Chronic Ankle Instability: Essential Insights and Treatment Options

Ankle sprains represent the most common presenting orthopedic problem to emergency rooms.  Furthermore, since a sprained ankle is so common, it is often mistreated or treated at home without proper care resulting in chronic ankle instability and associated secondary ankle problems.

Common Presenting Findings of Chronic Ankle Instability:

• Looseness of the ankle with ankle giving way or giving out
• Catching of the ankle
• Locking of the ankle
• Pain along the arch tendon (posterior tibial tendon)
• Pain along the outside ankle tendon (peroneal tendon)
• Swelling of the ankle
• Abnormal rotation of the foot over time

These findings are due to the ankle being loose and subsequent instability of the ankle causing secondary problems such as ankle tendon tears, cartilage damage or bone spurs.  These secondary ankle pain sources are more often the presenting complaint as the patient has gotten used to the loose ankle as a primary source of pain.

Diagnostic testing for chronic ankle instability includes physical exam, x-rays, MRI and possible CT scan.  Each test has specific pluses.  Physical exam is used to check ankle looseness, tendon pain and ankle joint palpation for loose bodies and bone spurs and capsule inflammation.

An MRI offers the best information.  The ankle ligaments, tendons, cartilage and bone can be check.  The information in an MRI is invaluable in checking the ankle and also for planning surgical procedures.

In rare cases a CT scan is used for additional information if a fracture or cyst in the bone is suspected.

Following examination and testing, a game plan for treatment is considered.  We often will try conservative care such as bracing, injection therapy and physical therapy for mild cases, but in a majority of cases, there is a surgical problem that needs to be corrected.

Common Surgical Treatments Associated with Chronic Ankle Instability:

• Ankle stabilization with primary ligament repair
• Peroneal tendon repair
• Arthroscopy with scar tissue and bone spur and loose body removal
• Syndesmosis repair
• Secondary ankle ligament repair
• Osteochondral lesion treatments
• Posterior tibial tendon repair (rare)
• Deltoid ankle ligament repair (rare)
• Ankle Pain with Neuroma

In most cases, the triad of common injury and the source of greatest pain and problems is a combination of ankle scar tissue formation, ankle instability and peroneal tendon tear. This triad has been reviewed and multiple papers have been published on the topic by University Foot and Ankle Institute.

The underlying cause of this triad is initial ankle sprain resulting in ligament tear that is not well treated.  Over time the ankle forms scar tissue due to the body trying to stabilize the loose ankle. The ligament tear and laxity of the ankle make the peroneal tendon work to hard trying to stabilize the ankle resulting in a tear of the tendon on the back of the ankle.  Over time the ankle develops chronic pain and weakness as the ligaments and tendons do not work as a whole

With proper work-up and testing and sound surgical planning, chronic ankle instability can be well treated with excellent outcomes.  The recovery is about 6 weeks in a cast and about 3 weeks of physical therapy after the cast is removed.  Patients are most often able to return to full activity with no restrictions and have full recovery to pre-injury level. We can help you recover from your ankle ligament tear injury.

Consider University Foot and Ankle Institute for advanced ankle surgery in California.