Ankle X-ray transforming into a balanced structure

Unlocking Ankle Stability: Can Radiography Predict Your Risk?

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Reliability study suggests radiographic assessment can identify those at risk of chronic ankle instability."

Ankle sprains are incredibly common, affecting a significant portion of the population annually. While many people recover fully, a substantial number go on to experience recurrent sprains and develop chronic ankle instability (CAI). This condition leads to persistent pain, weakness, and a feeling of instability, significantly impacting daily activities and athletic performance.

Identifying individuals at high risk of CAI after an initial ankle sprain is crucial for proactive intervention. Understanding contributing factors such as joint geometry can allow targeted preventative measures and personalized treatment plans, potentially reducing the long-term burden of this debilitating condition.

New research investigates the reliability of using radiographic measurements to assess ankle joint geometry and predict CAI risk. This article explores the findings of this study, examining which measurements are most reliable and how they might contribute to future risk assessment models. Ultimately, this information could pave the way for more effective strategies to combat CAI and improve outcomes for those prone to ankle sprains.

Decoding Chronic Ankle Instability: The Role of Radiography

Ankle X-ray transforming into a balanced structure

Chronic ankle instability (CAI) isn't just a minor inconvenience; it's a multifaceted condition that can seriously impact your quality of life. Recognizing the factors that contribute to CAI is crucial for developing effective risk assessment and intervention strategies. Researchers are constantly seeking reliable ways to identify these factors, with radiographic measurements of ankle joint geometry emerging as a promising area of investigation.

One recent study delved into the reliability of specific radiographic measurements in predicting CAI risk. The study focused on three key areas:

Ankle Alignment: Measured using the Medial Distal Tibial Angle (MDTA) on a mortise view radiograph, this assesses the overall alignment of the ankle joint.
Fibular Position: Assessed on a lateral view radiograph, this measurement determines the position of the fibula (the smaller bone in the lower leg) relative to the tibia (the larger bone).
Ankle Joint Congruency: Evaluated on a lateral view radiograph, this assesses the congruity of the ankle joint using measurements like talar radius, talar height, and tibiotalar sector.

The study involved four observers assessing radiographs from 39 patients who had presented to the Emergency Department with a lateral ankle sprain. Each observer performed the measurements twice to determine both intra-observer (consistency within one observer) and inter-observer (consistency between observers) reliability. Intraclass Correlation Coefficient (ICC) was used to evaluate reliability, with ICC values above 0.70 considered good.

The Future of Ankle Instability Prediction

This reliability study sheds light on the potential of using radiographic measurements to predict chronic ankle instability. The study indicates that fibular position and talar radius measurements demonstrate good observer reliability and can be implemented in future risk assessment models. However, the other measurements assessed were prone to measurement errors and should not be used. This research provides a foundation for developing more precise and individualized risk assessment models, leading to earlier interventions, improved outcomes, and greater stability for those prone to ankle sprains.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1016/j.foot.2018.11.001, Alternate LINK

Title: Risk Of Chronic Ankle Instability: A Reliability Study On Radiographic Assessment Of The Ankle Joint Geometry

Subject: Orthopedics and Sports Medicine

Journal: The Foot

Publisher: Elsevier BV

Authors: Gwendolyn Vuurberg, Lauren M. Wink, Inger N. Sierevelt, Sjoerd Jens, Robert Hemke, Maarten A. De Boer, Ellen Den Butter, Gino M.M.J. Kerkhoffs, M. Maas

Published: 2019-03-01

Everything You Need To Know

What is Chronic Ankle Instability (CAI) and why is it important to understand its causes?

Chronic Ankle Instability (CAI) is a condition that results from recurrent ankle sprains. It leads to persistent pain, weakness, and a feeling of instability, significantly impacting daily activities and athletic performance. Understanding the causes of CAI is crucial for developing effective risk assessment and intervention strategies to improve outcomes for individuals prone to ankle sprains and reduce the long-term burden of this debilitating condition.

How can radiographic measurements help in predicting the risk of Chronic Ankle Instability (CAI)?

Radiographic measurements of ankle joint geometry are being explored as a method to predict the risk of CAI. These measurements, including Ankle Alignment (Medial Distal Tibial Angle - MDTA), Fibular Position, and Ankle Joint Congruency (talar radius, talar height, and tibiotalar sector), are assessed using radiographs. The reliability of these measurements can help identify individuals at a high risk of CAI, allowing for proactive interventions and personalized treatment plans.

Which specific radiographic measurements were evaluated in the study, and what did the study find?

The study evaluated three key areas of radiographic measurements: Ankle Alignment (MDTA), Fibular Position, and Ankle Joint Congruency. The study's reliability assessment revealed that Fibular Position and talar radius measurements demonstrated good observer reliability. However, other measurements assessed were prone to measurement errors and should not be used. This study provides a foundation for developing more precise and individualized risk assessment models.

What is the significance of Intra-observer and Inter-observer reliability in the context of this study?

Intra-observer reliability refers to the consistency of measurements by a single observer, while inter-observer reliability refers to the consistency of measurements between different observers. In the context of this study, both types of reliability were assessed to determine the dependability of using radiographic measurements to predict CAI risk. High reliability, indicated by Intraclass Correlation Coefficient (ICC) values above 0.70, suggests that the measurements are consistent and can be reliably used in future risk assessment models. This ensures that the predictions are based on consistent data, regardless of who is taking the measurements, ultimately leading to more accurate diagnoses and treatments.

How can the findings of the study influence the future treatment and management of ankle sprains and Chronic Ankle Instability?

The study's findings can influence the future treatment and management of ankle sprains and CAI by paving the way for more precise and individualized risk assessment models. Identifying reliable radiographic measurements, such as Fibular Position and talar radius, allows for earlier interventions and the development of targeted preventative measures. This can lead to improved outcomes, reduced instances of CAI, and ultimately, greater stability for those prone to ankle sprains. These findings support the potential to create more effective strategies for combating CAI and improving the quality of life for affected individuals.