Intrinsic risk factors for inversion ankle sprains in females--a prospective study

Ankle sprains are extremely common. However, very little is known about the variables that predispose individuals to these injuries. The purpose of this study was to examine prospectively intrinsic risk factors for inversion sprains in a young physically active female population. One hundred and fifty-nine female physical education students were evaluated for several possible intrinsic risk factors for inversion sprains at the beginning of their academic study. The evaluated intrinsic risk factors included anthropometrical and physical characteristics, ankle joint position sense, isokinetic ankle muscle strength, lower leg alignment characteristics, postural control and muscle reaction time during a sudden inversion perturbation. All sports injuries were registered during 1-3 years and exposure to sport was recorded (mean: 15.33+/-4.33 h a week). Thirty-two (20%) of the 159 females sprained their ankle. The number of ankle sprains per 1000 h of sports exposure was 0.75. The Cox regression analysis revealed that females with less accurate passive joint inversion position sense [hazard ratio (HR): 1.08, 95% confidence interval (CI): 1.02-1.14 for absolute error at 15 degrees inversion], a higher extension range of motion at the first metatarsophalangeal joint (HR: 1.03, 95% CI: 1.00-1.06) and less coordination of postural control (HR: 0.96, 95% CI: 0.93-1.00 for endpoint excursion; HR: 0.94, 95% CI: 0.89-0.99 for maximal endpoint excursion) are at greater risk of an ankle sprain. The findings of this study suggest that effective prevention and conservative rehabilitation of ankle inversion sprains should include attention to these variables.     

Intrinsic predictive factors for ankle sprain in active university students: A prospective study

The ankle is the joint most affected among the sports‐related injuries. The current study investigated whether certain intrinsic factors could predict ankle sprains in active students. The 125 participants were submitted to a baseline assessment in a single session were then followed‐up for 52 weeks regarding the occurrence of sprain. The baseline assessment were performed in both ankles and included the questionnaire Cumberland ankle instability tool – Portuguese, the foot lift test, dorsiflexion range of motion, Star Excursion Balance Test (SEBT), the side recognition task, body mass index, and history of previous sprain. Two groups were used for analysis: one with those who suffered an ankle sprain and the other with those who did not suffer an ankle sprain. After Cox regression analysis, participants with history of previous sprain were twice as likely to suffer subsequent sprains [hazard ratio (HR) 2.21 and 95% confidence interval (CI) 1.07–4.57] and people with better performance on the SEBT in the postero‐lateral (PL) direction were less likely to suffer a sprain (HR 0.96 and 95% CI 0.92–0.99). History of previous sprain was the strongest predictive factor and a weak performance on SEBT PL was also considered a predictive factor for ankle sprains.     

The effect of ankle taping or bracing on proprioception in functional ankle instability: A systematic review and meta-analysis

ObjectivesTo determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability.DesignSystematic review and meta-analysis.MethodsStudies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace.ResultsEight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08°, 95% CI: ?0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately.ConclusionsThe pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability.     

Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study.

OBJECTIVE: To identify intrinsic predictors of lateral ankle sprain. DESIGN: Prospective cohort study. SETTING: A performing arts secondary school and a dance school. PARTICIPANTS: One hundred fifteen adolescent dancers (94 female and 21 male) entered the study. One ankle of each dancer was randomly assigned to a test group (n = 114), and the other was assigned to a validation group (n = 112). PREDICTORS: Eighteen measures, including age, dance history, previous ankle sprain, ankle and foot laxity and range of motion, and balance from test ankles were entered into a backwards stepwise Cox regression model. The model generated with the test group was used to predict ankle sprains in the validation group. MAIN OUTCOME MEASURE: Time to first lateral ankle sprain. RESULTS: An increased risk of sprain in the test group was predicted by younger age [hazard ratio (HR) = 0.65, 95% CI 0.45-0.94], previous sprain of the contralateral ankle (HR = 3.76, CI 1.24-11.40), increased passive inversion range (HR = 1.06, CI 1.00-1.12), and inability to balance on demipointe (HR = 3.75, CI 1.02-13.73). Of these predictors, only previous sprain of the contralateral ankle significantly predicted ankle sprain in the validation group (HR = 3.90, CI 1.49-10.22). The predictive accuracy of this variable was not strong (positive likelihood ratio of 2.01 and negative likelihood ratio of 0.45). CONCLUSION: A history of previous lateral ankle sprain is associated with an increase in the risk of future sprain of the contralateral ankle.     

