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.