ANKLE & FOOT
A frequent injury seen in orthopedic clinics is a sprained ankle. These types of injuries can be seen in pediatric patients, athletes, and even older adults. However, when someone presents with an ankle sprain and says they sprain it “all the time,” you may be dealing with ankle instability. While ankle instability is very common, if left untreated it can lead to repeat injuries, chronic pain, and even arthritis.
What is Ankle Instability?
Ankle Instability occurs when the lateral ligaments in your ankle are injured and become stretched or torn, and do not heal properly. The lateral ligaments responsible for the stability of your ankle are the Anterior Talofibular Ligament (ATFL), and the Calcaneofibular ligament (CFL).
What are the signs and symptoms are ankle instability?
Ankle instability typically presents with recurrent ankle sprains or “rolls.” It can also present with the feeling of weakness in the ankle. Ankle instability is diagnosed with a physical exam and eventually imaging. The anterior drawer test is performed to assess ankle instability. It is performed by stabilizing the tibia (shin bone) with one hand, while the other hand grasps the calcaneus and applies an anterior (toward the front) force to the talus. A positive sign is when the motion of the ankle has no firm end point and has laxity.
What causes ankle instability?
Ankle instability is usually caused by prior ankle sprains. Other causes can include ligament laxity, for example patients with Ehlers Danlos Syndrome. While ankle sprains are the primary cause of ankle instability, having a cavus foot, also known as a high arch, can predispose the patient to ankle sprains and ankle instability,
What should you do about it?
Ankle Instability should not be ignored. The first line of treatment for patients should include physical therapy, bracing, activity modification, anti-inflammatory medications, and icing.
While many patients improve significantly with this conservative treatment, some do need surgery. Surgery is typically recommended for patients with continued pain and recurrent injuries. Surgery is highly recommended in these individuals because continued injuries can lead to ankle arthritis and other injuries. The ankle joint is different than the rest of the joints in our body, in the sense that you develop arthritis if you have an injury to the joint. In addition, recurrent sprains can lead to injuries to the cartilage as well as tears to the tendons in the ankle, especially the peroneal tendons.
The surgery recommend for ankle instability is a lateral ligament reconstruction, also known as a Brostöm ligament repair. It is often also performed with an ankle arthroscopy, because patients with ankle instability often also have injuries to the cartilage in the ankle joint called osteochondral lesions.
Ankle instability should not be ignored and should be evaluated by an orthopedic foot and ankle provider.
Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016 Oct-Dec;6(4):103-108. doi: 10.4103/2231-0770.191446. PMID: 27843798; PMCID: PMC5054646.
