Chronic Ankle Instability & Ankle Sprains

Ankle sprains are common injuries that can happen to anyone. Chances are you know of people who have sprained their ankle—and maybe you’re one of them. But what you may not know is that ankle sprains are closely linked to a persistent condition called chronic ankle instability. In fact, the relationship between a sprained ankle and chronic ankle instability is so intertwined that one can lead to the other, and vice versa. In a sense, ankle sprains and chronic ankle instability are like a “chicken-and-egg” situation.

To understand these two conditions, let’s first take a look at how the ankle works. The ankle is the joint where the leg and foot bones come together to form a hinge-like structure that enables movement. The leg and foot bones are attached to each other by fibrous bands called ligaments; there are three main ligaments in the ankle. By connecting the bones, these ligaments serve the purpose of limiting excessive motion in the ankle. In essence, ligaments keep your ankle stable and serve as the body’s natural ankle brace—and that lets you keep your balance.

What happens when you sprain your ankle? An ankle sprain is a sudden twisting of the ankle that causes one or more ligaments to be stretched or torn. Injury to the ligaments renders them unable to do their job and restrict excess motion—and that makes it difficult to walk without wobbling. Proper healing has to take place before the ligaments can be strong enough to once again keep the ankle stable. However, typically the healed ligaments will not be as strong as they once were before the injury.

But what exactly is chronic ankle instability? As the name implies, chronic ankle stability is a longstanding decrease in ankle stability—in other words, a weakened ankle. People with chronic ankle instability experience a repeated giving way (or turning or twisting) of the outer side of the ankle. This can occur at various times—when walking, when doing other activities, and even when just standing. In particular, walking on uneven surfaces or participating in sports can be difficult for those with this condition.

Chronic ankle instability and ankle sprains are closely linked because repeated sprains often cause—and perpetuate—chronic ankle instability. In turn, having chronic ankle instability makes a person vulnerable to having more ankle sprains. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional ankle problems, including more sprains. Subsequent sprains can also damage bones or cartilage of the ankle joint.

You may be wondering if all ankle sprains lead to chronic ankle instability. The answer is “no,” because not all ankles sprains are alike—some involve more serious ligament damage than others. Also, it greatly matters how the sprain was treated. Proper treatment, which include rehabilitation, can strengthen the muscles around the ankle and retrain the tissues that affect balance. In contrast, ankles that haven’t been treated effectively and haven’t undergone proper rehab may remain weakened and prone to spraining again. It’s the repetition of sprains that can cause chronic ankle instability.

Anyone—children and adults—can sprain their ankle, but some individuals are more likely to do so than others. People with high arches are susceptible to these sprains, because there is constant imbalance in the foot that can cause the ankle to roll outward. Athletes are also no strangers to ankle sprains, especially those who play sports that require jumping or moving side-to-side. And some people are born with weak ankles or lax ligaments, which makes them more prone to ankle sprains.

The signs and symptoms of chronic ankle instability vary from person to person. The classic sign, as already mentioned, is a repeated turning of the ankle, especially on uneven surfaces or when participating in sports. Often the ankle feels wobbly or unstable. Many patients also have persistent discomfort and swelling of the ankle, as also occurs in ankle sprains. In addition, pain or tenderness is often present. In time, some people with chronic ankle instability may develop arthritis in the ankle joint, which can bring chronic pain and swelling.

If you have problems with your ankle turning, it’s important visit Dr. Menchin and Dr. Hetman at our Memorial City or Katy location to get a thorough evaluation and diagnosis, and find out what you can do about it. Proper treatment will help you today—and will also help prevent future sprains.

To evaluate and diagnose your condition, your Houston and Katy foot surgeons will obtain your history, asking whether you’ve experienced any previous ankle injuries or imbalance. The surgeons will also examine your ankle and foot to check for tender areas, signs of swelling, and instability of your ankle. Sometimes x-rays or an MRI are ordered, although these imaging studies are not always needed.

Once the surgeons have diagnosed your condition as chronic ankle instability, a treatment plan can begin. The plan will be individualized to your particular case and will be suitable for your level of activity. Many cases are successfully treated nonsurgically, while other cases may require surgery.

The cornerstone of nonsurgical treatment for chronic ankle instability is physical therapy. This is a vital strategy aimed at reducing the wobbliness of the ankle. PT involves a variety of exercises and other modalities to strengthen the ankle, improve balance and range of motion, and retrain your muscles. Bracing is another useful strategy. Many patients wear an ankle brace to get support for their ankle and keep the ankle from rolling; thus, wearing an ankle brace can help prevent future sprains. In addition, nonsteroidal anti-inflammatory drugs such as ibuprofen may be prescribed to reduce the pain and inflammation.

While these nonsurgical approaches are very helpful for many patients, they do not bring successful results for everyone. In patients who have not responded to these approaches or who have a greater degree of instability, Dr. Menchin or Dr. Hetman may recommend surgery. This usually involves repairing or reconstructing the damaged ligament or ligaments. Various procedures are available, and the surgeon will select the procedure that’s best suited to the severity of instability and the patient’s activity level.

If you have a history of spraining your ankle, do not hesitate to contact Dr. Menchin and Dr. Hetman at Foot Specialists of Memorial and schedule a visit with us at our Houston or Katy office. Remember, proper treatment will help you today—and, very importantly, can help prevent problems from recurring in the future. 

Katy residents should come to our new office on Greenhouse and experience why Foot Specialists of Memorial was the top rated foot and ankle office in the Memorial area the past 4 out of 5 years.



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