Correlates of Perceived Ankle Instability in Healthy Individuals Aged 8 to 101 Years

Published:September 22, 2016DOI:


      • Perceived ankle instability is common in the healthy population.
      • Female sex, younger age, abdominal adiposity, and ankle flexibility are linked with ankle instability.
      • Reference data for the Cumberland Ankle Instability Tool will facilitate the management of ankle instability in clinics and research.



      To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population.


      Cross-sectional observational study.


      University laboratory.


      Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project.


      Not applicable.

      Main Outcome Measures

      Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed.


      Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%–3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P<.001) for each centimeter of increased waist circumference.


      Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.


      List of abbreviations:

      BMI (body mass index), CAIT (Cumberland Ankle Instability Tool), CI (confidence interval), PGT (paper grip test), REDCap (Research Electronic Data Capture), SEIFA (Socio-Economic Index for Areas)
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