Is ankle support a myth?

There are a number of studies cited in this forum thread.

Subjects were filmed at 60 Hz while on an inversion platform that suddenly inverted the right ankle 35 degrees . We measured 5 trials of sudden inversion for each subject in high-top and low-top shoes. [...] RESULTS: The high-top shoes significantly reduced the amount and rate of inversion.

The results from three studies indicate that, in the absence of additional taping or external support, wearing high-top shoes does not reduce the risk of ankle sprains. Indeed, in one study, the wearing of low-top shoes resulted in a lower incidence of ankle sprains compared to high-top shoes (Rovere et al. 1988). In two recently published meta-analysises, it was also concluded that the role of footwear in the prevention of ankle sprains was not clear (Quinn et al. 2000).

In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots.

I think the picture that emerges is this:

From a strictly biomechanical point of view, ankle support works. The same person, in the same state of training, will have a lower risk of ankle injury with a higher-topped shoe or boot.

But in clinical studies that look at injury rates among people who wear different footwear in a real-life training or sports scenario, there are not significant differences.

I think your own experience hints at an explanation for this:

When I do wear shoes (approch shoes etc) I get sore ankles.

Soreness means a body part is stressed more than normal. But the body is generally good at adapting and strengthening frequently overloaded parts until they can perform the same workload without any problems.

Wearing high-topped boots protects your ankles not just from injury but also from becoming strong and agile enough to not sustain injury without that protection.

Since they provide no better protection against injury in the long term, high-top boots are an inferior choice due to their higher weight (the effect of which is amplified when worn on the feet), at least for frequent hikers.

Of course, low-top shoes do come with a higher strain and risk of injury until the training effect sets in; so someone used to always hiking in high-top boots should probably stick to less rough terrain for some time after switching.

posted over 8 years ago

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Michael Borgwardt‭

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The high boots choice extends beyond ankle support and depends on both terrain and personal comfort aspects.

Here in Scotland the paths (when present) can be variable, and underfoot ranges from bog to lichen covered rocks to large loose boulders. A high boot often provides a level of water resistance that low cut boots & shoes don't provide, so a choice about cold and wet feet becomes part of the mix. Often the Goretex type shoes just don't last and have leak points.

If the terrain is loose boulder or slippy rocks then one factor for boots is the impact protection between the side of the ankle and the rock, which isn't there for a trainer/shoe. A bruised ankle bone can ruin a day and make for a long walk out.

On the flip side, my wife had an achilles heel issue which, once there, was exacebated by the boots and she now swears by the low trainers, despite the cold wet feet (the waterproof sox just don't cut it). Meanwhile I'm keeping with my leather boots and wooly sox which keeps my ankles protecetd, feet dry and numb toes warm and cozy. If I was walking in a high dry well marked path region I'd probably change to a lighter weight boot (but still with the padded ankle if scrambling).

It's about whether the environment wins. Choose your clothes and shoes for that.

posted over 8 years ago

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Philip Oakley‭

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Since you asked for actual studies, I think a study on general ankle support in sports will be helpful (It focuses on basketball and volleyball, but has also some generic information that might be useful): Here is a study on ankle support in general.

One should note that hiking does not seem to be affected by that much ankle injuries in general, as mentioned after the abstract:

[...] Some sports like basketball and volleyball have high ground reaction forces when players land from a high jump, which accentuates the sprain and the rate of injury. This accounts for these sports having 79% and 87% of inversion sprains respectively and 2.5 times more ankle injuries than walking or hiking. [...]

On injury prevention:

[...] As has already been mentioned, although some limitation of ankle range of movement can be achieved with taping and bracing, it is doubtful whether tapes and braces will withstand the forces of an inversion sprain [...]

From the summary:

[...] that both mechanical and functional stability of the ankle can be improved with taping [...]

[...] Both taping and braces have been shown to prevent ankle sprains in basketball and soccer players, [...]

And the key points:

• Restrict range of movement
• Reduce reinjury rate
• Improve proprioception
• Limitation of movement is lost after exercise
• No negative effect on most performance tests
• Little negative effect on other joints

Summa sumarum, what I gained from reading this paper:

Ankle support does indeed help - so I guess high boots will indeed help too. But: If you have healthy ankles the differences might not be significant. When the ankles are already instable support seems to be desirable.

I recommend reading over the paper on your own to gain a better picture.

EDIT: * Disclamer: This patent does not link to any research that confirms the following statements, take them with a grain of salt.*

In further research I stumbled upon the following patent.

