Q & A

What Is Chronic Ankle Instability?

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Chronic ankle instability is a common and debilitating condition characterized by recurring sprains of the outer (lateral) side of the ankle. This condition can develop following a single serious ankle sprain or may be due to repeated inversion ankle sprains. Usually the “giving way” occurs while walking on uneven surfaces or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability.

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Causes

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Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.

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Repeated ankle sprains often cause – and perpetuate – chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle such as arthritis, synovitis, or tendon injury. 

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Symptoms

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People with chronic ankle instability often complain of:

• The ankle feeling wobbly or unstable, especially on uneven surfaces or loose gravel

• A repeated turning of the ankle

• Persistent (chronic) discomfort and swelling

• Pain or tenderness

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Diagnosis

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In evaluating and diagnosing your condition, Dr. Tien will ask you about any previous ankle injuries and instability. She will examine your ankle to check for tenderness, stretching of the ligaments, and instability of your ankle. X-rays or other imaging studies may be helpful in further evaluating the ankle.

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Non-Surgical Treatment

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Non-surgical treatment may include:

• Immobilization in a cast or boot may be beneficial in the setting of an acute injury. 

• Bracing- Some patients wear an ankle brace to gain support for the ankle and keep the ankle from inverting. Bracing also helps prevent additional ankle sprains.

• Physical therapy- involves various treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport

• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.

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When Is Surgery Needed?

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In some cases, Dr. Tien will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. Surgery usually involves repair or reconstruction of the damaged ligament(s). She may also consider an ankle arthroscopy procedure to remove scar or fibrous tissue from the ankle joint and repair lesions with the ankle bone (talus) if needed. The surgeon will select the surgical procedure(s) best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.