How a Sprained Ankle Can Easily Become Chronic Ankle Instability

Sprained Ankles Can Easily Become Chronic Ankle Instability

A sprained ankle is among the most frequently incurred injuries worldwide. In the United States, more than 23,000 ankles are sprained each and every day. 

The usual cause of an acute ankle sprain is a sudden shift in weight-bearing that causes the outside edge of a person’s foot to roll under, and the inside edge to lift up. Such an abrupt redirection of force can stretch or tear the tough fibrous bands, known as ligaments, which strap the ankle’s structure together. 

This process is known as inversion, and the resulting ligament damage is called an inversion sprain. Eversion sprains, where the outside edge of the foot is lifted up while the inside edge rolls under, are much less common than inversion sprains.

What are lateral ankle ligaments?

Ligaments are strong and resilient tissues that connect bones to other bones.

The ankle’s architecture features three ligaments on the outside of the ankle joint. Called “lateral ankle ligaments”, these strong bands are meant to provide constant stability, no matter what energetic conduct the ankle’s owner is enjoying. (The ligaments on the inside of the ankle, which are damaged in an eversion sprain, are called medial ligaments.)

The demands we place on our ankles by vigorous activities like sports, ballet, hiking, etc., all too frequently impose immediate forces that stretch or even sever those ligaments. Sports activities are the primary risk factors that lead to ligament injury.

The symptoms of a sprained ankle are swelling, bruising, tenderness to touch, internal pain, and, sometimes, long-lasting instability of the ankle. That long-lasting instability of the ankle is known as chronic ankle instability.

A severe ankle sprain easily turns into chronic ankle instability 

Urgent care centers and emergency rooms are the usual front line of health care for sprained ankles. The physical examination and treatment they provide is usually meant to be temporary until a more thorough follow-up with an orthopedic sports medicine foot specialist can be scheduled for proper treatment.

Many sprained ankles are minor and don’t need treatment besides the application of RICE (an acronym for rest, ice, compression, and elevation) and over-the-counter anti-inflammatory medication. 

It’s estimated that roughly 30% of individuals will develop some level of chronic ankle instability after the initial lateral ankle sprain occurs due to under-treatment of the injury.

Too often people with nagging ankle pain, coupled with a general feeling of the ankle “giving way” will stoically ignore it or use an ankle brace and taping to temporarily help with functional instability and mechanical instability. Yet they never fix the underlying problem.

Over time, this can lead to higher levels of recurrent injury, chronic pain, lower leg weakness, and decreased physical activity. This can be due to many things. These can include: 

  • Issues with the Achilles tendon, which connects the gastrocnemius and soleus muscles to the calcaneus bone in the foot (which is the most important tendon for walking, running, jumping, and standing on tiptoes)
  • Ligament laxity
  • Chronic lateral ankle pain
  • Arthritis
  • Recurrent ankle sprains 
  • Avascular necrosis of the talus

It is often the case that the more severe the ankle sprain, the higher the chance it will never completely heal and need surgical intervention

How we diagnose chronic ankle instability 

Chronic ankle instability is often composed of three elements. It’s usually a triad of instability caused by ankle ligament damage, scar tissue formation, and a tear of the peroneal tendon. (The peroneal tendon attaches a muscle in the calf to the ankle’s structure.) 

The most common symptoms reported by ankle instability patients are a constant ache in the outside of the ankle which increases with activity, that nagging sense of the ankle “giving way” and swelling. 

Since most of the damage is to soft tissue (with impingement), x-rays are of little use in assessing the damage. At UFAI we most commonly use magnetic resonance imaging (MRI) to obtain definitive information.

Treatment options for chronic ankle instability

Physical Therapy

Physical therapy is often critically important to a successful ankle sprain recovery. A physical rehabilitation program can be the difference between a fully healed ankle and chronic ankle instability.

Successful physical therapy is not only for reducing swelling and inflammation along with the important strengthening exercises you learn. Physical therapy plays an important role in reconnecting the patients’ minds with their ankles’ physical apparatus.

This concept is known as proprioception. We think it’s important to learn this word, its spelling, its meaning, and how to pronounce it. Even if only to impress your friends. ☺

What is proprioception

Proprioception means your mind’s awareness of your body’s precise position in the space/time continuum. Put into the practical terms of ankle rehabilitation, proprioception means your mind’s awareness of exactly how your ankle is positioned at the instant that your foot makes contact with the soccer field, the basketball or tennis court, the ballet stage, or the hiking trail.

What are sensorimotor skills?

Proprioception is inextricably linked with abilities known as sensorimotor skills. These skills involve the mind first receiving messages (sensory input) from locations in the body and then producing an appropriate physical response (motor output) to that input. 

Multiple research projects have shown that inversion ankle sprains occur due to improper positioning of the foot and ankle at the moment of contact with the field, court, etc. 

So, awareness of the precise position of your foot, and the sensorimotor ability to make postural adjustments in response to that knowledge, are crucial to both the prevention of ankle instability and its rehabilitation.

Physical therapy is key in avoiding diminished proprioception and inadequate sensorimotor skills

Authoritative studies have shown that chronic ankle instability can be caused by a combination of diminished proprioception, inadequate sensorimotor skills, and weakness in muscles (known as evertor muscles) that run from your calf down into your foot. When healthy and strong, evertor muscles mitigate sprains by preventing the outside edge of your foot from rolling under.

Successful chronic ankle instability rehabilitation includes proprioception training and strength training of the evertor muscles.

Surgical treatment for chronic ankle instability

In many cases of chronic instability, the symptoms of an ankle injury have been present for so long that various complications become what is termed “hardened” or “baked-in”, meaning conservative treatment like physical therapy is generally not helpful for long-term relief.

In this case, you will be glad to know that the surgeons of University Foot and Ankle Institute are leaders in restoring pain-free and reliable stability to patients suffering from chronic ankle instability. Two of the more common surgical techniques that are performed are called the “UFAI Triad” and “InternalBrace”.

What is the UFAI Triad Surgery

The UFAI Triad is an arthroscopic surgical procedure called, scar tissue and debris are removed. The repaired ligaments are then firmly reattached. 

What is InternalBrace?

InternalBrace is a remarkable surgical advance is used to tightly knit the torn ankle ligaments back together, and firmly attach them to the corresponding bone. This process decreases the healing time by over a month. And no secondary surgery is necessary. When their job is accomplished, the components of InternalBrace are naturally absorbed by the body.

Why choose University Foot and Ankle Institute for the treatment of chronic ankle instability?

The UFAI success rate in curing ankle instability is among the highest in the country. Over 99% of our patients return to full and unrestricted activity following our chronic ankle instability surgery and rehabilitation protocols.

If you’re experiencing foot and ankle problems, we’re here to help. Our nationally recognized foot and ankle surgeons offer the most advanced care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.

For more information or to schedule a consultation in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.

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