Instability in Recommendations for Ankle Instability

To prevent ankle sprains, what's the right course of action - brace or no brace?
 
In my last blog I discussed “toning shoes”, which are designed to create an unstable walking surface for the wearer with the thought that this results in more muscle recruitment.  Today I will discuss instability of a different sort, that of lateral ankle instability (never a desirable thing!) 
 
I recently read a blog written by Dr. Doug Ritchie, a renowned sports medicine podiatrist.  He revealed that he will be part of a multidisciplinary panel over the next year tasked by the National Athletic Trainers Association  to develop guidelines for the prevention of ankle sprains, and to update current treatment guidelines.  He cited a study which came out this past year by Frey, et al published in the Journal Foot and Ankle International entitled, “Prophylactic ankle brace use in high school volleyball players.”   The findings of this study were split, and Dr. Ritchie discusses some flaws of the study responsible for this, particularly that there was a  large study group with a disproportionately small control group. Overall it found no protective benefit in the incidence of ankle sprains with the use of an ankle brace in high school volleyball players. It also contradicted itself by simultaneously concluding, based on a subgroup of subjects, that female players with or without a history of sprains should wear a rigid or semi-rigid brace for this sport. 
 
Obviously, there is some confusion to be cleared up, and I look forward to Dr. Ritchie’s updates from the panel.  In the meantime, what is the outdoor enthusiast with a history of ankle sprains to do when exercising on an unstable surface?
 
The lateral ankle ligaments consist of three ligaments.  When a sprain happens, one of three things has taken place: 1) the ligaments have been stretched (grade I sprain), 2) the ligaments have been partially torn (grade II sprain), or 3)  the ligaments have been completely ruptured (grade III sprain).  Ligaments take 4-6 weeks to heal.  The ankle needs to be braced during this time; otherwise, the ligaments potentially heal in a stretched out position, resulting in a “loose” ankle.  A chronically unstable ankle can eventually become an arthritic ankle.  In addition, I have my athletic patients wear a brace during athletic activity for six months following their injury.
 
But is this the right course of action, and is there a benefit to bracing for previously injured athletes compared to athletes with no prior history of ankle sprain? I look forward to the updates of the panel in answering the question and will be sure to keep you posted!
 

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