[...] The sole is so configured that the boot can be defined to hold the wearer's ankle substantially more firmly than has heretofore been possible. The sole is so shaped that the sole configuration itself effectively performs the rolling action, both on initial contact and on take-off from a step or stride, which would otherwise require flexing of the ankle and foot muscles during normal walking. Thus, the present sole makes it possible to construct a hiking boot which has substantially improved performance in terms of protecting the wearer from fatigue and injury while walking long distances over various terrains. [...]

The text above basically states that with this sole less ankle movement is required, therefore reducing the risk of fatigue and therefore injury:

[...] holding the hold the wearer's ankle substantially more firmly [...]

Where we get to the "the force needs to move somewhere else topic (knee)" which is not evaluated, as so often.

The US army performed a test on hiking boots in 1999 - quite an interesting read, but with no real value besides that high top boots have different effects on ankles too.

The Asolo AFX 535 (boot 10) scored very well as to perceived comfort, prevention of slipping, and rate of oxygen consumption during unloaded walking. It performed poorly at preventing foot or ankle pain [...]

The study also considered

[...] shielding the foot from rocks and stones [...]

which is obviously a factor if you want to compare high top vs low top boots. It has a slight impact on ankle injuries that could be prevented by higher boots, so you might want to factor that in for further research.

posted over 8 years ago

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Haini‭

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This isn't an answer but it's too long for a comment. Since I was the author of that quote you snipped and info from BPL (where I'm a member) has already been presented, I'll just offer my anecdotal evidence that shoes are fine for your stated parameters if you have nothing wrong with your lower extremities. To me it boils down to being fit for the activity. If your ankles are weak (as evidenced from your's being sore when you wear approach shoes) then you need to build them up before going to shoes all the time. By "weak" I mean using some muscles more than they are used, just like doing any activity that stresses muscles in ways they aren't used to will cause you to be sore the next day. I just had to contort myself in all different ways to paint my deck and my back, neck and shoulders are letting me know.

I only get to take 1 big trip a year. The rest of the year I may get to do a couple local trips but they are short and easy terrain. My first trip in 2009 at age 42 I rolled one ankle 3 times pretty well. It was quite painful for a while but I still managed 100 miles over 10 days in the Smoky Mountains. I guess I should note I didn't work out and sit behind a desk all day. 69" tall and around 160 lbs. After that trip I started wearing only sandals nearly everywhere.

I think on the 2010 trip (first time in Rockies) I only rolled it once but I was in much better shape that summer from gutting/remodeling my house (and down to 145 lbs!). 2011 trip I had a major knee issue (took first major downhill too quickly) and a couple small ankle tweaks. After that, I realized I needed to train more before my trips with the goals being to strengthen my knees (and by default the rest of my lower extremities) and build some cardio for the elevation. Now I walk/jog the bleachers at the high school for an hour 3 x /week a couple months before each trip. That's it. Well, I also started biking a little this year. Since then I've not had any knee or ankle issues. I can almost guarantee I would have severely sprained/strained my ankle on this last trip because of the difficulty of the terrain, but the many times I felt my foot shift to the side or rotate it held up just fine. I would have fallen if I was wearing boots. Of course, the flipside is a I move much quicker and hop to smaller rocks sometimes since I am wearing shoes.

That brings up the other huge benefit of shoes is they are still lighter than any similar boot and that is a proven advantage. Think I saw a question here where someone posted the Army study.

No, shoes aren't for everyone. Some people clearly have foot/ankle issues that may not work well with shoes. Some people are so clumsy they need ankle protection from rocks. :) However, that could be a false assumption on their part since they may not need the protection if they were in lighter shoes that allowed them to be more nimble. Some people are not willing to put in any effort to strengthen their feet/ankles over time. For the majority of folks hiking on trails (or off trail) in summer, shoes are the superior choice. I think those that try them and don't like them think they'll feel as good or better the first couple times and that's just not the case unless you've already got solid feet and ankles from playing sports or similar. Or perhaps they went with too light a shoe with little or no rockplate.

I could add more but this is long enough already. I just figured I should chime in since you had quoted me. :) Oh, and I personally use Inov-8 Roclite 315 shoes that sadly aren't made anymore. :( If you find a brand/model that works well for you, buy several pair since they normally only stick around a couple years.

posted over 8 years ago

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topshot‭

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Are the studies relevant?

