Patient Education

Ankle Instability

Description

Your ankle joint is what enables your foot to move up and down when you walk. As you might imagine, you use that joint rather a lot. (In fact, have you thanked your ankles lately for everything they do for you? Sent them flowers? Called on their birthday?) But, sometimes, you might get a little overeager. Sometimes you twist around trying to get the ball back from that other guy, come down a little too hard when jumping, or step carelessly into a 15-foot pit with tigers prowling at the bottom. These are the kinds of things that might cause trauma to your ankle.

Once you’ve sprained your ankle for the first time, your ligaments (bands of tissue that connect things together) typically become overstretched, or even torn. If the injury doesn’t heal properly, the ligaments are left kind of loose, making your ankle more unstable, and more prone to being injured again. So, the next time, it might not take a 15-foot pit to get another sprain; it might only take a 10-foot pit, and so on, until merely stepping off the curb (with or without tigers present) makes you sprain your ankle.

A weakening of the ligaments and repeated ankle sprains is a condition called chronic ankle instability. It’s pretty much a vicious cycle, where injury leads to more injury. It’s not a pleasant cycle to be in, and can be a real nuisance, particularly for athletes who rely on the proper function of their joints. The bones that make up the ankle joint may actually become misaligned, namely the talus, which is the foot bone in the ankle joint. After repeated ankle injuries, it might become tilted inward, whereas it is normally supposed to rest squarely in the little box created for it by the ends of your leg bones.

Symptoms

People with chronic ankle instability typically find it rather difficult to walk on uneven surfaces, and may notice that their ankle turns inward rather too easily. This may make your foot feel all wobbly when you try to walk (not a great symptom, particularly if you’re a tightrope artist). You’re also likely to get sprains over and over again, which will likely cause swelling around the ankle, bruising, pain and discomfort. The pain may become chronic, and over time, bone spurs may develop in the joint, which means more pain and swelling.

Diagnosis

Your podiatrist will likely examine the ankle by checking for swelling and tenderness, and will probably ask you about a history of ankle injuries in the past. He or she may also put pressure on your ankle joint by pushing it inward to see if it moves farther than is normal, or exhibits other signs of instability.

X-rays may be used to get a peek at your bones (instability in the ankle joint will sometimes show up as a misalignment of the talus in the ankle joint), or your podiatrist may choose to use other imaging methods such as a CT scan or MRI. (These images may be taken while your podiatrist puts pressure on the ankle, which will help the instability to show up more readily if it’s present.)

Treatment

Basically, treatment revolves around getting your ligaments to heal, treating the pain associated with ankle instability, and strengthening your muscles to prevent further injury. Your podiatrist may encourage the healing of your ligaments by immobilizing your ankle joint. This might be done by using a cast or a brace (which can both be attractively decorated using stickers, glitter, and/or sequins). You can usually combat the pain in your ankles by using anti-inflammatory medication, such as ibuprofen, or other prescription medications.

Your podiatrist may also recommend a round of physical therapy. This will help rehabilitate your ligaments, strengthen the muscles that affect the ankle, and provide greater stability as you move your foot.

If your ankle doesn’t respond well to the above treatments, your podiatrist will likely discuss the possibility of surgery with you. Surgery may be used to tighten up the ligaments in your ankle, or may use some tissues from around your ankle to strengthen up the joint. Another method your surgeon may use is to graft a tendon in from another part of your body and use it to stabilize your ankle. All surgeries have benefits and disadvantages; your podiatrist can help you decide which would be the best for you.

The good thing about this condition is that it’s very treatable. And with care, you’ll be back to your normal activities in next to no time. Just try to avoid those tiger-filled pits from now on.