International Journal of Medical and All Body Health Research  |  e-ISSN: 2582-8940  |  Double-Blind Peer Review  |  Open Access  |  CC BY-NC-SA 4.0

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     2026:7/4

International Journal of Medical and All Body Health Research

e-ISSN: 2582-8940 | Open Access

Effectiveness of Intrinsic Foot Muscle Strengthening versus Gluteal Muscle Strengthening, Each Combined with Balance Training, in Adults with Chronic Ankle Instability: A Randomized Comparative Study

Sakshi Yadav, Siddhi Haldulkar

Assistant Professor, Department of Physiotherapy, Jagannath University, Jaipur, Rajasthan, India; MPT Second-Year Student, Department of Physiotherapy, Jagannath University, Jaipur, Rajasthan, India

Article Information

Volume / Issue7 / 3 (July-August 2026)
Pages224-229
AccessOpen Access

Publication Timeline

  • Received13 June 2026
  • Accepted11 July 2026
  • Published

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Abstract

Background and objectives: Chronic ankle instability (CAI) is a common sequela of recurrent lateral ankle sprains, producing impaired balance, reduced functional ability, and persistent pain. Rehabilitation traditionally targets either distal (foot) or proximal (hip) musculature. This study compared the effectiveness of intrinsic foot muscle strengthening combined with balance training against gluteal muscle strengthening combined with balance training in improving functional outcomes in adults with CAI.
Methods: Forty participants with CAI (CAIT ≤ 24) were randomly allocated in a 1:1 ratio to Group A (n = 20; intrinsic foot muscle strengthening + balance training) or Group B (n = 20; gluteal muscle strengthening + balance training). The intervention ran for 8 weeks, three supervised 45-minute sessions per week (24 sessions). Assessment was performed by a blinded assessor pre- and post-intervention. Analysis used paired and independent t-tests and repeated-measures ANOVA, with significance set at p < 0.05.
Outcome measures: Primary outcomes were the Cumberland Ankle Instability Tool (CAIT) and Star Excursion Balance Test (SEBT). Secondary outcomes were the Foot and Ankle Ability Measure (FAAM), Manual Muscle Testing (MMT), and the Visual Analogue Scale (VAS) for pain.
Results: Both groups improved significantly across all outcomes after intervention (p < 0.001). Group B showed significantly greater gains than Group A in functional stability, neuromuscular efficiency, and pain reduction (all between-group p < 0.001), with very large to extremely large effect sizes (Cohen's d 2.90–5.11). A significant time-by-group interaction confirmed a steeper recovery trend in Group B.
Conclusion: Both intrinsic foot muscle strengthening and gluteal muscle strengthening combined with balance training are effective for managing CAI; however, gluteal strengthening combined with balance training produces superior functional and pain outcomes, supporting a proximal-to-distal, kinetic-chain rehabilitation approach.
 

Keywords

Chronic ankle instabilityIntrinsic foot musclesGluteal strengtheningBalance trainingCAITSEBTRehabilitation

References

  1. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability. Br J Sports Med. 2014;48(13):1014-1018. [Google Scholar][Crossref]
  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. Br J Sports Med. 2014;48(13):123-130. [Google Scholar][Crossref]
  3. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364-375. [Google Scholar][Crossref]
  4. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290. [Google Scholar][Crossref]
  5. Kelly LA, Cresswell AG, Racinais S, Whiteley R, Lichtwark G. Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. J R Soc Interface. 2014;11(93):20131188. [Google Scholar][Crossref]
  6. McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):1810-1819. [Google Scholar][Crossref]
  7. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51. [Google Scholar][Crossref]
  8. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and single-leg squat. J Orthop Sports Phys Ther. 2011;41(9):625-632. [Google Scholar][Crossref]
  9. Jeong JR, Kim JH, Lee JS. Effect of hip strengthening on balance and function in chronic ankle instability. J Phys Ther Sci. 2015;27(7):2261-2264. [Google Scholar][Crossref]
  10. Leavey VJ, Sandrey MA, Dahmer G. Comparative effects of 6-week balance, gluteus medius strength, and combined programs on dynamic postural control. J Sport Rehabil. 2010;19(3):268-287. [Google Scholar][Crossref]
  11. Su Y, et al. Combined strength and balance training for postural control and function in chronic ankle instability. 2024. [Google Scholar][Crossref]
  12. Rodríguez-González P, et al. Foot intrinsic strengthening improves self-perceived function and balance in chronic ankle instability. 2023. [Google Scholar][Crossref]
  13. Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences. Sports Med. 2013;43(6):385-393. [Google Scholar][Crossref]
  14. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005;26(11):968-983. [Google Scholar][Crossref]
  15. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower-extremity injury. J Athl Train. 2012;47(3):339-357. [Google Scholar][Crossref]
  16. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(S11):S240-S252. [Google Scholar][Crossref]
  17. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2005. [Google Scholar][Crossref]
  18. Donovan L, Hart JM, Saliba SA, et al. Rehabilitation for chronic ankle instability with or without destabilization devices. J Athl Train. 2016;51(3):233-251. [Google Scholar][Crossref]

How to Cite

Yadav, S., & Haldulkar, S. (2026). Effectiveness of Intrinsic Foot Muscle Strengthening versus Gluteal Muscle Strengthening, Each Combined with Balance Training, in Adults with Chronic Ankle Instability: A Randomized Comparative Study. International Journal of Medical and All Body Health Research, 7(3), 224-229. https://doi.org/10.54660/IJMBHR.2026.7.3.224-229

Yadav, Sakshi, and Siddhi Haldulkar. "Effectiveness of Intrinsic Foot Muscle Strengthening versus Gluteal Muscle Strengthening, Each Combined with Balance Training, in Adults with Chronic Ankle Instability: A Randomized Comparative Study." International Journal of Medical and All Body Health Research, vol. 7, no. 3, 2026, pp. 224-229. https://doi.org/10.54660/IJMBHR.2026.7.3.224-229.

Yadav, S. and Haldulkar, S. (2026) 'Effectiveness of Intrinsic Foot Muscle Strengthening versus Gluteal Muscle Strengthening, Each Combined with Balance Training, in Adults with Chronic Ankle Instability: A Randomized Comparative Study', International Journal of Medical and All Body Health Research, 7(3), pp. 224-229. doi: 10.54660/IJMBHR.2026.7.3.224-229.

Yadav S, Haldulkar S. Effectiveness of Intrinsic Foot Muscle Strengthening versus Gluteal Muscle Strengthening, Each Combined with Balance Training, in Adults with Chronic Ankle Instability: A Randomized Comparative Study. International Journal of Medical and All Body Health Research. 2026;7(3):224-229. doi:10.54660/IJMBHR.2026.7.3.224-229

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