prevention of ankle injuries fitmaking

Understanding lateral ankle instability and preventing it with exercises using FLEXVIT® bands

Guest article by NeuroXtrain

Lateral ankle instability (LAI) is a complex condition that is sometimes difficult for general medical professionals to diagnose and treat. The assessment and treatment of chronically unstable ankles is due to the complexity of the unstable ankle. It consists of three joints: the talocrural joint, the tibiofibular syndesmosis and the subtalar joint. All three joints function synchronously to enable the complex movement of the ankle joint. The main factors responsible for the stability of the ankle joint are the joint surfaces, the ligament complex and the muscles that enable the dynamic stabilisation of the joints.

The lateral ankle joint consists of the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL) and the calcaneofibular ligament (CFL).

Parts of the lateral ankle joint:


  • Anterior talofibular ligament (ATFL)
  • Posterior talofibular ligament (PTFL)
  • Calcaneofibular ligament (CFL)

The ATFL originates at the lateral malleolus and attaches to the lateral talar articular facet. The primary function of the ATFL is to resist inversion into plantar flexion. The ligamentum fibulare calcanei originates at the anterior edge of the fibula and attaches to the calcaneus. The CFL crosses both the subtalar joint and the ankle joint.

The primary tasks of the CFL are to resist inversion in neutral and dorsally flexed positions. It also restricts subtalar inversion, which limits talar slope. Finally, the posterior talofibular ligament is the most robust of the lateral ligaments, but only plays a complementary role in ankle stability. The PTFL originates at the posterior edge of the fibula and attaches to the talus. Of the three ligaments, PTFL and ATFL are intracapsular and only the CFL ligament is extracapsular to the ankle joint.

Prevent lateral ankle instability

Why does a chronically unstable ankle occur?

Lateral ligament instability can occur in two ways: through functional or mechanical instability.

Mechanical ankle instability

Mechanical instability results either from an acute injury or from chronic repetitive strain. It leads to a weakening and alteration of the mechanical structures of the ligaments and makes the ankle joint unstable. The most common mechanism of injury in a lateral ankle sprain occurs when a plantar flexion force is applied to an inverted ankle joint as the body moves over the foot. The ATFL is the most frequently damaged ligament, followed by the CFL and then the PTFL.

Ligaments often heal in a stretched position, which can lead to plastic deformation. This in turn further reduces the ability to support the foot.

Frequency of ligament rupture


  • ATFL – most common
  • CFL
  • PTFL – rarest

Functional ankle instability

Functional instability is the sensation of ankle instability or recurrent, symptomatic ankle sprains due to proprioceptive loss. Lateral ankle instability can also be caused by hereditary ligament laxity associated with Marfan syndrome, Ehlers-Danlos syndrome and Turner syndrome.


Prevention of ankle injuries in sport

40% of all sports injuries are ankle sprains. This makes ankle sprain (AS) the most common injury at sporting events. 50% of basketball traumas and almost 30% of football injuries can be directly attributed to ankle injuries.


The literature reports that women have a 25% higher rate of grade I sprains compared to men. In addition, they have a higher predisposition to future sprains once they have suffered an ankle sprain.


The ATFL is involved in 90% of all ankle sprains, while the CFL is involved in 50-75% of cases and the PTFL in only 10% of cases.

Medical history and physical examination

A detailed history can point the doctor in the right direction when diagnosing a patient with unstable ankles or ankle pain. Patients will regularly report repeated episodes of the ankle “giving way” on unsteady terrain or feeling loose. They may pay particular attention to certain activities where they are aware of potential harm. Ankle pain can also be a problem, although it is generally not the main complaint.


Hypermobility should also be an issue in the initial assessment of patients as laxity can lead to additional injury. Range of motion and strength are also critical for a complete examination, especially when compared to the contralateral limb (unaffected side).


Ankle sprains are classified into 3 grades, from the mildest to the most severe injury.

Functional classification of ankle sprains

Grade I – the patient can put full weight on the foot and walk.

Grade II – the patient walks with a distinct limp.

Grade III – the patient can no longer walk.

Anatomical classification

Grade I – Stretching of the collateral ligament complex.

Grade II – Partial tear of one or more ligaments of the collateral ligament complex.

Grad III – Complete rupture of the lateral ligament complex.

Stadium I – Involvement of the ATFL – microscopic ruptures.

Stadium II – ATFL involvement predominantly with CFL injury.

Stadium III – ATFL and CFL involvement with complete disruption of both bands and gross laxity noted on examination.

Treatment and management

Conservative treatment of lateral ankle instability consists of early functional rehabilitation, including protection of the chronically unstable ankle as well as:

  • Rest
  • Uplifting Position
  • Compression
  • Restoration of the range of motion
  • Progressive weight loading taking into account symptom tolerance
  • Physiotherapy
Prevent ankle injuries

Even with adequate functional rehabilitation, 10 to 40 % of patients develop a chronically unstable ankle after an acute ankle sprain. Several studies have been published that show the advantages of conservative therapy on the one hand. On the other hand, they also outline surgical treatment for cases that do not respond adequately to conservative treatment.

More than 70 different surgical techniques for correcting the unstable ankle have been described in the literature. They can be divided into three main categories:

  • anatomical
  • non-anatomical
  • Anatomically augmented tenodesis reconstruction

Let’s look at some exercises that can be done with elastic fitness bands (FLEXVIT ®). This can prevent ankle sprains and strengthen the muscle that surrounds the ankle joint.

Fitnessband Exercises

Exercise 1: Hip abduction and ankle eversion

Trains the gluteus medius and peroneus muscles, which has been shown to be essential for rehabilitation after an ankle sprain or unstable ankle. It also prevents future possible ankle injuries.


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Exercise 2: Isolated ankle eversion

The peroneus muscles.


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Exercise 3: Proprioception + ankle dorsiflexion training


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Gibboney MD, Dreyer MA. Lateral Ankle Instability. [Updated 2020 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.

Distributed under the terms of the Creative Commons Attribution 4.0 International License.

About the Authors

Team NeuroXtrain

Antoine Fréchaud (left) and Nathan Touati (right) run NeuroXtrain, a website specialising in writing articles and various content on sports science, athlete rehabilitation, performance and new technologies for athlete health.

Find other Articles from NeuroXtrain in our Blog or online.

Practical content such as videos on specific rehabilitation/prevention/strengthening exercises and much more:

DISCLAIMER: This content (the description, images and videos) does not constitute medical advice or a treatment plan and is intended for general educational and demonstration purposes only. This content should not be used for self-diagnosis or self-treatment of any health, medical or physical condition. This content cannot replace professional advice or a visit to a doctor. Before using exercises against specific complaints, a doctor or physiotherapist should always be consulted to be on the safe side.