Advice on Foot Care

Research published in this month’s issue of Clinical Rehabilitation found balance training to significantly improve stability in those individuals with a history of chronic ankle sprains. Twenty-nine participants with chronic ankle instability were assigned to a 4 week balance training group or a control group. The participants in the balance training group had supervised ankle rehabilitation with emphasis on balance stabilization in a single-limb stance for four weeks. After the four weeks, the control group showed no difference in balance or ankle movement control, but the ankle balance training group showed improvement in both. The same authors studied ankle instability in another group of 31 individuals with chronic ankle instability. The participants were also randomly divided into an intervention group and a control group. The intervention group received 4 weeks of supervised balance training, while the control group received no training. They found that the balance training group had significant improvements in not only the postural control and balance tests, but they also reported less instability in their ankles.

The theory behind balance training is the interaction between the receptors in the joints and the brain. When an injury occurs to the ankle, the receptors in the ankle are damaged along with the ligaments. Once the receptors are damaged, they do not send reliable signals to the brain to report ankle movements. The brain’s ability to know what position the joint is called proprioception. Balance training has been shown to improve proprioception.

For individuals with chronic ankle instability (repeated ankle sprains), a 4-6 week balance training program with the following exercises may help. Only try the balance training after an ankle sprain has healed or at the advice of your physician. Start with the first stance and do the sets each day until you can complete them, then move on to the next step.

1. Stand on one leg and try not to wobble. Hold this stance for a minute. Rest and then repeat ten times.
2. Once you can stand without wobbling on one leg, do the above set with arms across your chest.
3. Once you can complete the above step, try the same set with your eyes closed.
4. Once you can complete the above step, stand on one leg and hop up and down ten times. Rest and then repeat this step 10 times or until the leg fatigues. Do not hop repeatedly if the ankle feels unstable.
5. Once you can complete the above step, start with step #1, except use a pillow. The pillow will mimic an unstable surface.

Do not try the exercises with an injured ankle. If the ankle feels unstable (as if it will give out from under you) then stick with step 1 until the ankle feels more stable. Another trick is try standing on one leg while brushing your teeth, or even when standing in line at the store. Anytime when you are standing, lift the unaffected leg and try to balance for a minute.

McKeon PO, Paolini G, Ingersoll CD, Kerrigan DC, Saliba EN, Bennett BC, Hertel J.  Effects of balance training on gait parameters in patients with chronic ankle instability: a randomized controlled trial. Clin Rehabil. 2009 Jul;23(7):609-21.

McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. J. Med Sci Sports Exerc. 2008 Oct;40(10):1810-9.

More information on ankle sprains.

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