The Impact of Ankle Injuries on Postural Stability and Balance Control Among Athletes: A Systematic Review

Abstract

Context:

Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport.

Objective:

To evaluate systematically how different types of ankle injuries affect postural stability in athletes by classifying and comparing findings across distinct sport archetypes (eg, multidirectional, linear, balance-focused) to identify sport-specific impairments.

Data Sources:

A search was conducted in PubMed, Scopus, Embase, and Web of Science from inception up to August 31, 2025, for observational studies assessing postural stability in athletes with ankle injuries.

Study Selection:

Studies published in any language were included if they assessed postural stability in athletes with ankle injuries. Data were extracted independently by 2 authors, and any disagreements were resolved through discussion. Study quality was assessed using Joanna Briggs Institute checklists (cross-sectional: 8-item; cohort: 11-item; case-control: 10-item). Reporting quality was evaluated using the STROBE checklist.

Study Design:

Systematic review.

Level of Evidence:

Level 1.

Data Extraction:

Data were extracted on static and dynamic balance (DB), including postural sway, center of pressure, stabilization times, and reach distances in the Star Excursion Balance Test (SEBT) and Y Balance Test (YBT).

Results:

A total of 59 studies involving 4848 participants were included. Most participants were youth (61%, aged 19-29 years) and adolescent (32%, aged 12-18 years) athletes, with a limited focus on female-only cohorts (6.7% of studies). Athletes with ankle injuries showed deficits in static and DB, with chronic ankle instability (CAI) causing persistent impairments in stabilization times and reduced reach in the SEBT/YBT. Pivoting sports (eg, soccer, basketball) exhibited greater balance deficits than endurance or balance-focused sports.

Conclusion:

Ankle injuries, particularly CAI, result in significant balance impairments, necessitating sport-specific rehabilitation addressing both distal and proximal neuromuscular control. Static tests may underestimate functional deficits.