This module represents mid-stage criteria in a structured, algorithmic, and evidence-based approach to assessing a patient's readiness for progressing activities after musculoskeletal foot and ankle injuries. The ultimate aim is to guide clinicians in making informed decisions for return to jogging, plyometrics, and higher-level activities.

Postural control is a critical aspect of functional recovery. Research indicates a direct correlation between postural sway and ankle injuries. Increased variance in postural sway, particularly noted in athletic populations like high school basketball players, is linked to a higher incidence of ankle sprains. Assessments like the Star Excursion Balance Test and center-of-gravity sway measurements have proven effective in identifying individuals at risk, showing that athletes with poorer postural stability are more prone to injury. Therefore, balance assessments serve as valuable screening tools to recommend balance training, potentially decreasing both primary and secondary injury risk. It's important to acknowledge that a history of ankle sprains can itself impair postural stability, complicating risk assessment for future injuries.

Foundations of Postural Control

From a dynamic systems theory perspective, postural control is determined by three interacting components:

• The Individual (Organism): This encompasses motor, sensory, and cognitive aspects. Factors such as musculoskeletal integrity, muscle synergies, sensory system function (vision, vestibular, proprioception), sensory organization, cognitive strategies, and cognitive resources all play a role. Age, health conditions, muscle strength, joint mobility, and body composition can significantly influence an individual's postural control. Following foot and ankle injuries, individuals often exhibit altered joint positional sense due to interference with mechanoreceptors.
• The Postural Task: This relates to whether the balance demand is proactive (anticipatory) or reactive, and if it involves maintaining a steady state or performing dynamic movements.
• The Environment: This includes support surfaces, sensory context, and cognitive load or sensory stimulation in the surrounding area.

Constructs of Postural Control Assessment

• Postural control is broken down into three primary constructs, each with specific measurable outcomes:

• • Steady State Postural Control: This is the ability to control the body's center of mass relative to its base of support in predictable and non-changing conditions. Outcomes measured can include the duration an individual can maintain a position, the amount of postural sway, the number of balance faults over time, platform deflections, and changes in center of pressure metrics.
  • Anticipatory Postural Control: This refers to the ability to activate muscles for balance control before voluntary movements. Relevant outcomes include reach distances in various directions, postural sway during planned movements, platform deflections, and changes in center of pressure.
  • Reactive Postural Control: This is the ability to regain a stable position following an unexpected perturbation. Measurements for reactive control often include postural sway, platform deflections, changes in center of pressure, and crucially, time to stabilization.