Hoop Mom: Ankle Instability

Teresa finds some answers and counsel for a three-sport, ninth-grade athlete who suffers chronic ankle sprains and whose parent is wondering about ankle braces.

My daughter is in ninth grade, and she is a chronic ankle sprainer! She plays basketball, volleyball and softball and has turned her ankle in each sport. She has been to a physical trainer for strength training of her ankle, but he still recommends she wear an ankle brace forever. She has been having her ankles wrapped daily. Can you advise? And is the brace the way to go, and if so, is there one really good one for all sports?

Wondering

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Dear Wondering:

When it comes to the world of ankles, I turn to my reliable source: Richard T. Bouché, DPM, of The Sports Medicine Clinic in Seattle (and former team podiatrist for the Seattle Storm). According to Dr. Bouché, chronic ankle instability can be difficult since "the damage is done" concerning ligaments on the outside – or lateral – part of the ankle. He notes that ankle instability can be mechanical or functional, and it’s important to determine which type of instability your daughter is experiencing.

"Functional instability can be treated conservatively if the causative factors are identified (e.g., a tight Achilles tendon, weak muscles, etc.) and it is determined that no mechanical instability exists," Dr. Bouché says. "Functional instability usually responds well to an aggressive physical therapy program stressing dynamic strengthening and proprioceptive (position sense) exercises."

Mechanical instability, on the other hand, can be determined by ankle examination and special "stress testing" that checks for damaged ligaments. If mechanical instability is established, Dr. Bouché says, an ankle rehabilitation program can be attempted.

If rehab efforts aren’t effective, "appropriate mid- or high-top, stable athletic shoes are recommended as well as an ankle brace," he says. Ankle braces can vary from elastic sleeves to sleeves with straps to lace-up braces to plastic AFO (ankle-foot-orthoses) devices. All ankle braces provide some proprioceptive effect, he adds, but many of the braces that provide mechanical stability can be bulky and cumbersome, which limits some of the normal desired motions of the ankle.

Patients with chronic ankle instability who have not responded to conservative treatment should be evaluated by a sports physician, who is likely to recommend specific shoes and an ankle brace, Dr. Bouché recommends. Shoes for each sport should be evaluated for stability and brace compatibility: The brace needs to fit appropriately and should work well with athletic shoes.

"The brace should provide some mechanical stability but will not be a panacea to prevent further injury," he says. "Right now there probably is no brace on the market that can completely prevent one from spraining their ankle."

Dr. Bouché recommends www.ankleshop.com as a starting point for viewing the variety of ankle braces on the market. "If your daughter has severe instability, then a lace-up brace with straps is probably a good place to start," he says. "If the ankle instability continues despite ankle bracing and appropriate shoes, seek professional care – surgery may be a consideration."

Good luck to your daughter.

Hoop Mom

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Teresa Wippel has been involved with select basketball for a number of years and is mom to 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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