What is ankle instability?
Ankle instability is a condition in which the outer (lateral) side of your ankle keeps giving way. This condition often arises as result of recurrent ankle sprains that are very much common both in athletes and the general population.
What causes ankle instability?
Your ankle has various ligaments, which are strong band-like structures. They help keep your ankle and foot stable when you walk. When you sprain your ankle, these ligaments are stretched or torn, making your gait unsteady. A sprained ankle warrants rehabilitation to strengthen the attached muscles and the affected ligaments. However, a failure of rehabilitation following repeated ankle sprains will make your ankle chronically unstable.
According to Dr. Reed, most patients who present with ankle instability fall into the 20 to 40-year-old range. However, with Seattle’s bend toward active lifestyles, it’s not uncommon to see patients with this condition in their 40’s and 50’s.
Are there any non-surgical measures for ankle instability patients?
Of course! For acute ankle instability associated with a recent ankle sprain injury, Dr. Reed recommends conservative measures like boot immobilization with a gradual transition to a brace that can be worn within the shoe over the course of the first few weeks of treatment. Physical therapy is a mainstay as it teaches patients to use tools and techniques to help with the laxity present at the ankle joint.
For patients with chronic ankle instability, both off-the-shelf and custom ankle braces are available which can be worn during athletic activity or on uneven ground. Again, physical therapy plays a major role here as well.
Surgery for Ankle Instability
In the event of persistent chronic ankle instability and when other options are of no use, Dr. Reed recommends surgical reconstruction or repair of the torn ligaments.
Ankle-instability surgery broadly falls into two categories: an anatomic ligament repair and a non-anatomic ankle-ligament reconstruction. Dr. Reed commonly uses a modified Broström repair to reconstruct one or more torn ligaments on the outer side of your ankle. He typically reserves ankle reconstruction with tendon augmentation for patients with extensive ligament laxity or as a salvage procedure when the modified Broström repair has failed.
While two or more different techniques may be combined to achieve optimal results, a typical procedure consists of the following steps:
- You may receive general anesthesia that puts you to sleep or a regional block to numb the affected ankle.
- A 7 cm (about 3 inches) incision is made over the outside ankle.
- The ligaments are released from their attachment to your fibula (the outer ankle bone).
- A groove is created in the fibula and the ligaments are pulled tight and sutured into the groove, eliminating the laxity in the ankle.
- Your surgeon may make any other necessary repairs to tendons and other structures in the area.
- Occasionally an ankle arthroscopy is warranted to evaluate and treat any injuries inside the ankle joint, such as cartilage damage.
What to expect after surgery?
Following surgery, your ankle will be placed in a plaster splint, and you will need to avoid putting any weight on the affected foot. After the second week, your surgeon will replace the plaster splint with a removable boot, which is worn for another two weeks. Formal physical therapy begins at around four weeks, and you will be required to wear an ankle support until 8 weeks after surgery.
How long does it take to resume normal activities?
The recovery time after the procedure varies from one individual to another but usually takes a minimum of 4 to 5 months to return to normal activities, says Dr. Mark Reed.