Parachute ankle brace and extrinsic injury risk factors during parachuting

INTRODUCTION: This study examined the injury prevention effectiveness of the parachute ankle brace (PAB) while controlling for known extrinsic risk factors. METHODS: Injuries among airborne students who wore the PAB during parachute descents were compared with injuries among those who did not. Injury risk factors from administrative records included wind speed, combat loads, and time of day (day/night). Injuries were collected in the drop zone. RESULTS: A total of 596 injuries occurred in 102,784 parachute descents. In univariate analysis, students not wearing the PAB (Controls) were 2.00 [95% confidence interval (95% CI) = 1.32-3.02] times more likely to experience an ankle sprain, 1.83 (95% CI = 1.04-3.24) times more likely to experience an ankle fracture, and 1.92 (95% CI = 1.38-2.67) times more likely to experience an ankle injury of any type. PAB wearers and Controls had a similar incidence of lower body injuries exclusive of the ankle [risk ratio (Control/PAB) = 0.92, 95% CI = 0.65-1.30]. After accounting for known extrinsic injury risk factors, Controls were 1.90 (95% CI = 1.24-2.90) times more likely than PAB wearers to experience an ankle sprain, 1.47 (95% CI = 0.82- 2.63) times more likely to experience an ankle fracture, and 1.75 (95% CI = 1.25-2.48) times more likely to experience an ankle injury of any type. The incidence of parachute entanglements that persisted until the jumpers reached the ground were similar among PAB wearers and Controls IRR (Control/PAB) = 1.17, 95% CI = 0.61-2.29]. CONCLUSION: After controlling for known injury risk factors, the PAB protected against ankle injuries, and especially ankle sprains, while not influencing parachute entanglements or lower body injuries exclusive of the ankle.     

Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes

ObjectivesTo investigate lower extremity muscle strength as risk factor for an acute ankle injury in youth athletes.DesignCohort study.SettingBasketball and floorball clubs.Participants188 youth (≤21) male and 174 female athletes.Main outcome measures1RM leg press, maximal concentric isokinetic quadriceps and hamstrings as well as maximal isometric hip abductor strength were measured and athletes were followed for an acute ankle injury up to three years. Cox regression models were used in statistical analyses.ResultsIn males, greater 1RM leg press and maximal quadriceps strength increased the risk of any type of acute ankle injury (Hazard ratio [HR] for 1 SD increase, 1.63 [95% CI, 1.12–2.39] and 1.43 [95% CI, 1.01–2.01], respectively). In females, greater 1RM leg press and difference between legs in hip abduction strength increased the risk of acute non-contact ankle injury (HR for 1 SD increase, 1.44 [95% CI, 1.03–2.02] and 1.44 [95% CI, 1.03–2.00], respectively). However, ROC curve analyses showed AUC:s of 0.57–0.64 indicating “fail” to “poor” combined sensitivity and specifity of these tests.ConclusionGreater strength in both sexes along with asymmetry in hip abductor strength in females increased the risk of acute ankle injury.     

Effects of elastic ankle support on running ankle kinematics in individuals with chronic ankle instability and healthy controls

BackgroundIndividuals with chronic ankle instability (CAI) have an increased risk for recurrent injuries. The preventive effects of external ankle supports are not fully understood. This study aimed to examine the effect of elastic ankle support on running ankle kinematics.Methods3D running gait analysis of individuals with and without CAI was conducted at three-minute-running trials at 2.78 m/s with and without elastic ankle support in a randomised order. Ankle kinematics and intra-individual standard deviations (variability) were calculated at each percent of the running gait cycle. Group and ankle support effects were calculated using statistical parameter mapping.ResultsTwenty-seven individuals were analysed (CAI: n = 14, controls: n = 13). When wearing ankle support, CAI individuals showed significantly decreased plantarflexion angles at 43–47 % (p = 0.033) and 49–51 % (p = 0.043) of the running gait cycle compared to normal running. In healthy controls, no differences in ankle angles between both conditions were found. Comparisons between CAI individuals and healthy controls showed statistically significant differences in the plantar-/dorsiflexion angles at 38–41 % (p = 0.044) with ankle support and at 34–46 % (p = 0.004) without ankle support. Significant ankle angle variability differences were found for ankle in-/eversion between CAI individuals and healthy controls (p = 0.041) at 32–33 % of the running gait cycle.ConclusionsElastic ankle support reduces the range of sagittal plane running ankle kinematics of CAI individuals but not of healthy controls. Further research is needed to evaluate the association between ankle support effects and the risk for recurrent ankle sprains.     

