Rethinking My Position On Preventive Ankle Bracing In Athletes

I have a special interest in the debate over preventive ankle bracing in athletes. In fact, I have voiced my opinion several times over the past two years in articles and blogs in Podiatry Today (see https://bit.ly/cs4JkR and https://bit.ly/qdlUJ9 ).

Most of my previous opinions about preventive ankle bracing have remained consistent. However, I have begun to rethink recommendations I have made in previous articles because of two recent studies. Specifically, I have changed my mind about recommending preventive ankle bracing for adolescent athletes.

Timothy McGuine, PhD, and associates at the University of Wisconsin conducted two high-quality Level 1 studies of preventative ankle bracing in high school athletes.1,2 Both of these studies, published in the American Journal of Sports Medicine, were randomized, prospective controlled trials. The authors tested the effectiveness of a lace-up ankle brace and injury rates in high school basketball and football players. Any practitioner should take notice of the findings in these studies due to their large number of subjects and the prospective design.

The results of the two studies were remarkably similar. In one study, comprised of 1,460 male and female high school basketball players, the rate of acute ankle injury was 0.47 in the braced group and 1.41 in the control (non-braced) group.1 In the other study, which included 2,081 male high school football players, the rate of acute ankle injury was 0.48 in the braced group and 1.12 in the control group.2

In other words, using a lace-up ankle brace reduced the incidence of acute ankle injuries threefold in basketball and more than twofold in football. McGuine and colleagues make some interesting observations and conclusions from their studies. The protective benefit of wearing an ankle brace was significant regardless of whether the athlete had experienced a previous sprain.

The authors also found no correlation of ankle sprain frequency with cleat design or upper design of the shoes (mid-top versus low-top). Finally, the study concluded there was no increased risk of knee injuries associated with wearing an ankle brace. This dispels the myth that restricting ankle motion may translate stress to proximal joints.

Other Pertinent Insights

The authors quote statistics that show that the cost of treating all ankle injuries in high school football players exceeds $581 million a year in the United States.3 With 1.1 million players wearing bilateral lace-up ankle braces, at a per unit cost of about $20 per brace, the total expense for a prevention program would be $40 million.

However, with evidence from this study showing that the braces could prevent 60 percent of the sprains in high school football, the cost savings would potentially exceed $270 million annually.

One observation of these two studies is that the participants wore lace-up style braces (each study used a slightly different brand and design). Most studies of preventive ankle bracing used plastic stirrup style braces. In a previous study of adolescent volleyball players, Frey and colleagues concluded that plastic braces were associated with fewer sprains than lace-up braces.4 The authors of this study, however, did not demonstrate the overall protective benefit of wearing ankle braces in high school volleyball.

In Conclusion

Due to this lack of evidence to show any protective effects of ankle braces on adolescents, I previously concluded that we should not recommend preventive bracing of this age group. These two recently published studies demonstrate significant benefit for wearing ankle braces in high school football and basketball, regardless of whether the athlete had been previously injured.1,2

When anxious parents ask me if their adolescent child should wear ankle braces, I will inform them that the only valid studies are specific to football and basketball. I will also clarify that the authors limited the outcomes of the studies to a lace-up, figure of eight style of ankle brace. Based upon this evidence, if the reduced risk of ankle sprain is at least twofold and authors found no negative effects of bracing, the obvious recommendation would be in favor of bracing versus no bracing at all. I welcome your comments.

References

1. McGuine TA, Brooks A, Hetzel S. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011; 39(9):1840-8.
2. McGuine TA, Hetzel S, Wilson J, Brooks A. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012; 40(1):49-57.
3. US Consumers Product Safety Commission, Directorate of Economic Analysis. Ankle Sprain, Strain and Fracture Injury Costs for Football. Obtained through a data request on April 22, 2011.
4. Frey C, Feder KS, Sleight J. Prophylactic ankle brace use in high school volleyball players. Foot Ankle Int 2010; 31(4):296-300.