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01-12-2014 | Research | Uitgave 1/2014 Open Access

Journal of Foot and Ankle Research 1/2014

Systematic review of chronic ankle instability in children

Journal of Foot and Ankle Research > Uitgave 1/2014
Melissa Mandarakas, Fereshteh Pourkazemi, Amy Sman, Joshua Burns, Claire E Hiller
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-7-21) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MM participated in the conception and design of the study, the collection, selection and review of papers and drafted the final manuscript. FP and AS were involved in the screening, selection and review of papers. JB was involved in the conception and design of the study and critically revised the manuscript for important intellectual content. CH was involved in the conception and design of the study, reviewing the papers and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.



Chronic ankle instability (CAI) is a disabling condition often encountered after ankle injury. Three main components of CAI exist; perceived instability; mechanical instability (increased ankle ligament laxity); and recurrent sprain. Literature evaluating CAI has been heavily focused on adults, with little attention to CAI in children. Hence, the objective of this study was to systematically review the prevalence of CAI in children.


Studies were retrieved from major databases from earliest records to March 2013. References from identified articles were also examined. Studies involving participants with CAI, classified by authors as children, were considered for inclusion. Papers investigating traumatic instability or instability arising from fractures were excluded. Two independent examiners undertook all stages of screening, data extraction and methodological quality assessments. Screening discrepancies were resolved by reaching consensus.


Following the removal of duplicates, 14,263 papers were screened for eligibility against inclusion and exclusion criteria. Nine full papers were included in the review. Symptoms of CAI evaluated included perceived and mechanical ankle instability along with recurrent ankle sprain. In children with a history of ankle sprain, perceived instability was reported in 23-71% whilst mechanical instability was found in 18-47% of children. A history of recurrent ankle sprain was found in 22% of children.


Due to the long-lasting impacts of CAI, future research into the measurement and incidence of ankle instability in children is recommended.

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