What is Chronic Ankle Instability?

The ankle joint has several supporting structures on the outside (or lateral side) of the ankle. The most frequently injured supporting structures are referred to as the lateral ankle ligaments. This is a collection of three ligaments that stabilize the ankle and resist excessive twisting or rolling of the ankle joint. These ligaments help when walking on uneven surfaces, stepping on a piece of gravel, or coming down a flight of stairs.

Ligaments are thick bands of tissue that run from one bone to another. Their primary job is to hold bones in their normal position. When one or more of these ligaments undergoes multiple injuries, they can either fail to heal or heal in a loose or weakened position. If that occurs, then the ankle joint becomes unstable. The result is a loose joint that frequently “gives out” during walking, running or other activities.

Most patients with chronic ankle instability have suffered repeated significant sprains over a period of years. Sometimes this occurs even if the sprains are treated appropriately each time. Some individuals are born with lax or excessively stretchy ligaments that give out more easily, whereas others may be born with a certain foot alignment that lends itself to more ankle injuries . An example is the high arched (or cavus foot) which develops these problems more often than patients with flatfeet. Likewise, patients who are born with a heel bone that sits slightly inward or inverted (called a varus alignment of the heel bone) are also more prone to injury.

Patients who suffer from chronic ankle instability often complain of:

• The ankle joint easily rolling or “giving out”, especially during certain sports like volleyball, soccer, dancing and basketball
  
• Persistent swelling can develop along the front of the ankle
  
• Pain and achiness can develop on the outside of the ankle or even deep within the ankle joint
  
• A loose or unstable feeling is also common. This can result in a lack of confidence in the ankle during certain activities
  

Diagnosing chronic ankle instability involves a history of repetitive sprains or injuries to the outside of the ankle. It also involves a physical examination by an experienced foot and ankle surgeon . This exam will help determine which of the ligaments is damaged and if there is an underlying cause like a bony malalignment. X-rays and MRIs are also useful to determine the extent of injury to the ligaments and to assess for cartilage and tendon damage.

Most chronic ankle instability can be treated without surgery. Treatment depends on the patient’s activity level and physical goals. Selecting the best treatment also depends on results of a detailed physical exam.

Non-surgical treatments for chronic ankle instability include:

Physical therapy - This goes beyond at-home range of motion exercises. A skilled physical therapist today has a variety of tools to help. Traditional manual treatments such as balance training, range of motion, and massage are still valuable, while ASTYM and dry-needling are two treatments that have gained in popularity in the last 5 to 10 years. These treatments help to release contracted muscle and scar tissue, allowing chronic, long-standing injuries to heal.

Bracing - Most patients suffering from frequent ankle sprains already have an over-the-counter brace. Bracing can go beyond an elastic sleeve to include firm uprights, as well as Velcro and lace-up supports. Sometimes a patient has failed over-the-counter bracing simply because the brace was the wrong kind for their specific injury. Other times, the brace just needs more time to be effective.

Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for injuries. A short course of steroids and even a cortisone injection may also be used.

Specialized injections - New, emerging technologies are being developed to help the body heal. Recent studies show promising results for specialized injections like Platelet-Rich Plasma (PRP) and stem cell treatments.

The goal is always to try to avoid surgical treatment when possible. If you have persistent pain and instability after completing non-surgical treatments, then you may be a candidate for surgery. Surgery for chronic ankle instability typically includes ankle arthroscopy and surgical tightening of the loose or torn ligaments (commonly referred to as the Brostrom procedure). Although most sprains heal with non-surgical treatments, these surgical procedures have high satisfaction rates with low rates of recurrence.

If you are experiencing symptoms of ankle instability, contact my office to schedule an exam and consultation . Together, we can develop the most appropriate treatment plan to strengthen and rehabilitate the injured ligaments as quickly and safely as possible.