Center of pressure during stance and gait in subjects with or without persistent complaints after a lateral ankle sprain

Study aimTo investigate differences in the center of pressure (COP) during gait and single leg stance between subjects with persistent complaints (PC) and without persistent complaints (NPC) after a lateral ankle sprain.Methods44 patients who consulted the general practitioner, 6–12 months prior to inclusion, with a lateral ankle sprain were included for the current study purpose. Using a 7-point Likert scale patients were divided into the PC or NPC group. All subjects filled out an online questionnaire, walked along a walkway and performed a single leg stance, both on the RSscan. Primary outcomes included the COP displacement, range and percentage used in mediolateral and anterioposterior direction.ResultsThere was a trend (p < 0.05) towards a more medially COP trajectory during walking at 34–46% and 83–96% and more anteriorly at 21–31% and 91–100% of the stance phase in the PC group compared to NPC group. Additionally, the COP was more laterally located in the sprained leg compared to the non-sprained leg in the PC group in the loading response phase (p < 0.05). An interaction was found for the percentage of anterior–posterior range used in single leg stance without vision.ConclusionThe COP trajectory discriminates between patients with PC and NPC. This indicates that roll off during gait might play an important role in the recovery of patients after a lateral ankle sprain and could be used to monitor treatment.     

Continued validation and known groups validity of the Quick-FAAM: Inclusion of participants with chronic ankle instability and ankle sprain copers

ObjectiveTo examine the factor structure and validity of the Quick-FAAM in individuals with chronic ankle instability (CAI) and those classified as ankle sprain copers (ASC).DesignCross-sectional.SettingLaboratory.ParticipantsAdult participants were included in both groups based on previously established criteria.Main outcome measure(s)The 12-item Quick-FAAM is scored on a 5-point Likert scale were scores are converted to a percentage (0–100%), and greater scores indicate greater function. The Cumberland Ankle Instability Tool (CAIT) is a 9-item scale used to assess impairments in individuals with a history of ankle sprain. Scores range from 0 to 30, and greater scores indicate greater impairment levels. Confirmatory factory analyses, internal consistency, and concurrent validity were determined. Known-groups validity and differences in scores between groups were examined. Alpha was set at p < 0.05.ResultsThe instruments were strongly correlated (r = 0.76, p < 0.001), the Quick-FAAM internal consistency remained high (α = 0.94) and the single factor was confirmed. The cutoff score differentiating between the groups was 94.79%.ConclusionsThe Quick-FAAM is a valid, shortened version of the FAAM. It also has the ability to discriminate between individuals with CAI and those classified as ASC. The Quick-FAAM should be considered for future use with individuals who have ankle sprain history.     

Clinical and radiological predictors for persistent complaints five years after a lateral ankle sprain: A long-term follow-up study in primary care

Objectives

To examine the five-year prognosis and potential prognostic factors of patients with an acute lateral ankle sprain in primary care setting.

A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players

Epidemiological studies have shown that 10–28% of all sports injuries are ankle sprains, leading to the longest absence from athletic activity compared to other types of injuries. This study was conducted to evaluate the effectiveness of external ankle supports in the prevention of inversion ankle sprains and identify which type of ankle support was superior to the other. A search strategy was developed, using the keywords, ankle supports, ankle brace, ankle tapes, ankle sprains and athletes, to identify available literature in the databases (MEDLINE, PubMed, CINAHL, EMBASE, etc.), libraries and unpublished papers. Trials which consider adolescents and adults, elite and recreational players as participants were the study of choice. External ankle supports comprise ankle tape, brace or orthosis applied to the ankle to prevent ankle sprains. The main outcome measures were frequency of ankle sprains. Two reviewers assessed the quality of the studies included using the Joanna Briggs Institute (JBI Appraisal tool). Whenever possible, results were statistically pooled and interpreted. A total of seven trials were finally included in this study. The studies included were of moderate quality, with blinding as the hardest criteria to fulfill. The main significant finding was the reduction of ankle sprain by 69% (OR 0.31, 95% CI 0.18–0.51) with the use of ankle brace and reduction of ankle sprain by 71% (OR 0.29, 95% CI 0.14–0.57) with the use of ankle tape among previously injured athletes. No type of ankle support was found to be superior than the other.     

Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

BackgroundAnkle osteoarthritis (OA) is associated with several physical impairments but investigations into balance impairments in this population are limited. Understanding balance impairments in ankle OA may help inform the management of this condition.Research questionDoes balance overall performance differ between individuals with symptomatic radiographic ankle OA, asymptomatic radiographic ankle OA and healthy controls? Are there any differences in mediolateral or anteroposterior balance, or confidence to perform balance tasks between these groups?MethodsNinety-six volunteers (31 symptomatic radiographic ankle OA, 41 asymptomatic radiographic ankle OA and 24 healthy controls) completed six static balance tasks: bilateral stance on a firm surface, bilateral stance on foam, and tandem stance, all performed with eyes open and closed. Centre of pressure (COP) data were collected using force plates. Confidence to perform each balance task was collected using an 11-point numerical rating scale.ResultsCompared to controls, participants with symptomatic radiographic ankle OA had greater COP area when standing on a firm surface, foam and in tandem with eyes closed (all p < 0.05) and greater total COP sway in both firm surface and tandem stance conditions (p < 0.04). Participants with symptomatic ankle OA had greater COP area (p < 0.04) and total COP sway (p = 0.01) than those with asymptomatic ankle OA during tandem stance. Total COP sway and area were similar between asymptomatic ankle OA and control participants. Some differences in mediolateral and anteroposterior balance were identified between groups. Individuals with symptomatic ankle OA had lower confidence to perform the tandem stance eyes closed task compared to controls.SignificanceBalance impairments and decreased balance confidence were identified in those with symptomatic radiographic ankle OA compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that balance deficits in ankle OA may be related to symptoms, rather than radiographic evidence of disease.     

The identification of risk factors for ankle sprains sustained during netball participation

ObjectivesAnkle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies.DesignProspective study.ParticipantsNinety-four netball players from club and inter-district teams.MethodsPreseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded.ResultsEleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation – a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00–16.35).ConclusionsThe identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance.     

Greater knee varus angle and pelvic internal rotation after landing are predictive factors of a non-contact lateral ankle sprain

ObjectivesThis study aimed to clarify the kinematic, kinetic characteristics associated with lateral ankle sprain.DesignA 16-month prospective cohort study.SettingLaboratory.ParticipantsA total of 179 college athletes.Main outcome measuresJoint kinematics, moment during single-leg landing tasks, and ankle laxity were measured. The attendance of each participating team, injury mechanism, existence of body contact, presence of orthosis, with or without medical diagnosis, and periods of absence were recorded.ResultsTwenty-nine participants incurred lateral ankle sprain during non-contact motion. The Cox regression analysis revealed that greater knee varus peak angle (hazard ratio: 1.16 [95% confidence interval: 1.10–1.22], p < 0.001) and greater pelvic internal rotation peak angle toward the support leg were associated with lateral ankle sprain (hazard ratio: 1.08 [95% confidence interval: 1.02–1.15], p = 0.009). The cut-off values for each predictive factor were −0.17° (area under the curve = 0.89, p < 0.001) and 6.63° (area under the curve = 0.74, p < 0.001), respectively.ConclusionsA greater knee varus peak angle and pelvic internal rotation peak angle after single-leg landing are predictive factors for lateral ankle sprain.     

Whole-body vibration and stretching enhances dorsiflexion range of motion in individuals with chronic ankle instability

ObjectiveThe purpose of this study was to determine if WBV performed concurrently with static stretching was more effective than static stretching alone to increase dorsiflexion ROM (DFROM) in individuals with chronic ankle instability (CAI).DesignControlled laboratory study.ParticipantsThirty-nine participants with CAI (history of ankle sprain, a feeling of “giving way” during activity, and a qualifying Foot and Ankle Ability Measure Ankle score) were divided into 3 groups (normative (N), static stretch (SS), and static stretch with vibration (SV)). Participants stretched the triceps surae 4 days/wk for 3 wks. Vibration was imposed at 34 Hz and 1.8 mm.Main outcome measuresDFROM was assessed in a straight and bent-leg position.ResultsNo differences were detected at any time in the N or SS group, however SS did exhibit large effect sizes with 95% confidence intervals (CI) that did not cross zero from baseline to 3 weeks for both measures. The SV group demonstrated increased DFROM from baseline for both time points and a large effect size with 95% CI that did not cross zero from post tx-1 to post tx-2.ConclusionsStatic stretching with WBV increases DFROM in participants with CAI more effectively than static stretching alone.     

