Ankle Sprains: The Truth about Bracing, Taping, and High-Top Footwear

I remember it like it was yesterday. It was a day in high school basketball practice and we were doing dribbling drills around the cones at full speed on the court when all of a sudden – BAM, a misstep of my left ankle results in a bad sprain and I’m on the ground grimacing in pain. Almost anyone reading this that grew up playing a sport with quick, sudden movements can recall their own version of a similar story. Heck, my left ankle suffered the same fate on multiple occasions. And each time I limped home, elevated and iced my ankles for days, and slowly returned to activity probably by the end of the week.

By the time I made it to college and was now solely running collegiately, my left ankle had only worsened. My freshman year I suffered a couple more sprains running on uneven surfaces, and all of a sudden, my confidence in my ability to step onto any surface with the slightest tilt to it gave me major concern.

Since that time, I’ve now run or hiked over 10,000 miles with several thousand being on technical running trails without a single significant ankle sprain on my left foot (which is now my better foot actually). What follows from here is a compilation of what the research says and how it coincides with my anecdotal experience on how to actually limit ankle sprains in the present and create stronger, more stable ankles for the years to come.

 

A. The Deception of Protection of High-Top Sneakers and Boots

In the Fall of 2016, I set out with what seemed like an ambitious goal at the time – hike the Laurel Highlands Hiking Trail in Western Pennsylvania, a trail 70 miles in length through rocky, mountainous terrain, in 3 days. I set out in my short neon yellow running shorts and tall ankle-high hiking boots and 20lbs on my back and was on my way. What I could remember most from that trip was on the last day, trying to complete the remainder of the miles to my car before sundown in a hurry and rolling my ankle more than I ever have in my life. Bouncing from rock to rock, my ankles got shakier, and my mind got increasingly indecisive.

Figure 1. Me in 2016 at the southern terminus of the Laurel Highlands Trail awkwardly sporting my hiking boots with my short running shorts.

I wore hiking boots specifically (not running shoes) because I was told that that was what you do to protect your ankles. What happened instead was probably making my ankles more susceptible to damage than they otherwise would have been.

While on one hand some studies show that high-top sneakers decrease peak ankle inversion rate and angles, the following is under controlled, static conditions^1,2. When it comes to evaluating the rate of ankle sprains on players during activity such as playing basketball, there have been little to no difference found between those wearing high-top sneakers compared to those wearing low-tops^3,4.

Why is this the case? In a study by Fu et al they tested muscle activation in a group of 13 physical education students under a variety of inversion and plantar flexion angles while wearing both high-top and low-top sneakers. In the study they found that when wearing high-top sneakers and stressing the foot into inversion (rolling the ankle inward), the participants had a significantly decreased reaction time in the peroneus brevis and peroneus longus, the two muscles on the outside of the ankle that act to evert the foot and prevent the ankle from rolling inward (i.e. spraining), as compared to when wearing low-top sneakers.

This means that while the high-top collar may prevent the foot from inverting to the same degree as when wearing a low-top sneaker (data is mixed and shoe dependent), it comes at the cost of dramatically dampening the bodies natural response to preventing the ankle from spraining in the first place. This goes without saying that the degree to which high-top sneakers prevent inversion stress is unlikely to be sufficient to prevent ankle sprains anyways, and injury rate has been found to be higher when wearing high-top shoes as compared to low-top shoes while also wearing an ankle brace⁴.

 

B. Making Sense of Things

So why exactly does this happen? Why does muscle activity change, increasing the likelihood of an ankle sprain, when wearing a high-top sneaker instead of a low-top sneaker? There are a couple of different theories with mixed data to support.

One theory is that a high-top shoe may feel safer to the brain and subconsciously lead to slower and decreased muscle activation because the high-top collar provides an illusion of protection.

Secondarily, when the ankle is wrapped up in a tight and constricted brace or high-top collar, your brain senses that the joint is secure, and the neuromuscular system adapts by decreasing activation of the muscles that would usually help stabilize the ankle.

Thirdly, there is some research to suggest that while wearing an ankle brace continuously for at least 8 weeks will not influence peroneal muscle latency (rate of firing) or proprioception, it will start to decrease amplitude (strength) of the peroneal muscle firing⁶. This reflects what many have come to know as the, “use it or lose it phenomenon”. The following goes like this:

The brain perceives greater stabilization of the ankle with a brace ➡️ the brace takes on some of the load of resisting unstable forces through the ankle that the peroneal muscles usually would ➡️ resulting in decreased strength of the muscles over time ➡️ diminishing the muscles ability to resist an ankle sprain if the foot does begin to invert

There have yet to be any long-term studies beyond a 2-month time period evaluating how these factors could change over an even longer period of time.

