Effects of adding gait retraining with visual feedback to resistance-balance training on kinematics, centers of pressure, and proprioception in individuals with chronic ankle instability: a randomized controlled trial

Abstract Background Chronic ankle instability (CAI) causes biomechanical alterations and leads to repeated ankle injuries, impairing daily activities and sports performance. Limited evidence exists on the combined effects of gait retraining with visual feedback added to resistance-balance training; however, this combination shows promise in enhancing proprioceptive retraining and recovery in individuals with CAI. This study examined the effects of adding gait retraining with visual feedback to resistance-balance training on kinematics, centers of pressure, and proprioception in individuals with CAI. Methods Forty-five participants with CAI (aged 20–30 years) were randomly assigned to three groups ( n = 15 per group): resistance-balance training, resistance-balance training with gait retraining using visual feedback, or control. A force plate (Bertec, USA), motion analyzer (Vicon, UK), and isokinetic device (Biodex, USA) were used to assess outcomes. The experimental groups were trained for eight weeks, three times weekly. Data were analyzed with SPSS and mixed ANOVA. Results Significant time-by-group interactions were observed for proprioception outcomes, including joint position sense error at 15° ( p = 0.001, η²=0.34) and maximum inversion minus 5° ( p = 0.007, η²=0.21), mediolateral center of pressure displacement (COP-X) ( p = 0.001, η²=0.42), and walking kinematics, including dorsiflexion ( p = 0.001, η²=0.33), plantarflexion ( p = 0.002, η²=0.26), inversion ( p = 0.001, η²=0.39), eversion ( p = 0.001, η²=0.28), and step length ( p = 0.001, η²=0.41). Post-hoc analyses revealed that the significant differences were primarily observed between the training groups and the control group, while significant differences among the training groups were only found for joint position sense error at 15°. No significant time-by-group interaction was observed for anteroposterior center of pressure displacement (COP-Y) ( p > 0.05). Conclusion Adding gait retraining with visual feedback to resistance-balance training significantly improves proprioception, center of pressure during walking, and ankle kinematics during walking in individuals with CAI, suggesting its potential value in clinical rehabilitation. Future studies should explore long-term effects with larger samples. Trial registration Iranian Registry of Clinical Trials (IRCT20230910059398N1), registered on 12 April 2024. Available at: https://irct.behdasht.gov.ir .