Do individuals with ankle instability show altered lower extremity kinematics and kinetics during walking? A systematic review and meta-analysis

Objective To determine if individuals with chronic ankle instability (CAI) demonstrate altered lower extremity kinematics and kinetics during walking. Data sources Relevant studies were sourced from PubMed, Embase, Cochrane Library, Web of Science, EBSCO and PEDro. Study selection Kinematic and kinetic studies involving joint angle and/or joint moment measured in individuals with CAI were included. Study appraisal and synthesis methods The Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess literature quality. Weighted mean differences (WMDs) in joint angles and moments between CAI and controls were analyzed as continuous variables. Results 1261 articles were screened, with a final selection of 13 studies involving 729 participants. Compared to non-CAI controls, CAI participants showed significantly greater ankle inversion angle (degree) (WMD: 3.71, 95% CI: 3.15 to 4.27, p < 0.001), hip adduction angle (degree) (WMD: 1.60, 95% CI: 0.09 to 3.11, p = 0.04), and knee valgus moment (Nm/kg) (WMD: 0.07, 95% CI: 0.01 to 0.13, p = 0.02) during walking. Additionally, there were no consistent findings or specific altered patterns in other lower extremity joint angles, or moment changes, regardless of the motion plane (sagittal, coronal, horizontal), for CAI compared with controls. Conclusions This review provides further evidence of altered lower limb kinematics and kinetics in the frontal plane in CAI participants during certain walking phases, which may partially explain the high level of recurrent ankle sprains observed in the CAI population, and support hip abduction and ankle eversion motor control exercises for CAI rehabilitation. Systematic review registration number PROSPERO (CRD42023420418). Key messages •Individuals with CAI exhibit greater ankle inversion and hip adduction angles during certain phases of walking compared to non-CAI controls.•There may be an increase in the knee valgus moment of individuals with CAI. •Altered lower extremity kinematics and kinetics may be associated with the occurrence of recurrent ankle sprains in CAI.