Ankle Instability

Ankle instability can occur as a result of an ankle sprain This condition occurs when after an ankle injury the ligament fails to heal properly. This makes the injured ankle less able to support the body's weight—i.e., less stable—which predisposes the patient to additional sprain and other ankle injuries in the future.

Types of ankle instability:

Mechanical instability:

Mechanical instability involves an ankle that is hypermobile and has lax ligaments.

Functional instability:

Functional instability is a subjective condition in which the ankle feels as though it is unstable.

Ankle instability happens when the outer part of the ankle constantly "gives out" on weight-bearing, usually, an inversion ankle sprain causing injury to the lateral ankle ligaments—stretches, ruptures, or tears. Other causes may be:

• Standing, running, or walking on uneven surfaces.
• Ankle impingement.
• Ankle arthritis
• Nerve damage.
• Ankle sprain that has not healed properly.
• The ligaments in the ankle may have been stretched or torn, and when such ligaments heal, they result in weaker and "stretched out" ligaments.
• Participation in activities that involve the ankle, such as ballet and gymnastics.
• High-intensity sports like basketball or football,
• Repetitive ankle sprains are also at risk for ankle instability.
• Muscle weakness,
• Tight Achilles tendon,
•  Fixed deformity of the forefoot or rearfoot.

The Symptom is mainly instability and imbalance, other symptoms include:

Intense pain and other times it may be a dull ache.

• Swelling.
• Tenderness to the touch.
• Stiffness.
• Bruising is associated with ankle instability.
•  Feeling of giving way.
• Wobbly or unstable feeling.
• The patient walks with a pronounced limp.
• The ankle tends to roll or lean towards one side due to under or over-pronation or due to the weak ligaments surrounding the ankle.

Pathology:

Ankle instability pathology typically occurs after walking or running, although it may also occur while standing still. Ankle instability results from an ankle sprain that has not healed properly. A sprained ankle stretches or tears connective tissues, affecting the balance.

Physical examination:

Physical examination may be painful, or uncomfortable. On clinical examination, the ankle ligaments appear stable and within normal limits, but the patient experiences a feeling of instability on weight-bearing. This condition can be caused due to different ankle conditions, such as ankle impingement, ankle arthritis, nerve damage, etc.

Stress x-ray:

A stress x-ray involves moving the ankle in certain directions to visualize the instability present.

X-rays:

A simple X-ray shows images to visualize the causes for instability.

Magnetic resonance imaging (MRI):

Magnetic resonance imaging (MRI) can help to detect damage to ligaments and tendons.

CT scan:

CT scan is done to reveal more detailed images of the bones of the joint.

Ultrasound:

Ultrasound produces images that may help to check the condition of a ligament or tendon when the foot is in different positions.

Medication: Non-steroidal anti-inflammatory drugs, Analgesics, etc.

Note: Medication should not be taken without the doctor's prescription.

Surgery:

Usually, mechanical instability is treated surgically, whereas functional instability is typically treated with bracing and physiotherapy. If conservative treatment does not work then surgery is suggested to repair the damaged ligaments in the ankle. Several different surgical approaches may be taken, such as direct repair of the injured ligaments by shortening and tightening the stretched ligaments.

Another approach is to replace or augment the damaged ligaments with donor tissue. This donor tissue may be synthetically created or may be taken from the patient's leg and used as an ankle ligament.

Rest:

Rest is one of the most difficult things to do as it is difficult for most people to take a break from the activities. Rest gives our body time to recover and lets the ligaments have a break in terms of supporting the body. If the ankles are sore, then take a few days off. If there is mild to moderate pain, it may be beneficial to take rest for 1-2 weeks.

Cryotherapy:

Cold therapy or cryotherapy relieves pain, by applying an ice pack to the ankle for 10 minutes twice or thrice a day. Ice therapy helps reduce swelling or inflammation which can lead to pain relief.

Compression:

Compression is important as it helps prevent inflammation in the area. Wrap the ankle with the elastic wrap or use a compression ice wrap that both compresses and applies cold therapy.

Elevation:

The affected leg is kept in elevation above the heart to assist gravity to reduce excessive swelling around the ankle.

Ankle support:

The patient may feel instability while walking or standing, therefore wearing an ankle brace can help support the weak ankles. An ankle brace provides moderate protection during sports. These can help steady the ankle while walking and also prevent additional ankle sprains that lead to chronic ankle instability. In severe cases, a custom-made orthosis may be recommended.

Kinesio taping:

Kinesio taping helps to provide mechanical support for ankle instability.

Transcutaneous Electrical Stimulation (TENS):

Transcutaneous Electrical Stimulation is effective in decreasing swelling, spasms, and pain.

Therapeutic Ultrasound:

Therapeutic ultrasound decreases pain, and swelling and thus improves function, and enhances the healing process.

Muscle flexibility exercises:

Stretching exercises are done to increase the flexibility in the ankle, Exercises that help by increasing the range of motion also help to improve balance, and strengthen the surrounding muscles. Exercises like tracing the letters of the alphabet with the foot, making small to large circles inwards and outwards, standing on one foot to improve balance, increasing difficulty, standing on one foot on a balance ball or Bosu ball, and strengthening with an elastic band are the recommended exercises.

Strengthening exercises:

Calf, ankle, and foot muscles require strengthening to provide normal dynamic ankle control and function. Strengthening exercises should be gradually progressed from non-weight bearing to partial and then full weight-bearing and resistance-loaded exercises.

Proprioception and Agility exercises:

Balance and proprioception are also affected by ankle instability. The physiotherapist guides the patient to improve their performance. Depending on the type of sport or lifestyle, balance and proprioception programs are designed to prepare the patient for light sports training. Further vigorous training is progressed to jogging, jumping, running and sport-specific drills involving high-intensity exercises.

The patient is advised to use proper footwear and other protective gear when participating in sports. And in the case of an ankle sprain, it is important to get immediate treatment done.