Risk Factors Causing Ankle Sprain among undergraduate female students


  • Hafiz Rana Muhammad Arslan Department of Allied Health Sciences, University of South Asia, Cantt Campus, Lahore.
  • Ali Hammad Subhani Physical Therapy & Rehabilitation Department, ARK Campus Mughalpura, Lahore
  • Hamza Shahzad Ehsan Rehab Physiotherapy and Sports Injury Clinic, Lahore
  • Sumbal Salik Johar Instituted of Professional Studies Lahore, Pakistan
  • Laila Niaz Khan Johar Instituted of Professional Studies Lahore, Pakistan
  • Fatima Tariq University of Management and Technology Lahore, Pakistan
  • Bushra Ijaz Hussain College of Health Sciences, Lahore, Pakistan




High heeled shoes align the foot in planter flexion, modifying the relative orientation of the skeletal structures of ankle, metatarsal, and metatarsophalangeal joints, and alter the insertion angles of the foot and gliding joint muscles, therefore increasing the risk factor for ankle sprain. Objective: Study conducted to determine Risk Factors Causing Ankle Sprain among undergraduate female students. Methods: Cross-Sectional study was conducted among 500 female students (Between ages 18-26 years) at Sargodha Medical College and completed in 06 months (June 2019-December 2019). Non-probability convenient sampling technique was used to collect data and then entered to SPSS-25 for further statistical analysis. Result: Among 500 participants, Age 19.65±1.416 years. Mean height (m) 1.61±0.073, mean weight (kg) 57.37±10.4, Mean BMI was 22.02±3.6. Female experience ankle sprain (54%), not experienced ankle sprain (46%) Significant association found between Ankle Sprain and body mass index (BMI) as the P value was 0.014 which was <0.05. Female wearing high heel have 1.082 times greater chance of developing ankle sprain (OR 1.082). Female wearing high heel for long duration (4-6 hrs.) have 1.271 times greater chance of developing ankle sprain (OR 1.271), female wearing high heel (3-4 inches) have 1.072 times greater chance of developing ankle sprain (OR 1.072), female using Pencil heel have 1.281 times greater chance of developing ankle sprain (OR 1.281). Conclusion: Significant association found between Ankle Sprain and body mass index (BMI). Female wearing, high heel for long duration (4-6 hrs.), high heel (3-4 inches height), using Pencil heel have greater chance of developing ankle sprain.


Yu J, Cheung JT, Wong DW, Cong Y, Zhang M. Biomechanical simulation of high-heeled shoe donning and walking. J Biomech. 2013; 46:2067-74. doi.org/10.1016/j.jbiomech.2013.05.009

Williams CM, Haines TP. An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006–2010. Journal of foot and ankle research. 2014;7(1):4. doi.org/10.1186/1757-1146-7-4

Busey S. The influence of the constant use of high-heeled French shoes upon the health and form of the female, and upon the relation of the pelvic organs. Trans Am Gynecol Soc. 1882;7:261-3. doi.org/10.2190/GA2M-FLA2-17FB-V5PE

Farrag A, Elsayed W. Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus Strength More Than Gastrocnemius in Healthy Young Females. Foot Ankle Int. 2016; 37:1008-16. https://doi.org/10.1177/1071100716649172

Frey C, Thompson F, Smith J, Sanders M, Horstman H. American Orthopaedic Foot and Ankle Society women's shoe survey. Foot & ankle. 1993;14(2):78-81. https://doi.org/10.1177/107110079301400204

Beynnon BD, Renström PA, Alosa DM, Baumhauer JF, Vacek PM. Ankle ligament injury risk factors: a prospective study of college athletes. Journal of Orthopaedic Research. 2001;19(2):213-20.

Cooke M, Lamb S, Marsh J, Dale J. A survey of current consultant practice of treatment of severe ankle sprains in emergency departments in the United Kingdom. Emergency medicine journal. 2003;20(6):505-7. doi: 10.1136/emj.20.6.505

Basmajian J, Bentzon J. An electromyographic study of certain muscles of the leg and foot in the standing position. Surgery, gynecology & obstetrics. 1954;98(6):662. doi: 10.3827/faoj.2010.0303.0001

Jackson LA, Von Eye A, Fitzgerald HE, Witt EA, Zhao Y. Internet use, videogame playing and cell phone use as predictors of children’s body mass index (BMI), body weight, academic performance, and social and overall self-esteem. Computers in Human Behavior. 2011;27(1):599-604. https://doi.org/10.1016/j.chb.2010.10.019

Hu P, Hu Y. Soft-Tissue Nail Fold Arc Resection Combined with a Shaped Dressing for Ingrown Toenails. Journal of the American Podiatric Medical Association. 2020;110(4). https://doi.org/10.7547/17-199

Mishra E, Jena S, Bhoi C, Arunachalam T, Panda SK. Effect of high heel gait on hip and knee-ankle-foot rollover characteristics while walking over inclined surfaces—A pilot study. The Foot. 2019;40:8-13. https://doi.org/10.1016/j.foot.2019.03.004

Paterson KL, Kasza J, Hunter DJ, Hinman RS, Menz HB, Peat G, et al. The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis and cartilage. https://doi.org/10.1016/j.joca.2016.12.003

Jabbar S, Sabir S, Irum S, Raza H, Wassi A, Subazwari AB. Prevalence of Forefoot Pain among High Heel Wearing Female Teachers and Students of Different Universities in Faisalabad. Health Science Journal. 2020;14(2):1-4. DOI:10.36648/1791-809X.14.2.710

Afzal F, Manzoor S. Prolong wearing of high heeled shoes can cause low back pain. J Nov Physiother. 2017;7(356):2. DOI: 10.4172/2165-7025.1000356

Frey C, Coughlin MJ. Women's shoe wear: An orthopaedist's advice. J Womens Health.1999; 8:45-9. http://doi.org/10.1089/jwh.1999.8.45

Gefen A, Megido-Ravid M, Itzchak Y, Arcan M. Analysis of muscular fatigue and foot stability during high-heeled gait. Gait Posture. 2002; 15:56-63. https://doi.org/10.1016/S0966-6362(01)00180-1

Han D. Muscle activation of paraspinal muscles in different types of high heels during standing. J Phys Ther Sci . 2015; 27:67-9. https://doi.org/10.1589/jpts.27.67

Cowley EE, Chevalier TL, Chockalingam N. The effect of heel height on gait and posture: a review of the literature. J Am Podiatr Med Assoc. 2009; 99:512-8. https://doi.org/10.7547/0990512

Ko DY, Lee HS. The changes of COP and foot pressure after one hour's walking wearing high-heeled and flat shoes. J Phys Ther Sci. 2013; 25:1309-12. doi.org/10.1589/jpts.25.1309

Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied ergonomics. 1987; 18:233-7. doi.org/10.1016/0003-6870(87)90010-X




How to Cite

Arslan, H. R. M. ., Subhani, A. H. ., Shahzad, H. ., Salik, S. ., Khan, L. N. ., Tariq, F. ., & Ijaz, B. (2022). Risk Factors Causing Ankle Sprain among undergraduate female students. Pakistan BioMedical Journal, 5(2), 59–63. https://doi.org/10.54393/pbmj.v5i2.251



Original Article

Most read articles by the same author(s)