as the presences of residual instability and episodes of ‘giving way’ which occurs following a lateral ankle sprain. It has been theorised that a fibular positional fault occurs following a lateral ankle sprain and this ‘shift’ may contribute to the ongoing ankle instability. <h3>Methods and Measures</h3> Twenty-five subjects with unilateral CAI (height=170.49±9.42 cm, weight=73.66±16.21 kg; age=19.8±1.8 years) and twenty-five subjects with healthy ankles (height=168.36±14.78 cm, weight=73.34±26.35 kg; age=19.7±1.6 years) participated in this study. CAI was identified as anyone scoring an 11 or greater on the Identification of Functional Ankle Instability questionnaire on the affected ankle and zero on the contralateral limb. Healthy subjects had no history of ankle injury on either side. Subjects were fitted with a night splint and positioned side lying on an L board to ensure neutral ankle and hip positioning. A single lateral radiograph was taken of the ankle and this process was repeated on the contralateral limb. A licensed radiologist measured the distance (mm) between the most anterior portion of the tibia and the most anterior portion of the fibula. <h3>Results</h3> Results of the RMANOVA yielded no significant side by group interaction (F_{11, 48}=1.75, p=0.19) and no significant differences between the sides or groups (p&gt;0.05). <h3>Conclusions</h3> It appears that these individuals with CAI did not have a significant shift in fibular position compared to the contralateral healthy limb or healthy individuals with no history of ankle sprains.