Association of kinesiophobia with balance control and self-reported ankle function in individuals with chronic ankle instability: A systematic review

Impaired balance control and poor ankle function are well-established clinical features of chronic ankle instability (CAI). Although accumulating evidence has highlighted the clinical relevance of kinesiophobia in individuals with CAI, its associations with balance control and self-reported ankle function remain unclear. This systematic review aimed to synthesize the available evidence regarding the associations of kinesiophobia with static and dynamic balance control and self-reported ankle function in individuals with CAI. A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and Google Scholar from inception to July 22, 2026. The search strategy used keywords related to chronic ankle instability, kinesiophobia, balance control, and ankle function. Methodological quality was assessed using the adapted Newcastle–Ottawa Scale (NOS) for cross-sectional studies. The findings were synthesized qualitatively due to heterogeneity in the study designs and outcome measures. Eight studies involving 407 individuals with CAI (57% female) examined the association of kinesiophobia with static balance control ( n = 2), dynamic balance control ( n = 4), and self-reported ankle function ( n = 4). It should be noted that some studies evaluated more than one outcome domain. The methodological quality of the included studies was moderate. Evidence regarding static balance control was limited and inconsistent. For dynamic balance control, individuals with CAI with kinesiophobia demonstrated longer anterior-posterior time to stabilization ( p < 0.001), greater anterior-posterior center of pressure (CoP) velocity ( p = 0.026), and lower mediolateral CoP velocity variability ( p < 0.001) during single-leg jump-landing in one study and lower anterior reach distance in the Y-Balance Test ( p = 0.036, Cohen’s d = 0.11) in another study, compared with those without kinesiophobia. In addition, kinesiophobia was negatively correlated with self-reported ankle function, assessed via the Foot and Ankle Ability Measure (FAAM), in three studies (FAAM-Sport: r = − 0.349, p < 0.05; Quick-FAAM: β = −0.290, p < 0.001; and FAAM-Sport: r = − 0.50, p = 0.005, respectively). The results of this review suggest that higher levels of kinesiophobia are generally associated with poorer self-reported ankle function, whereas evidence regarding static and dynamic balance control is limited and inconsistent. The direction and independence of these relationships remain uncertain due to the cross-sectional designs, heterogeneous measurements, small sample sizes, and inadequate adjustment for potential confounding factors. PROSPERO CRD420251133499. Not applicable.