Fear of Movement Linked to Poorer Ankle Function in Chronic Ankle Instability

Fear of movement, known clinically as kinesiophobia, appears to track closely with how people with chronic ankle instability rate their own ankle function, according to a systematic review published in BMC Musculoskeletal Disorders. The review, led by Mohammad Mehdi Abolhasani, Razieh Mofateh and Neda Orakifar, pooled evidence from eight studies covering 407 individuals with chronic ankle instability, 57 percent of whom were female. Its central conclusion is nuanced: higher kinesiophobia was generally associated with poorer self-reported ankle function, while the evidence linking fear of movement to measurable balance deficits remained limited and inconsistent.

Chronic ankle instability is a common consequence of ankle sprains, marked by recurring sensations of the ankle giving way alongside impaired balance control and diminished perceived function. Kinesiophobia, an excessive fear of physical movement due to feelings of vulnerability to painful injury or re-injury, has attracted growing clinical attention in this population. The review team set out to synthesize what the existing literature says about the associations between kinesiophobia and three distinct outcome domains: static balance control, dynamic balance control, and self-reported ankle function.

To assemble the evidence, the researchers conducted a systematic search of PubMed, Scopus, Web of Science, Embase and Google Scholar from database inception through July 22, 2026. The search strategy combined keywords related to chronic ankle instability, kinesiophobia, balance control and ankle function. Because the included studies varied widely in design and outcome measures, the team synthesized the findings qualitatively rather than performing a statistical meta-analysis. Methodological quality was evaluated with an adapted Newcastle–Ottawa Scale for cross-sectional studies, and the review protocol was registered prospectively on PROSPERO under registration number CRD420251133499.

The eight included studies did not all measure the same things. Two examined static balance control, four examined dynamic balance control, and four examined self-reported ankle function, with some studies contributing to more than one domain. The methodological quality of the studies was rated as moderate. That moderate rating matters, because it shapes how much confidence readers should place in the individual findings that follow.

For static balance control, the review found the evidence both limited and inconsistent, meaning the available studies did not converge on a clear pattern linking kinesiophobia to steadiness during quiet standing or similar tasks. The authors are careful on this point: no consistent association between fear of movement and static balance performance can currently be claimed for people with chronic ankle instability.

Dynamic balance, tested during more demanding tasks such as jump-landing, told a more textured story, though still one drawn from single studies rather than replicated across many. In one study, individuals with chronic ankle instability who had kinesiophobia showed longer anterior-posterior time to stabilization, greater anterior-posterior center of pressure velocity, and lower mediolateral center of pressure velocity variability during a single-leg jump-landing task compared with those without kinesiophobia, with p values of less than 0.001, 0.026 and less than 0.001 respectively. In a different study, kinesiophobia was associated with a lower anterior reach distance on the Y-Balance Test, a difference that reached statistical significance at p = 0.036 but carried a small effect size, Cohen’s d = 0.11. Center of pressure measures capture how the body’s weight shifts over the supporting foot during challenging tasks, so these findings suggest that fear of movement may coincide with altered postural control strategies under dynamic conditions, at least in the specific studies that reported them.

The most consistent signal emerged for self-reported function. Across three studies, kinesiophobia was negatively correlated with ankle function measured by the Foot and Ankle Ability Measure, or FAAM, a widely used patient-reported questionnaire for ankle and foot capability. One study reported a correlation of r = −0.349 for the FAAM-Sport subscale with p < 0.05; another reported a standardized beta of −0.290 for the Quick-FAAM with p < 0.001; and a third reported r = −0.50 for the FAAM-Sport subscale with p = 0.005. In plain terms, people who reported greater fear of movement tended to rate their own ankle function as worse, with the strength of the association ranging from modest to moderate across the three studies.

The review’s authors are explicit about the limits of what these associations mean. Because every included study used a cross-sectional design, capturing a single moment in time, the direction of the relationships remains uncertain. It is not possible to determine from this evidence whether fear of movement leads to poorer balance and function, whether perceived instability drives the fear, or whether both reflect some shared underlying factor. The studies also used heterogeneous measurement tools, relied on small sample sizes, and in many cases did not adequately adjust for potential confounding factors that could explain the observed associations.

Those caveats do not diminish the clinical relevance of the findings, but they do frame them. For clinicians working with patients who have chronic ankle instability, the review suggests that assessing kinesiophobia, for example with established fear-avoidance questionnaires, may offer useful information about how patients perceive their own ankle function. The dynamic balance findings, while intriguing, rest on individual studies and should be treated as preliminary until replicated. The static balance findings, by contrast, currently offer little support for a consistent relationship.

What the review ultimately delivers is a map of where the evidence stands rather than a definitive verdict. Higher kinesiophobia is generally associated with poorer self-reported ankle function in people with chronic ankle instability, an association supported by three independent studies using the FAAM family of instruments. The relationship between fear of movement and objectively measured balance control, whether static or dynamic, remains an open question that future longitudinal and intervention studies with larger samples and careful confounder adjustment will need to resolve. Until then, the safest reading of the accumulated evidence is that fear of movement and perceived ankle function travel together, while the balance story is still being written.

Subject of Research: Associations of kinesiophobia with balance control and self-reported ankle function in chronic ankle instability

Article Title: Association of kinesiophobia with balance control and self-reported ankle function in individuals with chronic ankle instability: A systematic review

Article References: Abolhasani, M. M., Mofateh, R., & Orakifar, N. (2026). Association of kinesiophobia with balance control and self-reported ankle function in individuals with chronic ankle instability: A systematic review. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10681-8

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10681-8

Keywords: chronic ankle instability, kinesiophobia, balance control, ankle function, systematic review, FAAM, Y-Balance Test, postural control, cross-sectional studies, fear of movement, Association, balance