How do neuromuscular characteristics of the peroneal muscles differ in adults with and without chronic ankle instability? A systematic review with meta-analysis

Review written by Dr Chris Bleakley info

Key Points

  1. Individuals with chronic ankle instability (CAI) show significantly greater errors in peroneal eversion force sense at both 10% and 20% of maximum voluntary isometric contraction compared with healthy controls.
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BACKGROUND AND OBJECTIVE

Lateral ankle sprains (LASs) carry a risk of long-term sequelae, most notably chronic ankle instability (CAI). Individuals with CAI often report recurrent episodes of giving way, instability, impaired balance, and repeated injury. CAI may arise from mechanical and/or neuromuscular impairments, although its clinical presentation is heterogeneous (1).

Particular attention has been directed toward the neuromuscular impairments of the peroneal muscle group in the pathogenesis of CAI, given their critical role in stabilizing the lateral ankle and optimizing foot position during dynamic tasks such as jumping and side-stepping. In this systematic review and meta-analysis, Altun et al. (2025) examined differences in peroneal muscle function between individuals with CAI and healthy controls.

Individuals with chronic ankle instability often report recurrent episodes of giving way, instability, impaired balance, and repeated injury.
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Clinicians should focus on early submaximal strengthening, targeted training of the peroneus longus for forefoot stability, and improving rate of force development to enhance rapid lateral stability after a sprain.

METHODS

  • Altun et al. (2025) focused on a range of neuromuscular characteristics of the peroneal muscles - including corticospinal excitability, strength, proprioceptive force sense, and electromyographic (EMG) measures.
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