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Chronic
Ankle
Instability
Chronic
ankle
instability
is a
condition
characterized
by a
recurring
“giving way”
of the outer
(lateral)
side of the
ankle. This
condition
often
develops
after
repeated
ankle
sprains.
Usually the
“giving way”
occurs while
walking or
doing other
activities,
but it can
also happen
when you’re
just
standing.
Many
athletes, as
well as
others,
suffer from
chronic
ankle
instability.


People
with chronic
ankle
instability
often
complain of:
A repeated
turning of
the ankle,
especially
on uneven
surfaces or
when
participating
in sports
Persistent
(chronic)
discomfort
and swelling
Pain or
tenderness
Chronic
ankle
instability
usually
develops
following an
ankle sprain
that has not
adequately
healed or
was not
rehabilitated
completely.
When you
sprain your
ankle, the
connective
tissues
(ligaments)
are
stretched or
torn. The
ability to
balance is
often
affected.
Proper
rehabilitation
is needed to
strengthen
the muscles
around the
ankle and
“retrain”
the tissues
within the
ankle that
affect
balance.
Repeated
ankle
sprains
often
cause—and
perpetuate—chronic
ankle
instability.
Having an
ankle that
gives way
increases
your chances
of spraining
your ankle
repeatedly.
Each
subsequent
sprain leads
to further
weakening
(or
stretching)
of the
ligaments—resulting
in greater
instability
and the
likelihood
of
developing
additional
problems in
the ankle.
Evaluation
and
Diagnosis

If your
ankle feels
wobbly or
unstable and
gives way
repeatedly,
or if you’ve
had
recurring
ankle
sprains, see
a foot and
ankle
surgeon to
have your
condition
evaluated
and treated.
Chronic
ankle
instability
that is left
untreated
leads to
continued
instability,
activity
limitations,
arthritis,
and tendon
problems.
In
evaluating
and
diagnosing
your
condition,
the doctor
will ask you
about any
previous
ankle
injuries and
instability.
Then he or
she will
examine your
ankle to
check for
tender
areas, signs
of swelling,
and
instability
of your
ankle as
shown in the
illustration.
X-rays, CT
scans, or
MRIs may be
helpful in
further
evaluating
the ankle.
Treatment
Options
Treatment
for chronic
ankle
instability
is based on
the results
of the
examination
and tests,
as well as
on the
patient’s
level of
activity.
Treatment
will depend
on the final
diagnosis
and should
be
personalized
to your
individual
needs. Both
conservative
(nonoperative)
and surgical
treatment
methods may
be used.
Conservative
treatments
include:
Anti-inflammatory
medications
such as
aspirin or
ibuprofen to
reduce
swelling
Physical
therapy,
including
tilt-board
exercises,
directed at
strengthening
the muscles,
restoring
range of
motion, and
increasing
your
perception
of joint
position
An ankle
brace or
other
support
An injection
of a steroid
medication
In the case
of a
fracture,
immobilization
to allow the
bone to heal
If your
condition
requires it,
or if
conservative
treatment
doesn't
bring
relief, your
doctor may
recommend
surgery.
Many
surgical
procedures
can be done
on an
outpatient
basis. Some
procedures
use
arthroscopic
techniques;
other
require open
surgery.
Rehabilitation
may take 6
to 10 weeks
to ensure
proper
healing.
Surgical
treatment
options
include:
Removing
(excising)
loose
fragments
Cleaning (debriding)
the joint or
joint
surface
Repairing or
reconstructing
the
ligaments or
transferring
tendons
Prevention
Almost half
of all
people who
sprain their
ankle once
will
experience
additional
ankle
sprains and
chronic
pain.
You can
help prevent
chronic pain
from
developing
by following
these simple
steps:
Follow
your
doctor's
instructions
carefully
and complete
the
prescribed
physical
rehabilitation
program.
Do not
return to
activity
until
cleared by
your
physician.
When you do
return to
sports, use
an ankle
brace rather
than taping
the ankle.
Bracing is
more
effective
than taping
in
preventing
ankle
sprains.
If you wear
hi-top
shoes, be
sure to lace
them
properly and
completely.
Non-surgical
treatment
may include:
Physical
therapy.
Physical
therapy
involves
various
treatments
and
exercises to
strengthen
the ankle,
improve
balance and
range of
motion, and
retrain your
muscles. As
you progress
through
rehabilitation,
you may also
receive
training
that relates
specifically
to your
activities
or sport.
Bracing Some
patients
wear an
ankle brace
to gain
support for
the ankle
and keep the
ankle from
turning.
Bracing also
helps
prevent
additional
ankle
sprains.
Medications.
Nonsteroidal
anti-inflammatory
drugs (NSAIDs),
such as
ibuprofen,
may be
prescribed
to reduce
pain and
inflammation.
In some
cases, the
doctor will
recommend
surgery
based on the
degree of
instability
or lack of
response to
non-surgical
approaches.
Surgical
options
mainly
involve
repair or
reconstruction
of the
damaged
ligament(s).
However,
other soft
tissue or
bone
procedures
may be
necessary
depending on
the severity
of your
condition
and whether
you have
other
problems in
the foot or
ankle. The
length of
the recovery
period will
vary,
depending on
the
procedure or
procedures
performed.
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