Functional instability of the ankle and the role of neuromuscular control: a comprehensive review

A review of current knowledge of the clinical syndrome of functional ankle instability is presented. Recent evidence has demonstrated that the majority of patients with functional instability of the ankle do not have mechanical hypermobility of the ankle joint. Functional instability of the ankle results from a loss of neuromuscular control. Components of neuromuscular control include proprioception, muscle strength, muscle reaction time, and postural control. Proprioceptive deficits lead to a delay in peroneal reaction time, which appears to be a peripheral reflex. Proprioception and eversion muscle strength improve with the use of passive supportive devices. Balance and postural control of the ankle appear to be diminished after a lateral ankle sprain and can be restored through training that is mediated through central nervous mechanisms. Methods of detecting deficits in neuromuscular control are presented along with rehabilitation techniques to treat functional instability of the ankle.