the ankle joint is in close proximity to the body s base of support , thus playing an 
 integral role in maintaining balance .
capsular and ligamentous structures , musculotendinous units , and the anatomical alignment of 
 the osseous components are the stabilizing elements of the normal ankle2 .
the ability to maintain balance during standing on a single 
 leg or both legs requires integrity of the visual , vestibular , and nervous systems . in the 
 presence of an intact vestibular system , standing with eyes closed depends mostly on the 
 normal function of the various proprioceptive receptors2 .
proprioceptive information is generated by ligamentous 
 mechanoreceptors , golgi tendon organs , and muscle spindles , which transduce mechanical 
 distortion of the surrounding connective tissue2 .
stability of the ankle joint during functional activities depends 
 on the presence of intact neural input from proprioceptors in the joint capsules , ligaments , 
 muscles , tendons , and skin2 . considering this knowledge ,
the findings of the related literature samples suggest that 
 ankle proprioception is closely related to balance control and that balance is negatively 
 affected by impaired ankle proprioception after injuries3
. however , the results of studies investigating the effects of 
 proprioceptive training on body balance , or vice versa , are conflicting4,5,6 .
powers et al . investigated the effect of 6 weeks of strength and 
 proprioception training on measures of muscle fatigue and static balance in subjects with 
 unilateral functional ankle instability ( fai ) and found that there were no significant 
 effects of strength or proprioception training on these measures4 .
suggested that 4 weeks of balance training was 
 effective in improving joint proprioception and single - leg standing ability in subjects with 
 unstable and non - impaired ankles5 .
chong 
 et al . mentioned that healthy subjects reported improvements in balance control following a 
 purported ankle proprioception training program , although their results revealed that a 
 training program that controlled general balance did not specifically target ankle 
 proprioception6 . considering the above - mentioned knowledge about the close relationship between ankle 
 proprioception and balance , and the conflicting results of the literature samples , the 
 present study aimed to investigate the effect of ankle proprioceptive training on static 
 body balance in healthy individuals .
this randomized - controlled , single - blind study was planned and performed as a graduation 
 study for physiotherapy and rehabilitation students .
the inclusion criteria for the study were absence of musculoskeletal , neurologic , 
 orthopedic , rheumatic or cardiopulmonary disease ; lower extremity deformity ; muscle weakness 
 ( < 4/5 according to manual muscle testing ) ; and postural impairment . among eligible candidates , 59 healthy university students ( 35 females , 24 males ) with an 
 age range of 1828 years
were included in the study , after signing informed consent forms , 
 in accordance with the declaration of helsinki .
subjects were randomized into the study 
 ( n=29 ) and control ( n=30 ) groups by drawing  study  or 
cards from closed 
 envelopes . all subjects received treatment or control conditions as allocated .
sex ( female / male ) , body mass ( kg ) , height ( m ) , and body mass index ( kg / m ) 
 values of the subjects were recorded as the physical characteristics .
in addition , their 
 dominant leg ( right / left ) and dominant foot length ( cm ) were recorded .
a physiotherapist , 
 blinded to the group of subjects , performed all assessments , including the static body 
 balance test .
static body balance was evaluated using a kinesthetic ability trainer ( sport kat model 
 650-ts , llc , usa ) , which shows the balance index scores in both conditions : single foot and 
 both feet .
this device consists of a circular platform with varying degrees of stability , 
 centered by a small pivot . in the preliminary session ,
the pound per square inch ( psi ) level was adjusted to 6 , and 
 once comfortable on the testing device , the subjects performed a formal static test .
they 
 stood on the platform with their hands on opposite shoulders ; they were then asked to stand 
 in place , maintaining balance .
the objective of the static balance test on this device was 
 to maintain the platform at the initial level relative to the x- and y - axes .
therefore , 
 during the static balance test , the subjects kept their eyes open to view the monitor screen 
 and tried to keep the 
the printouts included a numerical 
 score , based on the actual time spent on the exercise and the distance from the center of 
 the platform , measured every second .
the test was performed on both feet and on the dominant 
 and non - dominant bare foot , each testing session lasting for 30 seconds .
balance index 
 scores range from zero to 6,000 , and the lower the score , the better is the balance 
 index7 .
after balance assessment , the study group received a foot and ankle proprioceptive exercise 
 program composed of stretching ( fig .
1fig . 1.stretching exercises for dorsal and plantar flexors , invertors , and evertors ) , strengthening by theraband10 
 ( fig .
2fig . 2.strengthening exercises for dorsal and plantar flexors , invertors , and evertors ) , and balance board exercises ( fig . 3fig .
3.balance board exercises ) consecutively , for plantar and dorsiflexors and invertor and evertor muscles , each 
 with 10 repetitions per session , 5 days a week , for a total of 10 sessions .
balance index score evaluation was repeated at the 
 end of 2 weeks for both groups . stretching exercises for dorsal and plantar flexors , invertors , and evertors strengthening exercises for dorsal and plantar flexors , invertors , and evertors balance board exercises spss for windows
the kolmogorov - smirnov test was used 
 to test the normality of data distribution . since
normal distribution was observed , 
 quantitative data were analyzed by independent t - test for inter - group comparisons , and by 
 paired t - test for intra - group comparisons .
there were 17 ( 58.62% ) females and 12 ( 41.38% ) males in the study group , and 18 ( 60% ) women 
 and 12 ( 40% ) men in the control group .
the groups were similar at the baseline in aspects of physical characteristics ( p>0.05 ) , 
 except age , which was statistically higher in the control group ( p<0.05 ) ( table 1table 1.physical characteristics of the groupsstudyn=29xsdcontroln=30xsdage ( years)*21.11.822.11.9body mass ( kg)64.810.466.512.4height ( m)171.47.7170.89.8body mass index ( kg / m)21.92.322.72.8 * statistically significant ( p<0.05 ) ) . the dominant leg of five subjects was the left ( one in the study group and 
 four in the control group ) , whereas for the remaining , it was the right .
the mean dominant 
 foot length of the study and control groups was similar ( 39.832.05  cm and 39.772.84  cm , 
 respectively ; t=0.94 , p=0.925 ) .
