Ankle Instability occurs when the ligaments supporting the ankle become dysfunctional, allowing the ankle to "give" on a frequent basis. This can happen in patients who have global ligament laxity or increased flexibility, and in patients who have injured their ligaments through multiple ankle sprains.
Many times, the ligaments are not the primary source of pain, rather the surrounding structures that are impacted by the lack of ligament support. When the ligaments do not function properly, it places more strain on your muscles and tendons to provide support to your ankle. Also, every time the ankle "gives" or "turns" there is a risk for injuring the cartilage inside the ankle.
A complete evaluation of the ankle ligaments, as well as the surrounding structures is vital when treating ankle instability, much like with acute ankle sprains. Inability to identify secondary injuries can be detrimental to your recovery time and overall outcome.
MRI can be a great too to determine the extent of the ligament injury, as well as identify secondary injuries, such as Peroneal tendon tears or Osteochondral Lesion of the talus.
In-office injection can be a great tool to evaluate the ankle, as well as provide relief. Local anesthetic, numbing medicine, is used to help identify if there is pain coming from deep inside the ankle joint. If the injection brings immediate relief, it tells us that Ankle Arthroscopy would be beneficial. If the injection offers no relief, then Arthroscopy may not be required. Generally, we will also put a small amount of steroid in the injection to decrease inflammation and pain, and relief can last for several weeks.
Secondary Injuries That May Occur With Ankle Instability:
- Ankle Impingement/Synovitis
- Osteochondral Lesion of Talus (OLT)
- Peroneal Tendon Tear or Synovitis
- Syndesmosis Injury
Physical Therapy is the first line treatment for ankle instability. The goal of therapy is to train your ligaments and surrounding muscles to properly support the ankle, Physical therapy can be successful in up to 80% of patients with ankle instability.
Ankle Braces or Ankle-Foot-Othosis (AFO) devices can be used as an external support for the ankle, and custom AFOs can be used to manage ankle instability for many years. The downside to bracing is that it only works when you use it, and it doesn't actually correct the underlying instability. AFOs can be a great option in patients who are not surgical candidates.
Surgery is indicated in patients who have global ligament laxity, failed physical therapy, or have failed prior surgery attempts to repair the ankle ligaments. Surgery usually involves repairing (tightening) the loose ligaments. Sometimes, tendon grafts or bone anchors are used to create ankle support.
Ankle Arthroscopy is utilized in a majority of surgical cases for ankle instability. Arthroscopy is the best way to identify and treat secondary injuries inside of the ankle joint, and it can often identify injuries that cannot be found by MRI or Ultrasound.
If you have Ankle Instability, Call us at 512-593-2949 or CLICK HERE to Schedule an Appointment.