Hoop Mom: Ankle Braces

Teresa gets a viewpoint from Rich Bouche', the Storm team podiatrist, on using ankle braces.

Thanks for your recent column from Dr. Rich Bouche` on ankle sprains. During a recent high school girls’ game I attended, I noticed that every player on one team was wearing ankle braces. I assume this was a preventive measure and was thinking of implementing the same for my team this spring. What does Dr. Bouche` think of this idea?

Seattle Coach

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Dear Coach:

Dr. Bouche` (from the Sports Medicine Clinic at Northwest Outpatient Medical Center and the Seattle Storm Team Podiatrist during the last three seasons) was kind enough to provide the following answer to your question:

Prevention of ankle sprains is an excellent idea but having everyone wear an ankle brace does not address the root of the problem. I recommend that you first assess all the athletes on your team to see if there are any predisposing factors that would likely result in an ankle sprain.

These factors would include muscle weakness (rarely a problem), a tight Achilles tendon (a common problem), lax ligaments (common in the adolescent female population though rarely an issue in itself), inverted heel (rolled out) as seen in high-arched feet, and poor proprioception (balance and position sense).

Because most ankle sprains are not treated adequately, a key question to ask each athlete is if she has ever sprained her ankle before. Athletes who are most susceptible for re-injury are those who have had a prior sprain: the more severe the sprain, the more likely it can be re-injured.

Once these girls have been identified, they should pursue a thorough systematic rehabilitation program that stresses dynamic strength (ankle tendons on the top and outside of ankle), flexibility (especially of the Achilles tendon and calf muscle), and proprioception.

Of all areas of rehabilitation, studies have shown that proprioception is key to a stable ankle. One simple test to assess balance and position sense is to have the player stand barefoot and balance on the involved foot, first with eyes open and then with eyes closed. This position should be maintained easily for a 30 seconds. Players with ankle instability will be unable to hold this position without easily losing their balance.

Exercises with a wobble board, balance board or mini-trampoline are invaluable in the rehabilitation process. It’s a good idea for a physical therapist to oversee the program to ensure that exercises are properly prescribed and performed.

Regarding ankle devices to aid in the management of ankle sprains, there are three basic types of "braces" with different capabilities: Ankle sleeves provide no stability but provide compression and can be used for prevention because of their positive proprioceptive (balance and positioning) effect. These braces don’t tend to limit normal ranges of motion of the foot and ankle, which is good.

Ankle wraps come in two basic types. One is made with an elastic sleeve with "wrap-around" straps and the other consists of a nylon, canvas or neoprene lace-up brace with elastic wrap around straps. Both of these devices provide minimal, if any, stabilizing effect but again assist with proprioception. Many of these wraps can be uncomfortable and can limit some normal range of motion, which is not desirable.

Ankle orthoses (AO) or ankle foot orthoses (AFO) are braces with plastic stays and stirrups. They are effective at stabilizing the ankle in inversion (rolling out) and eversion (rolling in) but become less effective when the player is on the ball of her foot (the most common mechanism of ankle sprain). These braces tend to be bulky and can compromise normal function of the foot and ankle. I liken some of them to a "ski boot" effect – the player will not sprain her ankle but she will be challenged to play the game in a ski boot!

I don’t think there is one ankle device on the market today that will limit excessive ankle inversion (rolling out) without also limiting other normal joint motion. When and if a brace comes out that achieves this goal, then that brace could be recommended for ankle sprain prevention. Until then, my recommendation would be a strong rehab program (emphasizing strength, flexibility and proprioception) and identifying predisposing factors and history of previous injury.

That being said, there are two situations where I do recommend an ankle brace for a limited period of time:

After a grade 2 (partial tear) or a grade 3 (total rupture) sprain. For a six- to 12-month period following the injury, a brace may be needed if the player wants to continue to play regularly (while continuing her rehab, of course). With a chronic ankle sprainer. In this case, a brace may need to be worn indefinitely as the ankle ligaments are loose and the player is highly likely to re-injure the ankle repeatedly. Despite this fact, the player should also undergo an evaluation and attempt a proper rehab program.

Hoop Mom

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Teresa Wippel is team manager of the Warriors Basketball Club, a 6th Grade girls' team from the Seattle area, and mom to Warriors post player Amanda Waldron. In her other life, she is a freelance writer and editor. To ask Teresa a question, email her at

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