Diagnosing and Treating Ankle Instability

A common and often debilitating condition affecting people, especially the elderly, is chronic ankle instability – something we can treat in our office. This can typically occur after multiple minor or moderate ankle sprains or a single severe ankle sprain. Chronic ankle instability is one of the most common conditions that we see in the practice of foot medicine, or podiatry, today. The challenge with multiple minor or moderate ankle sprains or even a single severely sprained ankle is that it can result in residual symptoms which are then associated with chronic ankle instability. These conditions can lead to additional multiple ankle sprains and even secondary conditions that are even more debilitating, such as arthritis or a tendon tear and irritation. Synovitis has also been known to occur because of chronic ankle instability.

Over the course of around a hundred case studies, it has been noted that patients with chronic ankle instability have actually had the instability for an extended period of time, typically over six months. In addition, it has been noted that patients who have ankle instability often had multiple strains with difficulty playing sports, and this led to chronic lateral ankle pain. Patients themselves are often unaware that a single sprain, which is severe in nature, or multiple episodes with a moderate sprain are directly connected to their sports activities because they were unable to connect the two conditions. However, most patients do not realize that these conditions can lead to ankle instability and make their ankles more susceptible to damage.

When it comes to ankle instability, we have found that emergency room treatments are more than lacking. The reasons for this is when the emergency room doctors treat the ankle sprains, they typically do so with a wrap and oral pain medications to treat the immediate symptoms. There is no formal bracing used on the ankle, nor do these doctors recommend physical therapy which can strengthen the ankle in the aftermath of a sprain. As a result, the patient will never actually fully recover from the damage done to the ankle during this time period, and this can lead to severe pain and ankle instability in the long run. Over the course of years, especially if the ankle is subject to stress and re-injury, the patients find that the ankle consistently gets swollen and painful. These conditions become particularly noticeable as a patient starts to age. In addition, over time the ankle starts to feel more unstable to the patient, who may notice that even normal activities lead to a chronic inversion of the ankle. This, unbeknownst to the patient, is caused by the lack of proper ligament laxity and proprioception.

It is important to understand that pure ankle instability is different from functional ankle instability. In functional ankle instability, you may find that you experience pain and a feeling of looseness in the ankle when you step on it a certain way. This is caused by problems like ankle arthritis or an ankle impingement and is treated differently from chronic ankle instability. With functional ankle instability, though the ankle may feel floppy it is not actually unstable. A full and proper diagnosis is needed to determine if you have ankle instability, and what is the best method of treatment to follow to improve this condition.