Research Article

The lateralization pattern has an influence on the severity of ankle sprains

Andrzej Mioduszewski*, Mikołaj Wróbel and Emilia Hammar

Published: 28 April, 2023 | Volume 8 - Issue 2 | Pages: 016-020

Study design: Descriptive study.
Background: Many risk factors contributing to ankle sprains have been studied in medical literature with coordination and balance being two of the major endogenous factors described. These are influenced by lateralization – a developmental and adaptive ability determined by the asymmetrical construction of the human brain, with cross-laterality referring to mixed limb dominance.
Objectives: To determine whether cross lateralization is a risk factor for the severity of ligamentous injuries in ankle sprains since no data is yet available on such correlation. 
Methods: Two hundred forty-four patients with acute ankle sprains (136 men and 108 women) were prospectively evaluated between April 2006 and March 2009. The mean age was 30 (ranging from 18 to 76). Clinical and ultrasonographic examinations were performed on the study subjects. Laterality was then assessed by the Coren questionnaire and the AOFAS score was calculated. Patients with syndesmotic injuries and fractures were excluded from the study. Those qualified were divided into straight and crossed groups, according to their laterality type. 
Results: One hundred forty-four patients displayed straight lateralization, while cross-laterality was found in 100 subjects. Patients in the crossed group experienced more multi-ligamentous injuries than those in the straight group (p = 0.02). Following trauma, a higher AOFAS score was attributed to subjects that displayed a straight lateralization pattern, in comparison to subjects presenting with crossed laterality (p = 0.04).
Conclusion: Crossed lateralization is associated with higher severity of ligament injuries in ankle sprains and may be considered a risk factor for calcaneofibular ligament injuries.

Read Full Article HTML DOI: 10.29328/journal.jsmt.1001066 Cite this Article Read Full Article PDF


Ankle sprain; Lateralization; Sports Trauma; Prevention


  1. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. doi: 10.2165/00007256-200737010-00006. PMID: 17190537.
  2. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40. doi: 10.1007/s40279-013-0102-5. PMID: 24105612.
  3. Beynnon BD, Murphy DF, Alosa DM. Predictive Factors for Lateral Ankle Sprains: A Literature Review. J Athl Train. 2002 Dec;37(4):376-380. PMID: 12937558; PMCID: PMC164368.
  4. Beynnon BD, Renstrom PA, Alosa DM, et al. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001 19(2), 213-220.
  5. Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc. 1983;15(3):267-70. doi: 10.1249/00005768-198315030-00014. PMID: 6621313.
  6. Hosea TM, Carey CC, Harrer MF. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball. Am J Sports Med. 1982; 10:297-299.
  7. de Noronha M, Lay EK, Mcphee MR, Mnatzaganian G, Nunes GS. Ankle Sprain Has Higher Occurrence During the Latter Parts of Matches: Systematic Review With Meta-Analysis. J Sport Rehabil. 2019 May 1;28(4):373-380. doi: 10.1123/jsr.2017-0279. Epub 2019 Feb 4. PMID: 29809104.
  8. Pasanen K, Ekola T, Vasankari T, Kannus P, Heinonen A, Kujala UM, Parkkari J. High ankle injury rate in adolescent basketball: A 3-year prospective follow-up study. Scand J Med Sci Sports. 2017 Jun;27(6):643-649. doi: 10.1111/sms.12818. Epub 2016 Dec 29. PMID: 28033652.
  9. Kobayashi T, Tanaka M, Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health. 2016 Mar-Apr;8(2):190-3. doi: 10.1177/1941738115623775. PMID: 26711693; PMCID: PMC4789932.
  10. de Vasconcelos GS, Cini A, Sbruzzi G, Lima CS. Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis. Clin Rehabil. 2018 Dec;32(12):1581-1590. doi: 10.1177/0269215518788683. Epub 2018 Jul 12. PMID: 29996668.
  11. Coren S. The left-hander syndrome. New York: 1-st Vintage books. 1993
  12. Zazzo R. Methods of psychological examination of a child. Warsaw: PZWL.
  13. Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971 Mar;9(1):97-113. doi: 10.1016/0028-3932(71)90067-4. PMID: 5146491.
  14. Kitaoka HB, Alexander IJ, Adelaar RS. Clinical rating systems for the ankle-hindfood, mid-foot, hallux and lesser 310 toes. Foot Ankle Int. 1994; 15:135-149.
  15. Sobczyk M. Statistics [in Polish]. Warsaw: PWN. 2002
  16. Pekkarinen A, Salminen S, Järvelin MR. Hand preference and risk of injury among the Northern Finland birth cohort at the age of 30. Laterality. 2003 Oct;8(4):339-46. doi: 10.1080/13576500244000283. PMID: 15513230.
  17. DeLang MD, Salamh PA, Farooq A, Tabben M, Whiteley R, van Dyk N, Chamari K. The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis. Biol Sport. 2021 Sep;38(3):397-435. doi: 10.5114/biolsport.2021.100265. Epub 2020 Oct 28. PMID: 34475623; PMCID: PMC8329968.
  18. Niu W, Wang Y, He Y, Fan Y, Zhao Q. Kinematics, kinetics, and electromyogram of ankle during drop landing: a comparison between dominant and non-dominant limb. Hum Mov Sci. 2011 Jun;30(3):614-23. doi: 10.1016/j.humov.2010.10.010. Epub 2011 Mar 24. PMID: 21439665.
  19. Kobayashi T, Tanaka M, Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health. 2016 Mar-Apr;8(2):190-3. doi: 10.1177/1941738115623775. PMID: 26711693; PMCID: PMC4789932.
  20. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994 Sep-Oct;22(5):601-6. doi: 10.1177/036354659402200506. PMID: 7810782.
  21. Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Br J Sports Med. 2013 Apr;47(6):351-8. doi: 10.1136/bjsports-2011-090664. Epub 2012 Jul 4. PMID: 22763118.
  22. Mason J, Kniewasser C, Hollander K, Zech A. Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis. Sports Med Open. 2022 Nov 18;8(1):139. doi: 10.1186/s40798-022-00530-y. PMID: 36399159; PMCID: PMC9674823.
  23. Virgile A, Bishop C. A Narrative Review of Limb Dominance: Task Specificity and the Importance of Fitness Testing. J Strength Cond Res. 2021 Mar 1;35(3):846-858. doi: 10.1519/JSC.0000000000003851. PMID: 33470600.
  24. Dos'Santos T, Bishop C, Thomas C, Comfort P, Jones PA. The effect of limb dominance on change of direction biomechanics: A systematic review of its importance for injury risk. Phys Ther Sport. 2019 May;37:179-189. doi: 10.1016/j.ptsp.2019.04.005. Epub 2019 Apr 9. PMID: 30986764.
  25. Kimmerle M. Lateral bias, functional asymmetry, dance training and dance injuries. J Dance Med Sci. 2010;14(2):58-66. PMID: 20507722.
  26. D'Erme M. Le lesioni dei legamenti collaterali del collo del piede: diagnosi e follow-up con risonanza magnetica ed ecografia [Lesions of the collateral ligaments of the ankle: diagnosis and follow-up with magnetic resonance and ultrasonography]. Radiol Med. 1996 Jun;91(6):705-9. Italian. PMID: 8830353.
  27. Milz P, Milz S, Steinborn M, Mittlmeier T, Putz R, Reiser M. Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz high-frequency sonography and MRI compared in 20 patients. Acta Orthop Scand. 1998 Feb;69(1):51-5. doi: 10.3109/17453679809002357. PMID: 9524519.

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?