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 with giving way or giving out
- Catching of the ankle
- Pain along the arch tendon (posterior tibial tendon)
- Pain along the outside tendon (peroneal tendon)
- 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 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 looseness, tendon pain and 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 Treatment 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 scar tissue formation, 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 patient 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.
Call 877-989-9110 for a consultation at one of University Foot and Ankle Institute’s nine advanced care centers in Southern California.
Dr. Baravarian been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),
Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
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