Ankle Sprains and Chronic Instability: What it is and How we treat it…..


Have you ever experienced a bad ankle sprain? Does your ankle always seem to easily roll over or just feel weak or painful ? Do you feel you can’t trust your ankle in certain activities you used to enjoy?

Well you’re not alone. It’s a pretty common problem in adolescents and adults.

Here’s a few statistics on ankle sprains...

Ankle sprains are in fact the most common reported musculoskeletal injury. Nearly 2,000,000 (that’s two million!) patients suffer an ankle sprain annually in the United States alone.

One in five (5) patients who have a history of a “bad ankle sprain” report having chronic pain, limitations of activity, weakness or “giving way” of their ankle following their injury. The rate is one in 3 in athletic individuals. Up to 70 percent of people who have sprained their ankle badly once, will suffer another sprain in the future.

Incomplete healing of the ligaments on the outside portion of your ankle may result in a cycle of chronic instability of the ankle ligaments and recurrent ankle sprains. Ankle ligaments act like a firm rubber band and when damaged they lose their strength and ability to hold your ankle stable. Over time, continued stress and recurrent sprains can result in chronic lateral ankle instability, pain and weakness.

“Chronic lateral ankle instability” is diagnosed by a series of pertinent questions to determine a detailed history of your prior ankle injury, and a quality physical examination of your ankle. A series of simple in office ankle tests and maneuvers while seated and standing can determine if your ligaments are unstable and/or if your muscles and tendons which support your ankle are also weakened or injured.

Most often treatment begins with fitting of a contemporary designed ankle brace to use in athletic and/or work shoes. We also commonly prescribe a course of physiotherapy and rehabilitation which can be effective in reducing your pain and improving your function. You should always attempt a meaningful course of bracing and/or physical therapy as a first line of treatment for chronic lateral ankle instability.

If pain or symptoms of ankle instability persist, often an MRI or ultrasound examination may be ordered to further elucidate the presence and degree of ligament damage towards appropriate treatment going forward.

Patients who do not improve with bracing, physical therapy, and conservative treatment often benefit predictably from repair of the damaged ligament(s).

A significant advance and surgical innovation in the treatment of chronic lateral ankle instability is the advent of a surgical technique that augments the direct surgical repair of the native ligament damaged and serves to protect and essentially shield the native ligament from continued stress.

This simple surgical technique successfully protects the native ligament repair by a special type of suture material that is placed and secured overlying the native ankle ligament which serves similarly to a seatbelt which holds you safely in your car seat and secures you against untoward force. (See Diagram 1)

The suture material is placed overlying the native ligament to support and augment the native ligament repair as illustrated in this diagram illustrating the surgical technique. (See Diagram 2)

This advanced technique has been proven to improve mechanical strength of the surgical repair of ankle ligaments in the lab, and in multiple clinical studies comparing this advanced technique versus the historical standard of just simply repairing the native ligament and native tissue alone. Many professional and elite athletes who have sustained bad ankle sprains and failed to improve with bracing and physical therapy have undergone this augmentation with an accelerated return to play. This has been a proven advancement in the management of chronic lateral ankle instability. While we hope to provide a non-operative treatment plan in returning you successfully to your activities, this innovation has become well established with a predictable ability to enhance and protect your ankle ligament repair if you do suffer from chronic lateral ankle instability, pain and recurrent weakness. A common problem now being treated with a quality advance and innovation in surgical technique. Please see the attached link for further information relating to chronic lateral ankle instability.