* statistically significant ( p<0.05 ) the outcome measures were also similar in both groups at the baseline evaluation 
 ( p>0.05 ) ( table 2table 2.inter-group comparisons of the pre - intervention and post - intervention balance 
 index scores ( bis)study groupn=29xsdcontrol groupn=30xsddouble foot static bispre190.142.1220.671.7post*145.525.7192.280.5dominant foot static bispre243.081.5268.6115.2post*158.526.3222.477.3non - dominant foot static bispre266.794.4249.566.0post*171.236.9211.857.3 * statistically significant ( p<0.05 ) ) .
* statistically significant ( p<0.05 ) at the end of two weeks , statistically significant improvements were found in the balance 
 index scores of both groups ( p<0.05 ) ( table 
 3table 3.intra-group comparisons of the pre - intervention and post - intervention balance 
 index scores ( bis)pre - interventionn=29xsdpost - interventionn=30xsddouble foot static bisstudy*190.142.1145.525.7control*220.671.7192.280.5dominant foot static bisstudy*243.081.5158.526.3control*268.6115.2222.477.3non - dominant foot static bisstudy*266.794.4171.236.9control*249.566.0211.857.3 * statistically significant ( p<0.05 ) ) , and mean balance index scores of the dominant and non - dominant foot and both 
 feet were lower in the study group , indicating a higher improvement in balance scores 
 ( p<0.05 ) ( table 2 ) .
according to the results of this study , proprioceptive training for the ankle , including 
 stretching , strengthening , and balance board exercises during two weeks , caused more 
 significant improvements than no intervention in balance index scores in healthy 
 individuals .
the improvement of the balance index scores in the control group may be due to 
 the learning effect related to the measurement technique .
have stated that ankle proprioception plays an essential role in balance 
 control , since central processing of ankle proprioceptive information , along with other 
 sensory information , enables integration for postural and balance control3 .
hoffman and payne investigated the effects 
 of biomechanical ankle platform system training on postural sway in healthy high - school 
 students . compared with subjects of the control group , those of the study group who received 
 proprioceptive ankle disk training showed significant improvements in both the 
 medial - lateral and anterior - posterior parameters of postural sway11 .
mattacola and lloyd investigated the effects of a 
 six - week strength and proprioception training program on clinical measures of balance in 
 subjects with previously sustained first - degree lateral ankle sprains .
the results revealed 
 that the strength and proprioception training program produced improvements in balance , as 
 assessed dynamically on a single - plane balance board12 .
arslan , et al . investigated the effect of an eight - week 
 proprioception training program on dynamic postural control in taekwondo athletes , and 
 concluded that this program improved dynamic postural control in taekwondo athletes13 .
akre and kumaresan compared the 
 effectiveness of a four - week strengthening program and that of proprioceptive training on 
 dynamic balance in athletes with chronic ankle instability , and found that both 
 strengthening and proprioceptive training were equally effective in improving dynamic 
 balance14 .
lee and lin investigated the 
 effects of 12-week training with a biomechanical ankle platform system on postural stability 
 and ankle proprioception in 12 university students with unilateral functional ankle 
 instability , and showed that this training improved postural stability and ankle 
 proprioception15 .
the results of the present study , which are parallel to the findings of the related 
 literature samples3 , 11,12,13,14,15 , showed that ankle proprioceptive training had positive effects on 
 static body balance parameters in healthy individuals . in the present study ,
the effect of an ankle and foot proprioceptive training program , 
 which included strengthening , stretching , and balance board exercises , on static balance was 
 assessed in healthy young subjects when their eyes were open .
the rationale of this design 
 was that static balance with open eyes is the easiest condition and the first step of more 
 complex balance reactions .
positive outcomes of this type of training on the evaluated 
 measures show that it is worth assessing the effects of this ankle proprioception training 
 program in more complex conditions to maintain both static and dynamic balance , as well as 
 in prevention and management of many diseases / impairments such as functional unstable feet , 
 hypermobility syndromes , geriatric falls , or neurological problems with balance 
 disorder .
 [ purpose ] this study aimed to investigate the effect of ankle proprioceptive training on 
 static body balance . 
 [ subjects and methods ] in this randomized - controlled , single - blind 
 study , 59 university students ( 35 females , 24 males ) were randomized into study ( n=29 ) and 
 control ( n=30 ) groups . 
 the study group received a foot and ankle proprioceptive exercise 
 program including stretching , strengthening ( plantar and dorsi - flexors , invertor and 
 evertor muscles ) , and balance board exercises , each with 10 repetitions per session , 5 
 days a week , for a total of 10 sessions . the control group did not receive any 
 intervention . 
 static body balance was evaluated by a kinesthetic ability trainer , which 
 showed the balance index scores under both single foot and both feet conditions . 
 this 
 evaluation was repeated at the end of two weeks for both groups . 
 [ results ] outcome 
 measures of the groups were similar at the baseline . 
 balance index scores of both groups 
 improved at the end of two weeks , and the study group had significantly lower index scores 
 than those of the control group , indicating better balance . [ conclusion ] ankle 
 proprioceptive training had positive effects on static body balance parameters in healthy 
 individuals , and it is worth investigating the effects of this type of training in 
 patients with balance disorders . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION