Appearance
Chronic ankle instability is characterized by a recurring "giving way" of the lateral side of the ankle. This condition often develops after repeated sprains. Usually the "giving way" occurs while walking or doing other activities, but it may also occur when the patient is standing. Once the ligaments are injured to the point they can no longer maintain joint stability it is very easy for the ankle to undergo repetitive pathological inversion. This motion may lead to continued damage of the ankle joint structures as well as pain, swelling, and arthritic changes. Many athletes suffer from chronic ankle instability.

Symptoms Patients often complain that the affected ankle feels "unstable" or "gives out" frequently Patients typically feel unsteady when walking on uneven ground or sloped surfaces Repeated inversion injuries will occur with the slightest provocation Patients commonly report twisting or spraining ankles every few months with varying levels of severity Persistent swelling to the anterolateral aspect of the ankle Bracing or taping may not provide adequate stability

Myths About Ankle Injuries

• "If you have a foot or ankle injury, soak it in hot water immediately." False; don't use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.
• "Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.
• "The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.

Diagnosis
There may be tenderness to palpation of the anterior talofibular ligament or calcaneofibular ligament. Typically, one will see a positive anterior drawer sign similar to what you would see with an acute ankle injury. There is also increased inversion of the talus in the ankle mortise, particularly when compared to the contralateral ankle. When there is attempted rotary motion of the ankle within the mortise, the talus will often translocate laterally.

X-rays are used to evaluate for fractures; stress views may be used to look for instability; and osteochondral lesions may be visualized. Diagnostic ultrasound may be utilized to statically and dynamically evaluate the ankle ligaments and tendons. MRI may be ordered if additional pathology is suspected.

Treatment
Initial treatment involves managing symptoms and biomechanical control. Non-steroidal anti-inflammatories or steroid injections, if used alone, usually do not provide long term relief.

• Changes in shoe gear
• Functional orthotics are a vital part of treatment, especially when biomechanical abnormalities are present.
• Taping and bracing, particularly during athletic activity
• Physical therapy

other online resources

You can also download our Podiatry-at-a-Glance newsletters: A Guide to Lateral Ankle Instability .