There is still a phenomenon though through which high-top collars should actually increase ankle proprioception, and that is through the receptors on our skin. When the mechanoreceptors on our skin around the level of our ankle recognize something is snug and encapsulating it, this feedback should in theory increase the brains perception of where the ankle is in space (i.e. it’s proprioception), and this increased awareness should help prevent ankle sprains⁵. The problem with this is that even if a high-top collar is tied as snug as can be (they’re usually not due to discomfort), the collar will gradually loosen up with playing time, leading to inconsistent sensory feedback to the brain, and the neuromuscular dampening effect of the peroneal muscles prevailing in the end. In the end, the resulting acute and mid-term effects of wearing high-top shoes seem to be negative or at best neutral.

 

C. Ankle Bracing and Taping

The research on the efficacy of ankle bracing is quite extensive and indeed very supportive of its use. In a 1994 randomized controlled trial looking at 1,601 intramural basketball players at West Point over a 2-year period, they found 1.6 sprains per every 1000 in individuals wearing a semi-rigid brace vs 5.2 sprains per every 1000 that did not wear a brace⁷. Surve et al found a 5-time reduction in recurrent ankle sprains in athletes wearing a semi-rigid ankle brace vs those that did not⁸.

Notice the fact that significant improvements in ankle sprain rates are noted when wearing semi-rigid ankle braces as compared to lace-up ankle braces that athletes commonly wear within their shoes or cleats. Semi-rigid braces not only are able to resist greater inversion forces, but they are not susceptible to loosening and needing to be retightened as in the case of lace-up braces, which is similarly an issue with high-top shoes as previously discussed

Figure 2. Example of a lace-up ankle brace (left) vs a semi-rigid external ankle brace (right)

 What about the efficacy of taping? One of the downfalls of taping is that it will similarly lose it’s efficacy of resisting ankle motion with the initiation of play, but it does so even quicker than lace-up braces or high-top sneakers, with one study showing that athletic tape loses up to 50% of its mechanical restriction ability within 30 minutes of playing, and is essentially ineffective after an hour of playing without being re-taped⁹. However, there could be some additional benefit of trying to add in taping in addition to an ankle brace, which can prevent recurrent ankle sprain risk by 50-71%. Due to tape’s rapid reduction in efficacy, it is likely that many athletes will participate in high-velocity sports with less support in reality than they believe they have, likely increasing risk of injury. Good semi-rigid external braces can be much more costly than lace-up braces or tape, but for the additional security, many will find them worth the investment.

D. Reclaiming What Has Been Lost

Too often we choose to protect rather than enable. We would rather put young children in closed areas so they can’t hurt themselves rather than allow them explore their boundaries and acquire new information that will make them better equipped and stronger in the future. One is easy to do, the other option takes time to train while presenting a multitude of potential dangers. The same goes between deciding whether to brace or not to brace.

This is the fundamental question: how can we best protect our ankles and prevent likelihood of future ankle sprains without disabling our bodies natural protective mechanisms to prevent ankle sprains in the first place?

Regaining ankle strength and proprioception is key to everything.

In 2015 and 2016 when I accrued multiple ankle sprains to my left foot and began feeling very unstable despite going to physical therapy, I decided to slowly test it and took my time.

I began going out to technical hiking trails in low-top sneakers and slowly allowed my ankle to adjust to different foot positions at a multitude of different angles, making sure to go slow enough that I didn’t have any recurrent sprains. That part is critical. There is extensive research that foot strengthening and single leg balancing exercises have been shown to increase ankle proprioception as well as improve balance through training of your central nervous system as well¹¹. This process can take weeks, months, and years to take shape, as validated by my experience. I believe that not giving this process adequate time is what leads many to rush into surgery.

Every time you roll the ankle and tear a ligament or excessively stretch or tear a tendon, mechanoreceptors that help provide proprioception and prevent sprains are damaged and slowly must be re-trained. Each time you develop new tears, the process restarts anew. I became insistent to take my time with this and not continue to set myself back. Eventually I got to the point that I felt comfortable running in small doses on trails. By 2017-2018, I was able to hike over 2,000+ miles on the Pacific Crest Trail without a single ankle sprain. At that time and over the last decade I have hiked or run on trails in trail running shoes or just general running shoes. At that time and since then there are moments that the ankle begins to turn, but it quickly snaps back into alignment once it does. That is the power of a well-trained and stable ankle.

Figure 3. Summer of 2020 – I was up to running 80 miles a week mostly on single-track trails.

E. Summary

• Research shows a decrease in ankle inversion angles and ankle sprain rates when wearing low-top shoes compared to high-top shoes. The following are usually under static, controlled conditions.
• There are is no consistent data showing a difference in ankle sprain rate in athletes between those wearing high-top and low-top sneakers.
• High-top shoes blunt the bodies natural protective mechanism against ankle sprains by slowly down and decreasing the firing rate of the peroneal muscles which usually help prevent ankle sprains by everting the foot.
• Lace-up ankle braces and athletic tape do provide resistance to inversion forces leading to ankle sprains better than high-top shoes, but both loosen up and lose efficacy the longer the athlete is playing, increasing susceptibility to sprains.
• Semi-rigid braces are preferred, with studies that show the best results in reducing recurrent ankle sprains being in athletes wearing semi-rigid braces.
• Training ankle strength and proprioception is paramount to preventing recurrent sprains. The following can take time and must not be rushed. Rushing the process can lead to pre-emptive surgery which may not be necessary and will always come with potential complications.
• There is potential that ankle brace use can increase the likelihood of other lower extremity injuries, particularly at the knee, due to increased compensation that must occur in response to restriction of ankle joint range of motion¹².

