Abstract
Background and Objectives: Chronic ankle instability (CAI) is prevalent among soccer players, often resulting from recurrent ankle injuries (RAIs). Despite its impact on performance and long-term joint health, the associated risk factors remain insufficiently explored. This study aimed to identify the key risk factors for CAI among soccer players. Materials and Methods: A cross-sectional study was conducted among 310 soccer players from different professional sports clubs. The Arabic version of the Cumberland Ankle Instability Tool (Ar-CAIT) was used to assess ankle instability. Spearman's rho correlation and multiple linear regression were used to identify significant predictors of CAI. Additionally, structural equation modeling (SEM) was used to conduct mediation analysis and evaluate potential indirect effects. Results: Spearman's correlation analysis revealed significant negative associations between Ar-CAIT scores and both BMI (r = -0.158, p < 0.05) and RAI (r = -0.273, p < 0.01), while training hours were positively correlated with Ar-CAIT scores (r = 0.169, p < 0.05). Multiple regression analysis confirmed that higher BMI (β = -0.133, p = 0.017) and a greater number of ankle injuries (β = -0.285, p < 0.001) were associated with lower Ar-CAIT scores, whereas increased training hours (β = 0.140, p = 0.010) were predictive of better ankle stability. Mediation analysis revealed that BMI and training hours partially mediate the relationship between RAI and Ar-CAIT scores. Conclusions: RAI, elevated BMI, and reduced training hours were significant predictors of CAI in soccer players. These findings emphasize the importance of implementing targeted injury prevention and rehabilitation strategies, particularly focusing on weight management and structured training programs to reduce CAI risk. Future longitudinal studies are required to explore the underlying mechanisms contributing to CAI development.