Ankle instability

Definition


Medical treatment

For chronic ankle instability a combination of the following treatments is often successful at relieving symptoms and minimizing the risk of recurrent ankle sprains:
           - Therapy to strengthen the muscles surrounding the ankle joint: These include exercises to strengthen the muscles that evert and invert the ankle, particularly the everting muscles that allow the ankle to resist inversion including the peroneus longus and peroneus brevis
           - Improve ankle proprioception. : Aggressive therapy to improve proprioception should also be performed. Exercises such as standing on one foot with the eyes closed and later on a soft surface with the eyes closed can be very helpful in improving proprioception.
           - Evaluation and treatment by a physical therapist: The patient may benefit from strengthening and proprioception training under the guidance of a trained physical therapist.
           - Prophylactic splinting of the ankle: Prophylactic ankle splinting with the use of an ankle stirrup, ankle lacer, or ankle taping can be very helpful in patients who are participating in high-risk activities.

With appropriate rehabilitation including strengthening and proprioception training as well as splinting or bracing as required, most patients with ankle instability can be treated nonoperatively


Surgical treatment

Some patients will fail non-operative management and require or benefit from operative intervention. Typically, operative treatment is reserved for patients that suffer multiple ankle sprains or instability episodes that are not adequately controlled with non-operative management. In addition, patients with significant intra-articular pathology such as a talar OCL that are noted on clinical or intraoperative examination to have gross ankle instability will benefit from stabilization of the attenuated lateral ligamentous structures.

Anatomical repair of the outside (lateral) ankle ligaments (Broström procedure) including the anterior talofibular ligament and the calcaneofibular ligament is one common means of surgically stabilizing the ankle operatively. This procedure involves cutting the stretched out ligaments (anterior talofibular ligament and calcaneofibular ligament) on the outside of the ankle and repairing them in a tightened position.

Another similar operative treatment is a tendon reconstruction of the lateral ankle ligaments operative treatment. This procedure involves reinforcing the stretched out ligaments by weaving a tendon graft through bones in the outside of the ankle to provide increased support to this area.

A lateralizing calcaneal osteotomy may be required to realign the hindfoot in patients that fail an initial attempt at reconstructing the unstable ankle or patients with marked varus alignment. This is typically done using a Lateralizing Calcaneal Osteotomy. This procedure involves cutting the heel bone and shifting it to the outside. This bone cut is then stabilized with a screw.