 

F. My Recommendations

• Athletes playing high velocity sports with a history of ankle sprains should wear low top shoes with the use of a semi-rigid external ankle brace. Research is mixed on use of a brace without history of an ankle sprain. Wearing one may be worthwhile if the athlete does not feel that it dramatically affects their performance.
• If exercising at lower velocities on technical terrain or doing activities that require lateral movements or movements on uneven surfaces, (i.e. hiking, amateur tennis/pickleball) emphasize foot/ankle strengthening and single-leg stability and work into low-top sneakers or trail running shoes without a brace once comfortable doing so.
• If wearing a brace with a low top shoe for a high velocity sport, I recommend using the Tayco Athletic X Brace. The following is an external semi-rigid brace, meaning that it goes on over the shoe, taking away the discomfort that many feel with wearing a lace-up brace inside the shoe. The Tayco brace also is light and because it does not provide a snug fit on the ankle and lower leg, it will not dramatically change how you feel while participating in sport but still have the guardrails there on both sides of the ankle if you do have a sprain. If you would like to purchase any Tayco brace off of their website at taycobrace.com, you can use my code “DRSIERRA” and get $10 off your order in addition to free shipping.

 

References:

1. Zhang, J., Bai, T., Feng, L. et al.High-Top Shoes Reduce Ankle Inversion Injury Risk: Pressure and Kinematic Analysis during Sudden Inversion. Ann Biomed Eng 54, 767–776 (2026). https://doi.org/10.1007/s10439-025-03932-7
2. Sherman, Nestor W., and Mike Daniel. “Effects of High-Top and Low-Top Shoes on Ankle Inversion.” Journal of Physical Education, Recreation & Dance, vol. 73, no. 5, May 2002, pp. 6–6, https://doi.org/10.1080/07303084.2002.10607799.
3. “High-Tops or Low-Tops: What Does the Research Say? | MUSC.” edu, 2020, www.musc.edu/content-hub/News/2020/09/15/High-Tops-or-Low-Tops.
4. Fu W, Fang Y, Liu Y, Hou J. The effect of high-top and low-top shoes on ankle inversion kinematics and muscle activation in landing on a tilted surface. J Foot Ankle Res. 2014 Feb 18;7(1):14. doi: 10.1186/1757-1146-7-14. PMID: 24548559; PMCID: PMC3943374.
5. Papadopoulos ES, Nikolopoulos C, Badekas A, Vagenas G, Papadakis SA, Athanasopoulos S. The effect of different skin-ankle brace application pressures on quiet single-limb balance and electromyographic activation onset of lower limb muscles. BMC Musculoskelet Disord. 2007 Sep 12;8:89. doi: 10.1186/1471-2474-8-89. PMID: 17850663; PMCID: PMC2064916.
6. Han J, Anson J, Waddington G, Adams R, Liu Y. The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury. Biomed Res Int. 2015;2015:842804. doi: 10.1155/2015/842804. Epub 2015 Oct 25. PMID: 26583139; PMCID: PMC4637080.
7. Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, Horodyski M. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point. Am J Sports Med. 1994 Jul-Aug;22(4):454-61. doi: 10.1177/036354659402200404. PMID: 7943509.
8. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994 Sep-Oct;22(5):601-6. doi: 10.1177/036354659402200506. PMID: 7810782.
9. STOFFEL, KARL K., et al. “Effect of Ankle Taping on Knee and Ankle Joint Biomechanics in Sporting Tasks.” Medicine & Science in Sports & Exercise, vol. 42, no. 11, Nov. 2010, pp. 2089–2097, https://doi.org/10.1249/mss.0b013e3181de2e4f. Accessed 3 Nov. 2019.
10. Zwiers, R, et al. “Taping and Bracing in the Prevention of Ankle Sprains: Current Concepts.” Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine, vol. 1, no. 6, 6 Oct. 2016, pp. 304–310, https://doi.org/10.1136/jisakos-2016-000104.
11. Han, Jia, et al. “The Role of Ankle Proprioception for Balance Control in Relation to Sports Performance and Injury.” BioMed Research International, vol. 2015, no. 1, 25 Oct. 2015, pp. 1–8, www.hindawi.com/journals/bmri/2015/842804/, https://doi.org/10.1155/2015/842804.
12. McGuine TA Brooks A Hetzel S. “The effect of lace-up braces on injury rates in high school basketball players.” Am J Sports Med. 2011;39(9):1840-1848.