The ankle joint is one of the few right angled joints in the body that must bear our body’s weight plus gravity. Formed by the long bones of the lower leg, the Tibia and Fibula, connecting to the Talus and Calcaneum which make up the hind foot and heel, it gives attachment to numerous ligaments to support the many smaller bones and arches of the foot.
Unlike the more linear joints of the leg such as the knee, forces born through the ankle must support a great deal when the whole weight of our body must be absorbed with every step and even more so when running, running over an uneven surface or playing a sport requiring abrupt changes in direction.
Instability of the ankle is most commonly caused by repeated strain to the outside ligaments of the ankle, known collectively as the Deltoid Ligaments.
The combined ligaments of The Deltoid prevent the ankle turning over so that the sole of the foot is visible towards the body. Repeated stress to these ligaments can overstretch them such that they are unable to perform their job as stabilisers of the ankle.
Chronic ankle instability often begins as an initial sprain to the ankle causing stretched or torn deltoid ligaments. If proper rehabilitation does not take place then scar tissue can be laid down in the ligaments which reduces their elasticity and inhibits them from doing their job leaving the ankle vulnerable to further sprains. Apart from lending mechanical support, these ligaments also play a part in telling the brain the position of the foot and so are also important for balance control. Loss in balance control can lead to further sprain … each sprain leading to further weakening of the ligaments resulting in greater instability.
The diagnosis of Chronic Ankle Instability is initially performed by your Physio, Family Doctor or Orthopaedic Specialist. Stress and mobility tests are done to examine the laxity of the ligaments and any pain felt during the test.
Physical examination also includes swelling, bony abnormalities and history of haematoma (bruising). Further balance tests may be required, and X Ray or MRI scans requested in the event that a rupture or avulsion fracture may be the existing cause.
The resolution of Ankle Instability usually requires a course of Physiotherapy to strengthen the muscle groups supporting the stretched ligaments and to treat secondary issues such as swelling, bruising, balance and gait re-education.
Bracing or strapping may be necessary depending on how unstable the ankle is and non-steroidal anti inflammatories or infiltration may be necessary to speed up the recovery.
In severe cases where the ankle is “turning” or “giving way” more than once a week or a few times a month, then it really is time to seek help before the instability reaches the point of requiring surgery. Surgery is usually only performed when all other passive treatment as been unsuccessful. The surgical procedure would be individual to the patient following a detailed investigation.
This problem is frequently overlooked as being clumsy, tripping over, an OMG I have done it again moment! Or just being in such a hurry that you don’t consider that there might be a problem.
It’s worth while taking a thought as to how many times your ankle fails you and then consider that it might be worth having a check up.
Tracey Evans MCSP SRP COFIB col 220 – Physiotherapist
The Physiotherapy Centre
+34 609 353 805