The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players

BACKGROUND: A high body mass index and previous ankle sprains have been shown to increase the risk of sustaining noncontact inversion ankle sprains in high school football players. HYPOTHESIS: Stability pad balance training reduces the incidence of noncontact inversion ankle sprains in football players with increased risk. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Height, body mass, history of previous ankle sprains, and current ankle brace/tape use were documented at the beginning of preseason training in 2 high school varsity football teams for 3 consecutive years (175 player-seasons). Players were categorized as minimal risk, low risk, moderate risk, and high risk based on the history of previous ankle sprain and body mass index. Players in the low-, moderate-, and high-risk groups (ie, any player with a high body mass index and/or a previous ankle sprain) were placed on a balance training intervention on a foam stability pad. Players balanced for 5 minutes on each leg, 5 days per week, for 4 weeks in preseason and twice per week during the season. Postintervention injury incidence was compared with preintervention incidence (107 players-seasons) for players with increased risk. RESULTS: Injury incidence for players with increased risk was 2.2 injuries per 1000 exposures (95% confidence interval, 1.1-3.8) before the intervention and 0.5 (95% confidence interval, 0.2-1.3) after the intervention (P < .01). This represents a 77% reduction in injury incidence (95% confidence interval, 31%-92%). CONCLUSION: The increased risk of a noncontact inversion ankle sprain associated with a high body mass index and a previous ankle sprain was eliminated by the balance training intervention.     

Hip and knee muscle torque is not impaired in the first three months of a first-time lateral ankle sprain

ObjectivesThe primary objective was to compare hip and knee isometric muscle strength between individuals with a first-time acute lateral ankle sprain and controls. A secondary objective was to investigate hip and knee isometric muscle strength three months post-injury.DesignCross-sectional and prospective follow-up components.SettingLaboratory environment.ParticipantsForty-two participants (21 acute lateral ankle sprain and 21 controls) matched for age, sex, physical activity and leg dominance participated.Main outcome measuresHip and knee isometric muscle torque was assessed using a rigidly fixated hand-held dynamometer. Testing in acute lateral ankle sprain participants was performed within four weeks of injury and three months post-injury. Controls were tested at one timepoint.ResultsThere were no differences in hip or knee isometric muscle torque between acute lateral ankle sprain and control participants (mean differences <0.08). Hip and knee isometric muscle torque in acute ankle sprain participants did not differ between baseline and three months post-injury testing (mean difference <0.06).ConclusionsProximal lower limb isometric strength is not impaired within the first three months of sustaining a first-time lateral ankle sprain injury. This implies that hip and knee isometric strength deficits in individuals with CAI may occur at some later stage.     

Y-balance test performance and BMI are associated with ankle sprain injury in collegiate male athletes

Objectives

To determine if static balance, dynamic balance, ankle range of motion, body mass index (BMI), or history of an ankle sprain were associated with ankle sprain injuries within male and female collegiate athletes.

Subgroup characteristics of patients with chronic ankle instability in primary care

ObjectivesTo examine clinical and radiological characteristics of participants with an ankle sprain in general practice, classified into subgroups of a previously described chronic ankle instability (CAI) model.DesignCross-sectional study.Methods206 participants, who visited their general practitioner with a lateral ankle sprain 6–12 months before inclusion, completed a questionnaire, physical examination, radiography and magnetic resonance imaging. They were classified into three subgroups of the previously described CAI-model: mechanical instability (MI), perceived instability (PI) and recurrent sprains (RS). Regression analyses were applied to evaluate differences in subgroup characteristics.ResultsA total of 192 participants were eligible to be classified into the model. Of these participants, 153 participants were classified into the subgroups and 39 could not be classified. With overlap between the subgroups and patients falling into more than one subgroup, 59 were classified having MI, 145 having PI and 30 having RS. Participants with RS and PI were more often sports participants (OR 6.83;95%CI 1.35–34.56 and OR 4.44;95%CI1.06–18.63 respectively) than participants without RS and PI. Participants with MI more often had a tenderness on palpation of the anterior talofibular ligament (OR 4.09;95%CI 1.91–8.72) and a KL-score ≥ 1 in the talonavicular joint on X-ray (OR 2.24;95%CI 1.09–4.58), compared to participants without MI.ConclusionsSports participation, tenderness on palpation of the anterior talofibular ligament and early signs of osteoarthritis were variables that discriminated between subgroups of CAI. However, further research is mandatory in order to examine the usefulness of the CAI model in relation to prognosis and suitable intervention.     

Structural and functional foot and ankle characteristics associated with falls in older people

BackgroundFalls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors.Research questionwhat are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults?MethodOne hundred eighty-seven community-dwelling older adults (106 females) aged 62–90 years (mean 70.5 ± 5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls.ResultsSeventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73−0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15−0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10–6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07–1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02–1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors.SignificanceWe have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.