Ankle


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Update on Management of Lateral Ankle Instability

Almost everyone has either sprained an ankle or knows someone who has. It's one of the most common musculoskeletal injuries. Most people recover well from sprained ankles, but about 10 percent to 40 percent end up with some problems, such as chronic instability, which can make it easier to sprain your ankle again.

Researchers don't understand why a certain percentage of people end up with this instability, but a research team led by van Deun found that in a group of patients with unstable ankles, the patients had a different walk than those with stable ankles. The unstable ankle patients used their leg muscles in a different manner. In another study by Strauss and colleagues, it was found that patients with unstable ankles had higher rates of tendon problems, as well as other injuries or malformations in the foot.

The risk factors are a bit of a vicious circle. Having an unstable ankle increases your risk of having an ankle sprain - but having an ankle sprain increases the risk of having an unstable ankle. Other risk factors include the way you walk, any problems with your feet that may throw your walk out of alignment, as well as malformations of the bones. Lifestyle choices also increase risk. People who run and jump in the same sport (such as basketball and volleyball) have a higher risk of spraining their ankles.

Interestingly, if you've had repeated sprains, the risk increases not only because of the injury, but because of the way repeated sprains are often treated. Studies show that people who have sprained their ankle more than once tend to not take care of it as well as they should and they return to their pre-sprain activities earlier than recommended.

Sprained ankles may be prevented in some cases. If you know your ankle is unstable, you may want to learn how to tape it up before your activities, to provide support to the ankle. Bracing may also be an option for some people.

Diagnosing a sprain is partly ruling out a fracture (through x-rays), although some people with unstable ankles may find that stress x-rays (x-rays that show you standing on your foot or flexing it) show something in the soft tissue that helps the doctors identify the problem. Magnetic resonance imaging (MRI) is also a test that could show if the ankle is sprained.

During the physical exam, your doctor may move your foot up and down, especially if you knee is at a 90 degree angle. This tells the doctor a lot about your ankle's ability to move.

Standard treatment for a sprained ankle involves light or no weight-bearing, avoiding activities that could injure the ankle, along with ice, compression, and elevation. As soon as the acute pain fades and the swelling goes down, usually it's time to begin rehabilitation with either physiotherapy or exercises. Most people find good relief within two weeks or so, but it can take up to six to eight weeks for a full recovery.

In order to protect the ankle during recovery and prevent a recurrence, some people choose to use braces when doing activities such as running. Whether this works really seems to depend on the patient.

Surgery is not a common treatment for sprained ankles but sometimes it is the last resort if the ankle becomes dangerously unstable. The surgeries can replace the injured structures into their original locations or a tendon is taken from elsewhere and used to replace the damaged one. In some cases, arthroscopic surgery, surgery done through tiny incisions using long handled instruments and a camera to visualize the area are done to clean out problems left behind after the surgery.

The authors of this article concluded that standard treatment for ankle instability is functional rehabilitation but that surgery may be needed if the standard treatments don't work.

Cyrus E. Taghavi and Nelson F. Soo-Hoo. Lateral Ankle Instability. In Current Orthopaedic Practice. April 2009. Vol. 20. No. 2. Pp. 117-122.

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