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Chronic ankle instability is a condition where you sprain your ankle over and over again. The majority of the time it occurs after an initial severe ankle sprain, which is followed by monthly, weekly, or potentially even daily sprains to the ankle joint.
In the majority of cases of chronic ankle instability, the ligaments on the outside of the ankle have stretched out to the point where the ankle is unable to maintain a stable position. This is typically caused by an eversion injury, which occurs when the ankle turns inward and the body turns out. This stretches the ligaments on the outside of the ankle. Following an eversion injury, people typically have difficulty performing cutting activities such as rolling, twisting the foot, running on a trail, playing basketball, tennis, football, or soccer.
Symptoms of chronic ankle instability are the sensation that one’s ankle is going to roll or turn, even with the simplest activities. This could include stepping off of a curb or simply when stepping on a rock or pebble. You will also experience recurrent swelling, tenderness, and pain on the outside of the ankle, as if a new acute sprain has once again occurred.
The problem is usually evaluated by direct examination of the ankle joint. The ankle will have the signs of an acute ankle sprain, which include occasionally swelling and tenderness along the lateral ankle ligaments. Most importantly, the ankle will feel unstable.
Often your orthopedic specialist will perform what is called an anterior draw test. In this examination the leg bone is stabilized while the heel bone is pulled forward. If the ankle joint feels as if it is shifting forward more than what is considered normal, this is a positive anterior draw test and is consistent with stretched out ligaments on the outside of the ankle.
Further necessary tests usually include X-rays and, occasionally, MRI scanning. MRI scanning is a way to look directly at the soft tissues of the ankle and directly evaluate whether the ligaments do appear chronically stretched out or ruptured.
Nonsurgical options for chronic lateral ankle instability include physical therapy to regain strength and retrain the nerves and muscles around the ankle joint. Wearing an ankle brace, usually in a very tight lace-up support, is another option. The brace immobilizes the ankle to the point that it is very difficult to re-sprain the ankle.
Surgery may also be necessary for some people. The surgical options for chronic ankle instability usually entail a two-step process. The first step involves an ankle arthroscopy, in which a small camera is inserted into the ankle joint so that the surgeon can see whether there is extensive scar tissue build up or any damage done to the surface of the ankle joint.
The second step is a surgery to tighten or recreate the ligaments on the outside of the ankle joint. If your ankle ligaments are stretched out but still intact, many times a procedure called a Brostrom procedure will be performed. This procedure entails simply tightening up one’s natural ligaments. If the ligaments are very stretched out or one has already undergone a Brostrom-type procedure, a more extensive ligamentous reconstruction of the ankle joint would be necessary. In this case, potentially a graft may be used to recreate the ligaments on the outside of the ankle.
The majority of people with chronic lateral ankle instability who undergo surgery do very well. Recovery includes three to four weeks in a cast followed by immobilization in a brace and physical therapy. Before returning to sports, the majority of people require two to three months of recuperation.
Dr. Jason Rudolph is an orthopedic surgeon at Coordinated Health who specializes in foot and ankle reconstruction and sports injuries.