Background: In 2010, the nationwide incidence of ankle sprains has been estimated to be 1,016,282 with a greater incidence in females and individuals 25 years of age and younger. Among individuals with a history of ankle sprains, 32-74% report chronic symptoms, recurrent ankle sprains, and/or perceived instability. Ankle braces are used both prophylactically to prevent first time injuries among athletes participating in sports considered high risk for ankle sprains (e.g. volleyball, basketball, soccer) and more commonly to prevent recurrent ankle sprains. Ankle braces have been found to restrict ankle joint range of motion during activity while not negatively affecting performance. There is a large selection of ankle braces on the market offering varying levels of support. This makes it difficult for an individual to know what brace is needed for their condition that also meets their satisfaction for comfort.

Purpose: To determine the differences in gait characteristics and user satisfaction when walking and running while wearing four different ankle braces in a healthy population.

Methods: A convenience sample of 20 participants, 18 years or older healthy individuals were recruited. Participants were excluded if they reported being pregnant or being treated for a musculoskeletal injury. After explanation of the study and consent were obtained, each participant completed background information and the Cumberland Ankle Instability Tool (CAIT). Participants then completed a 1 minute, 3mph walking gait assessment unbraced, followed by a 2-minute, 6mph unbraced running assessment. Following the unbraced condition participants were randomly assigned into 1 of 4 conditions: [1] 329 Ankle Sleeve, [2] AS1Pro, [3] Eclipse 1, or [4] Eclipse 2. Participants placed an assigned brace on each ankle and then repeated the walking and running assessments. Next, the participants filled out a 10-item satisfaction questionnaire, and were randomly assigned a second brace. The protocol was repeated until they completed the walking, running, and satisfaction survey in all 4 brace conditions. Outcome measures: The last 30 seconds of the walk and run assessments were used as the data collection periods. Data collected was averaged over the 30 seconds and included knee (flexion/extension), ankle (dorsi/plantar flexion), and foot (inversion/eversion), and bilateral step length. Brace satisfaction scores questionnaire consisted of ten items using a 7-pt. Likert scale ranging from 1 (extremely dissatisfied) to 7 (extremely satisfied) and include characteristics of appearance, ease of application, fit, comfort while walking and running, stability, interference with ability to move, ability of brace to prevent ankle injury, and overall satisfaction.

Statistical Analysis: Descriptive statistics were calculated to determine if the assumptions of parametric statistics were met. Once the data was validated and the assumptions were met a series of repeated measures ANOVA statistics were calculated. Each measure of walking and running gait characteristics were tested in the model over five conditions (four braces and unbraced condition). If any of these statistics demonstrated a significant main effect (p<.05) the means across the five data collection points were further evaluated with Tukey post hoc comparisons. The same model was used to examine each of the 10-satisfaction question separately and then when these 10 scores are summed to a total satisfaction score.

Results: A total of 10 males and 10 females with an average age of 31.1 years participated in this study. There was a significant difference in 7 of the 10 satisfaction questions where the 329 sleeve had greater satisfaction than all of the bracing conditions. These satisfaction questions were Appearance, Ease of Application, Fit, Walking Comfort, Running Comfort, Overall Comfort, and Overall Satisfaction. During the walking phase of the study there was significantly greater ROM with both Baseline and 329 Sleeve being greater than AS1Pro and E2 for left knee flexion (p=0.000, Base=59.34, 329=58.22, AS1Pro=56.65, E2=56.645) and right knee flexion (p=0.002, Base=58.645, 329=58.63, AS1Pro=56.155, E2=55.63). When running, the E2 brace was significantly less than Base and 329 for right (p=0.004) and left (p=0.004) foot supination/pronation at heel strike. Additionally, both the baseline (x=8.79) and 329 Sleeve (x=8.17) were significantly greater (p=0.001) than the AS1Pro(x=5.365) for L Foot supination/pronation foot-off. The E2 (x=3.735) was significantly less (p=0.001) than all other conditions (Baseline=8.79, 329 Sleeve=8.17, AS1Pro=5.365, E1=6.71) for L Foot supination/pronation Foot Off when running.

Clinical Relevance:The use of ankle braces is common among many athletes. However, when faced with choosing what brace to use, many do not know the difference between the braces. The results of this study support previous literature in finding that the semi-rigid brace allows normal sagittal ankle motion while limiting frontal plane ankle range of motion when running. However, the 329 Sleeve had the greater satisfaction than all other braces when walking and running. Therefore, a brace should be chosen based on the level of restriction needed as well as the comfort.