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Chronic Ankle Instability

Have you ever felt that your ankle was about to give way while walking or running? Does it come with any pain or aching on the outside of your ankle? Did you know you may be suffering from chronic ankle instability? Let’s get into exactly what chronic ankle instability is, how to identify it, and what you can do to treat it.

What Is Chronic Ankle Instability?

Chronic ankle instability refers to recurring symptoms of pain and weakness on the outside of the ankle due to trauma. The initial trauma may be a sprain, bone fracture, or inflamed tendon. This means that every acute injury can potentially cause chronic ankle instability, especially when it is not treated appropriately or the ankle is not allowed to heal completely before returning to regular physical activities.

Causes of Chronic Ankle Instability

The most common cause of chronic ankle instability is an untreated ankle pathology or one that hasn't been allowed to heal correctly. As a result, the soft tissues and ligaments around the ankle bone are weak and unable to support the amount of force traveling through the ankle bone during weight-bearing activities. Some other causes of chronic ankle pain are:

  • Arthritis of the ankle or surrounding joints
  • Nerve injury
  • Inflamed tendons
  • Bone fractures
  • Scar tissue formation
  • Joint swelling

Symptoms of Chronic Ankle Instability

Chronic ankle instability is quite common among athletes and sportsmen. Unfortunately, it is sometimes misdiagnosed because of its similarity to other ankle conditions. Repeated ankle sprains are indicative of chronic ankle instability. If you keep sustaining ankle sprains at the slightest activity, it is likely because you already have chronic ankle instability.

Here are some other symptoms to look out for:

  • Feeling of instability in the ankle while walking
  • Pain from both interarticular and multi-articular sources
  • Ankle stiffness
  • Persistent swelling around the ankle
  • Tenderness around the ankle

Who Is at Risk of Getting Chronic Ankle Instability?

The following can increase your risk of developing chronic ankle instability:

  • Repeated ankle sprains
  • Incomplete rehabilitation of previous ankle injuries
  • Ligamentous laxity
  • Participation in high-risk sports that involve a lot of sudden turns and pivoting on the ankle (e.g., basketball)
  • Varus deformity of the hindfoot

Chronic ankle instability is generally more common in athletes and sportsmen than in the general population, so it could be said that sports can increase the chance of developing this condition.

Complications Associated with Chronic Ankle Instability

Like most other foot conditions, chronic ankle instability can quickly get out of hand when it is not treated. Each new sprain further weakens the ligament, causing greater instability and increasing the chances of developing other ankle problems. Several conditions have been associated with chronic ankle instability. Some of the most common are outlined below.

Osteochondral Defects

Osteochondral defects (OCD) are injuries to the talus that occur because of trauma to the ankle. They include blistering cartilage layers; intra-bone, cyst-like lesions; and cartilage fractures. OCD can lead to further ankle joint instability and pain.

Os Trigonum Syndrome

Os trigonum results from repetitive plantarflexion stress and may also be triggered by repeated ankle sprains. It is a painful condition caused by a bony outgrowth behind the talus. The outgrowth will cause nerve impingement, which results in pain.

Peroneal Tendinopathy

Peroneal tendinopathy is a chronic inflammation of the peroneal tendon. It occurs due to progressive stress of the peroneal tendon over a long period and weakens the active ankle stabilizers.

Sinus Tarsi Syndrome

This condition is categorized by pain and tenderness in the sinus tarsi located on the lateral side of the hindfoot. It can occur after a single ankle sprain or a series of them.

Subtalar Instability

Subtalar instability has an unknown etiology, perhaps because it is often missed during diagnosis. However, it has also been related to chronic ankle instability and increased inward rotation of the ankle.

Treatment Options for Chronic Ankle Instability

The earliest possible treatment of chronic ankle instability is essential to avoid complications and minimize its effects on daily life. There are two approaches to the treatment of chronic ankle instability: non-conservative means and surgical means.

Non-Surgical Treatment

There is no single approach that solves the problem of chronic ankle instability. Therefore, the following treatment methods should be used together for the best results.

  • Rest Getting off the ankle will take some stress off the foot and give room for the ligament to heal.
  • Using NSAIDs Using non-steroidal anti-inflammatory medication like ibuprofen can help limit inflammation.
  • Splinting and taping Ankle splinting or taping can help limit the risk of further injury, ensuring the ankle is kept in position while performing high-risk activities. You can use an ankle stirrup or an ankle lacer to do this.
  • Physical therapy A physical therapist plays a vital role in managing chronic ankle instability. This condition causes proprioceptive deficits and muscle weakness. As a result, the physiotherapist will prescribe exercises to strengthen the muscles around the ankle joint and improve balance, coordination, and proprioception.
  • Custom orthotics If the shape of your foot places more stress on your ankle ligaments and predisposes you to chronic ankle instability, a custom orthotic may be necessary. For example, a molded insole will be prescribed to use with your shoes to reduce the stressors.
  • Immobilization It may be necessary to immobilize the ankle to allow healing to take place.

Surgical Treatment

If intervention is early enough, NSAIDs, braces and splints, physical therapy, and custom insoles should be enough to treat chronic ankle instability. Surgery is considered where non-conservative management does not curb symptoms and significant weakness in the ankle persists.

Surgical approaches for managing chronic ankle instability include anatomical repair of the ligaments, tenodesis, and a calcaneal osteotomy.