I don't think you're going to get a meaningful answer to your question from a survey of studies - there are simply too many confounders that they don't control for. Here are some of the most important:

• Proprioception Not all shoes are equal. At one end you have true "barefoot" shoes with minimal midsoles and very high proprioception. At the other end many approach and walking shoes have thick soles that give little ground feel. Proprioception plays a huge role in the prevention of ankle injury, as good ground feel gives the brain the timely feedback it needs to take the action required to avoid injury.

• Flexibility of the sole Let's say you stand on a hidden rock with the potential to turn your ankle. In a minimal shoe, the brain quickly knows there's an issue as we've seen, and because the sole is flexible it can wrap your foot around the obstacle to help prevent injury. Try it for yourself - it's striking how an unencumbered foot can adapt to the terrain. With a thick and rigid sole the brain only knows that there's a problem when the ankle begins to turn, and because there's no scope for altering the shape of the foot it has far fewer options for saving the situation. At a certain angle footwear with a rigid sole passes the point of no return and "capsizes", ripping your ankle. This is much less of an issue with a flexible sole.

• Stack height This is the distance between the ground and the sole of your foot. The higher the stack height, the greater the leverage when your ankle begins to turn and the greater the potential for injury.

• Heel to toe drop The lower the drop, the more naturally your power train can function and respond to threats underfoot.

• Weight The weight of the shoe or boot has a significant impact on agility and the ability to recover from a threat, as does the weight of the person and the load carried.

• Personal conditioning and transitioning Most of us spend our lives in padded footwear with a high drop. Changing to more minimal footwear requires careful and sensible transitioning. This may well be the reason for your sore ankles when wearing approach shoes. If a couch potato suddenly did a 10k run they would have sore muscles too. You need to build up over weeks or months depending on age and condition, and you may also need to consciously adjust your gait if you are a strong heel-striker. If you have specific issues with foot and ankle health you many need a well-designed exercise programme to rebuild a normal healthy gait. Podiatrists who specialise in rehab claim they can resolve a wide range of conditions, but most of the profession still focuses on orthotics.

• Design and usage of the boot's ankle support As a general rule, the greater the ankle support, the less comfortable the boot will be to walk in. For example ski boots give maximum ankle protection but you walk like a duck. Designs and support vary greatly, but in practice most walkers I see have the ankles quite loosely laced for comfort at the expense of support. So the support offered on a lab treadmill is one thing, but the support offered when the boot is used in the field is quite another.

All of these variables have an enormous impact on the risk of ankle injury, but I'm not aware of any study that even begins to address them comprehensively. The research is nowhere close to providing a meaningful answer.

So how can you make an informed decision?

The bottom line is that every hiker has to make a personal choice.

What we can say with confidence is that lightweight footwear is a perfectly responsible option provided you transition properly, and we don't need to go to the labs to tell us this. Many thousands of hikers have covered many millions of miles in lightweight trail shoes, and I'm not aware of any credible evidence that this has led to a spate of ankle injuries. This is a huge sample of real people walking in real conditions, and trumps any artificial lab study, I would suggest. Anyone who claims that lightweight footwear is inherently dangerous is simply ill-informed.

The old-guard accused the early lightweight hikers of being irresponsible, but now 10lb packs are pretty much mainstream. There are no lab studies that prove this is safe - just a huge amount of practical experience that it works for anyone who develops the requisite attitudes and skill-set. It's the same with lightweight footwear.

For any hike there is a wide range of footwear that could do the job, each with it's own pros and cons. We all head out for different reasons and through a great variety of terrain. We all have different priorities and notions of comfort. So we all have to figure out what works for us through trial and error.

Personally I prioritise light weight and agility: I choose the most minimal footwear I can possible get away with. I'm happy to put up with damp feet and the occasional bang on the ankle in return, and I was happy to put in the effort to transition properly. I came to this decision through years of experimentation and have found something that works very well for me. But it may not work for you. I know many others who wouldn't dream of walking the same terrain without a shanked leather walking boot.

Both are perfectly valid choices. My only aim in promoting lightweight footwear on this site is to open people's minds to alternatives they may not have considered. Though I will say that the more committed and experienced the walker and the more ambitious the project, the more likely it is that they will choose a lightweight option. Long-distance thru-hikers in traditional boots are a vanishing species, in the same way that few people nowadays hike the AT or the PCT with 40lb base-weights.

posted over 8 years ago

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Tullochgorum‭

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