Ankle instability is a condition in which the ankle joint is unstable and can lead to frequent sprains, swelling, or continued pain. In order to understand ankle instability, it is important to understand the anatomy of the ankle. The ankle is a joint (junction of two or more bones) which connects the foot to the leg. It is comprised of one foot bone called the talus and two long leg bones called the tibia (on the inside) and the fibula (on the outside). The three bones are held together by many ligaments on the medial and lateral aspects of the ankle. Ligaments are soft tissue ‘bands’ that connect bone to bone. (not to be confused with tendons that connect muscle to bone). The most commonly injured ligament is the ATFL (anterior talofibular ligament), which usually tear in approximately 66% of ankle sprains.
Causes of Ankle instability:
Causes of ankle instability include:
- Ankle sprain (link)
- Ankle fracture (avulsion of the lip of the fibula)
- Tendon Trauma
- Ankle position – varus or valgus
- Foot position
- Genetic conditions
With these problems, the strength and stability of the ankle are compromised. Imagine a rubber band that loses its elasticity and can no longer hold items tight. If the rubber band becomes weakened the items inside would become loose and patients usually state their ankles “give out” while walking. When the ligaments cannot hold the bones of the ankle tight there is rocking or wobbling that occurs between the bones at the joint. It may be very slight at first, however, as we age there will be more “wear and tear” on the ankle joint.
Diagnosis of Ankle Instability
After a trauma or injury, we perform an examination, take x-rays or order MRI. The x-rays help evaluate the position and bone structure of the ankle and an MRI gives a better picture of the integrity of the individual ligaments.
Treatment Of Ankle Instability
Conservative care is either with a fitted boot, an ankle strap (dispensed on site for adults and kids), a rehabilitation program, or icing. Sometimes, if a complete tear is present or if there is pain or instability after initial treatment then we use surgery. Dr. Gold is board certified in foot and ankle surgery. Newer techniques allow them to re-enforce the ligaments after primary repair with either a graft(link) or anchoring directly into the bone with Fiber wire, this makes the repair stronger and you do not have to sacrifice a tendon. Post-procedure care depends on the extent of the injury and ranges from immediate walking and physical therapy to three weeks off of the ankle.