Definition

Ankle instability refers to a condition where the ankle is unable to properly support the body, causing it to feel unstable or prone to rolling outward.

The ankle is one of the most commonly injured body parts in sports. It is estimated that between 10-30% of sports injuries involve the ankle. Ankle instability can develop if an ankle sprain is not treated correctly, if the same ankle is injured multiple times, or if the injury fails to heal properly. Around 15-20% of ankle sprains lead to ankle instability.

Causes

Ankle instability is a relatively common condition. It typically occurs when an ankle sprain has not fully healed or recovered. During a sprain, the ligaments, which are the connective tissues that join the bones of the foot, may stretch or tear.

A complete recovery is necessary to strengthen the muscles around the ankle and retrain the tissues that help maintain balance. If the recovery process is not thorough, the ankle can be injured again. Each time an ankle is sprained, the ligaments become weaker, which increases the likelihood of instability.

The activities that most commonly contribute to ankle instability include:

• Incorrect movements while running, climbing, or quickly descending stairs, as well as getting out of bed too abruptly.

• Running or stepping on uneven surfaces.

• Improper landing after a jump.

• Collisions with other players or opponents in sports such as soccer, basketball, or other team sports.

Risk Factor

Ankle instability is often linked to injuries that are influenced by specific factors. Some individuals are more likely to develop ankle instability due to the following risk factors:

• Athletes, particularly those involved in sports like soccer, basketball, volleyball, or dance.

• Failing to stretch before engaging in physical activities.

• Wearing high heels or shoes that don't fit properly during intense activities.

• Having weak or stiff ankles, often due to previous injuries.

• Being overweight or obese.

Symptoms

Symptoms of ankle instability can vary from person to person, but typically include:

• The ankle frequently rolling to one side and feeling unstable, especially when walking on uneven terrain or during physical activity.

• Persistent pain and swelling in the ankle region.

• Pain on the outer side of the ankle.

• Difficulty with walking or standing for prolonged periods.

Diagnosis

To diagnose ankle instability, a healthcare provider will need to carry out a few important steps, which include a thorough medical interview, a physical exam, and additional tests. A general practitioner or an orthopedic specialist can make the diagnosis.

Medical Interview

The doctor will begin with a medical interview or history-taking process. This involves gathering information from the patient by asking several important questions to understand their medical history. Some common questions to diagnose ankle instability include:

• The main complaint and any related symptoms.

• The duration of the symptoms.

• Whether there is a history of prior injuries, and if so, details about how the injury occurred.

• The patient’s medical history.

• Any prior medical conditions.

• The patient's daily activity levels.

• A family history of similar issues or conditions.

Physical Examination

The physical examination typically starts by checking the patient's overall health, which includes assessing blood pressure, respiratory rate, body temperature, and pulse. The doctor will also evaluate the patient's walking pattern to identify any gait abnormalities. The patient might be asked to stand, and the doctor will observe any changes in the positioning of the heel while standing.

Afterward, the doctor will gently press on the patient’s foot to check for any tenderness, bruising, or swelling around the ankle. The foot will be moved to assess any limitations in the patient’s ability to move their foot.

Diagnostic Tests

To confirm the diagnosis, the doctor may recommend additional tests, such as X-rays, CT scans, or MRIs, to get a clearer picture of the condition.

Management

Treatment for ankle instability can generally be divided into two categories: surgical treatments and non-surgical options. The appropriate treatment will depend on the patient’s condition, the severity of the instability, and their personal preferences.

Non-Surgical Treatments

Non-surgical treatments may include physical therapy, which focuses on:

• Stretching and muscle exercises to strengthen the ankle and surrounding muscles.

• Improving balance and increasing range of motion.

• Rehabilitation to help patients return to their normal activities.

Patients may also be provided with supports like braces or insoles to stabilize the ankle and foot, helping to prevent further complications and alleviate pain. In addition, pain relievers and anti-inflammatory medications may be prescribed to reduce pain and swelling.

Surgical Procedures

In certain cases, if non-surgical treatments do not yield satisfactory results, surgery may be recommended. An orthopedic surgeon may perform a procedure to repair or reconstruct the damaged ligaments in the ankle, depending on the severity of the instability.

Complications

If not properly treated, ankle instability can lead to persistent heel pain, reduced mobility in the foot, and long-term changes in walking patterns. Even after treatment, there is a chance that ankle instability could return, sometimes resulting in nerve damage in the foot.

Prevention

Since ankle instability is often linked to a history of previous ankle sprains, there are several preventive measures that can be taken to reduce the risk of developing this condition:

• Wearing proper shoes

Wearing shoes that fit well and are the right size can provide essential support to your feet, reducing the risk of ankle instability. Proper footwear prevents the formation of spaces in the shoe that could contribute to instability.

• Using heel braces

For individuals with a history of ankle sprains, wearing ankle braces can offer additional support and assist in facilitating safe movement and walking.

• Stretching before physical activities

Before engaging in activities that involve extended walking or physical exertion, it is crucial to stretch your ankle and feet. This practice helps maintain flexibility and can prevent injuries to the ankle.

• Strengthening exercises

Strengthening exercises can be beneficial for individuals with ankle instability. These exercises should be performed regularly, ideally on a weekly basis, to train the muscles around the foot and ankle area.

When to See a Doctor?

Seek medical attention immediately if you experience difficulty walking, ankle pain, problems with balance while walking, or frequent trips and falls despite undergoing non-surgical treatments. You can start by seeing a general practitioner or directly visit an orthopedic specialist or orthopedic surgeon.

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