Chronic Ankle Instability and Pain: Diagnosis & Treatment

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
  • Locking
  • Pain along the arch tendon (posterior tibial tendon)
  • Pain along the outside tendon (peroneal tendon)
  • Swelling
  • 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:

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. Bob Baravarian

Dr. Bob Baravarian

Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as co-director of University Foot and Ankle Institute. He is Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

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.
Dr. Bob Baravarian

Leave a Reply

Your email address will not be published.

3 + 17 =

  • CustomerSure
    Everyone is amazing.
    Susan H.
  • CustomerSure
    PT Staff are very nice and knowledgeable. It took me a little time to understand how the PT was correcting my issue, but I think I've been cured!
    Terasa H.
  • ZocDoc
    Professional, to the point, pleasant. Very happy with service and the ability to schedule via Zocdoc.
    Deborah F.
  • CustomerSure
    Everyone is courteous, professional and efficient.
    Joseph O.
  • Yelp
    I love Dr Bob! I am a runner and my feet were hurting so badly that I wanted to stop doing the activity that I loved.  I went to him reluctantly on a recommendation from a friend and his friendly office staff brought ...
    A.M.
  • Yelp
    I had my first experience with this office earlier this week. Dr. Franson spent ample time with me, and was very attentive to my concerns and questions. I especially appreciated his relaxed, but thorough, way of deali...
    Chuck S.
  • Yelp
    I've been seeing Dr Baravarian for about a year for a chronic foot injury and I'm very happy with him and the Sherman Oaks office.  The staff at UFAI is knowledgeable and friendly. It's consistently easy to get an ea...
    Tracy L.
  • Yelp
    Dr. Baravarian is a very caring and patient doctor. During my first visit with him he really took the time to listen to my concerns and talk to me about all my options regarding my chronic pain. I highly recommend Dr....
    Tina B.
  • Yelp
    I saw Dr. Baravarian after being misdiagnosed by a previous doctor. I was suffering from foot pain for several months - I am a runner and even short walks were becoming increasingly painful. Everyone in the office is ...
    Christie C.
  • Google+
    I came to University Foot and Ankle Institute after being misdiagnosed by another doctor. I am a runner and foot pain was making even the shortest walks difficult and painful. Everyone at the office is very nice and D...
    Kay C.
Same day appointments now available!
or call 24/7:
  • University Foot & Ankle, a Preferred Provider to:
  • UCLA Health System - UCLA Medical Group
  • MPTF - Member Industry Health Network
  • Cirque du Soleil
  • ATP - Association of Tennis Professionals
  • And consulting physicians for:
  • C&S - Cedars-Sinai
  • Saint John's Health Center