Is your ankle still giving you problems long after a sprain that should’ve healed? Ankle sprains are one of the most common musculoskeletal injuries. According to the National Institute of Health, over 70 percent of those who sprain their ankles develop some form of residual physical disability. Most ankle sprains are treated using RICE protocol (rest, ice, compression, elevation); however, some injuries don’t heal like others and can cause you trouble if left untreated. Ankles are comprised of ligaments, bones, and joints. The ankle has three lateral ankle ligaments and sprains can add strain or stress to these ligaments. Those with chronic ankle instability are more susceptible to severe sprains or minor slips of the ankle.
Causes
Chronic ankle instability is oftentimes a result of a severe sprain that hasn’t healed properly. Those with “double-jointedness,” collagen vascular disorders like rheumatoid arthritis, or Ehlers-Danlos syndrome could also be more susceptible to ankle instability.
“Something as simple as stepping on a curb could result in a severe sprain,” said Benjamin R. Proto, DPM, FACFAS of TPMG Orthopedics in Newport News. Wearing heels or athletic activity can lead to ankle instability. Those with a history of multiple ankle sprains are also more likely to present with ankle instability.
Symptoms
• Pain or tenderness around your ankle
• Unstable or weak ankles, especially during activity
• Ankle sprains from minor traumas or twists
• Multiple sprains (3-4 or more) in a short period of time
Treatment Options
There are multiple treatment options. Most cases will start with an anterior drawer test of the ankle, an exam that assesses the ankle’s ligaments and instability through small movement and rotation of the ankle. A positive anterior drawer test means that your ankle probably has some instability. In some cases, if someone is experiencing significant pain or particularly unstable injuries, they’ll receive an MRI instead of an anterior drawer test. An MRI is a sensitive test that can detect ligament tears.
After testing is complete, treatment for ankle instability can vary from case to case. Most patients can be treated without surgery. Nonsurgical treatment options include anti-inflammatories, ankle braces, and exercises that strengthen the muscle controlling the ankle joint.
Surgery is considered for patients who do not improve with non-operative measures. Only about 5-10 percent of patients end up having surgery to correct ankle instability. A Brostrom Procedure is a relatively simple operation that repairs the torn ligaments on the outside of your ankle. A doctor will clean out the ankle’s inflammation with a scope and repair the ligament with an anchor. Those who require surgery can expect to spend three weeks off their foot followed by physical therapy.
Prevention
There are a few ways to prevent ankle instability injuries in the future. Athletes should consider working with trainers and therapists to prevent further injury. Taping, strapping, and sometimes orthotics are all approaches to avoid future sprains and instability. The age of the injury can also impact your treatment strategy.
No one should have to go through life in pain or off balance. If you start to notice the signs of ankle instability, ask your doctor what treatment might be best for you.
Benjamin R. Proto, DPM, FACFAS, joined TPMG Orthopedics in 2007 and has established himself as one of the Peninsula’s leading foot and ankle specialists, offering his patients the latest advancements in foot and ankle care. In his surgical practice, Dr. Proto utilizes minimally invasive techniques and specializes in partial and total joint replacement of the foot and ankle, ankle arthroscopy, and ankle fusion to address painful and dysfunctional joints.
