Chronic Ankle Instability

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Regain Stability and Strengthen Your Ankles
Male athlete with chronic ankle instability.

Discover how we can help you find relief from chronic ankle instability.

If you feel constant instability when placing weight on your ankle, it may be a sign of chronic ankle instability. Affecting the outermost part of the ankle (lateral side), the condition may develop after sustaining numerous ankle sprains. The instability associated with the condition usually occurs with some type of movement. In some individuals, simply standing may produce a “giving away” sensation.

  • While more common in athletes, anyone can be affected by chronic ankle instability.
  • There are several conservative treatments that may provide relief before surgery is considered.

Signs of Chronic Ankle Instability

Patients with chronic ankle instability often notice that their ankle automatically turns inward. This usually happens when walking or running on uneven surfaces or while involved in some type of sports-related activity that requires regular foot and ankle movements. There may also be a persistent feeling of instability or an inability to stand for long periods of time without taking weight off of the affected area.

Patients sometimes reach a point where they are no longer confident walking on certain surfaces out of a fear of losing their balance. Athletes may get to a point where they constantly need to wear ankle braces or other supportive devices to maintain stability. Some degree of discomfort, which range from a dull ache to intense pain, is often felt around the ankle, especially after it has turned inward or moved into a position that stresses ankle tendons. Visible swelling or redness might also be seen around the affected ankle.

Foot suffering with chronic ankle instability.
Female athlete with chronic ankle instability.

Possible Causes

About 20 percent of athletes who have an acute (suddenly occurring) ankle sprain will develop chronic ankle instability. Following a sprained ankle, muscle reaction time may decrease, contributing to instability. The condition can also be caused by ankle sprain that hasn’t healed properly. Individuals that participate in activities that involve a lot of foot movements like ballet, gymnastics, football, soccer, or basketball, may progressively weaken ligaments from repeated over-extension and stretching of these tissues.

How Is Chronic Ankle Instability Diagnosed?

A foot doctor will likely ask you about your previous experiences with ankle sprains. You may also be asked about what types of activities or movements seem to cause the feeling of instability. They will also examine your ankle and other parts of your foot to look for things like tenderness and swelling. An X-ray and other image tests may be done to make a positive diagnosis and rule out other possible structural issues with your foot and/or ankle. For patients who aren’t athletic, a podiatrist might check for signs of arthritis, an inflammation-based condition that can sometimes affect tissues around feet and ankles.

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Non-Surgical Treatment Options

If your ankle isn’t severely injured, you may benefit from initial rest for a few days to allow the affected tissues time to heal and the use of anti-inflammatory medications. Cold therapy involves the application of ice to the affected area at 15-20 minute intervals to reduce swelling and inflammation. A variation on cold therapy is a contrast bath where the foot and ankle is placed in cold water and then warm water. Ankle wraps may also help to prevent swelling. Exercises to strengthen muscles, tendons, and ligaments may also improve stability. Additional non-surgical treatment possibilities for chronic ankle instability include:

  • Temporary bracing
  • Massage therapy
  • Prescription NSAIDs (anti-inflammatory medications)

Surgical Treatment Options

Surgery becomes a possibility when physical therapy, immobilization, medications, and other treatments aren’t significantly improving the affected ankle’s stability. Surgery is typically done with arthroscopic procedures that minimize the need for larger incisions. Performed under general anesthesia, the Brostrom operation is the most common surgical procedure performed to stabilize ankles. It involves repair of the anterior talofibular ligament.

The Gould modification is sometimes done to stabilize the subtalar joint. This joint is responsible for most of the range of motion in the hindfoot. Recovery time from the Brostrom procedure is about 3-6 months for most patients. The majority of patients who undergo such procedures usually respond well to post-surgery rehab.

The most effective way to prevent chronic ankle instability is to make a conscious effort to minimize repetitious ankle movements and avoid motions, such as excessive twisting or turning, that may irritate tendons and other soft and joint tissues. Even if conservative treatments manage symptoms, individuals who are highly athletic may prefer to explore surgical solutions to maintain their desired performance level. A podiatrist can recommend treatments based on the severity of your condition and your goals.

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