Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense.

OBJECTIVE: To present a comprehensive review of the influence of altered kinesthesia and joint position sense on chronic ankle instability and to present a model connecting deficits in ankle position sense with the increased risk of sustaining lateral ankle sprains. DATA SOURCES: I searched MEDLINE for the years 1966-2001 using the key words ankle and kinesthesia or position sense and books on proprioception. DATA SYNTHESIS: Study findings suggest a risk for unprovoked lateral ankle sprains when the lateral border of the foot accidentally catches the ground surface during the late swing phase of normal locomotion. In normal situations, the lateral border of the foot clears the ground by only 5 mm, and a small increase in ankle-position error may substantially increase the risk of a collision. Findings of affected kinesthesia and joint position sense in subjects with chronically unstable ankles dominate over studies showing nonsignificant results, but the answer is far from clear. CONCLUSIONS/RECOMMENDATIONS: Changes in joint position sense and kinesthesia of a magnitude found in subjects with chronically unstable ankles can lead to an increased risk of sustaining lateral ankle sprains. Results from a small number of studies suggest that balance and coordination training can restore the increased uncertainty of joint positioning to normal levels.