Ankle instability occurs when the ankle repeatedly gives way during sporting or daily activities. This can lead to joint pain, swelling, inflammation, and damage to the tendons around the ankle. Finally, damage can occur to the joint surface cartilage, bony spurs form (osteophytes), and arthritis ensues.

The condition is often a result of repeated ankle sprains. Ankle sprains are one of the most common sporting injuries. It is a stretching of the outside ligaments of the ankle. Following multiple ankle sprains or a single severe injury, the ligaments can tear (rupture) completely apart.

Symptons

Ankle instability often leads to joint pain, swelling, inflammation and damage to the tendons around the ankle. Damage can also occur to the joint surface cartilage, bony spurs form (osteophytes) and arthritis ensues.

Treament – Non-operative

The first line of treatment for ankle sprains is rest, ice, compression, elevation with painkillers and anti-inflammatory medication (if tolerated).

Rest

Rest can help ease the swelling and pain experienced in the ankle. Avoid walking long distances, running, physical activity, standing for prolonged and bearing weight on the affected ankle. Use crutches if necessary.

Ice

An ice pack or crushed ice wrapped in a towel can be applied for 15 minutes every two to four hours to reduce pain and swelling.

Compression

A compression bandage can be wrapped over the ankle to completely cover the injured region. The bandage can be removed every hour to allow for ice treatment. Compression will reduce further swelling and internal bleeding, while providing support to the injured area.

Elevation

Recline and elevate the injured ankle above the heart to help decrease swelling and pain. Painkillers while elevating the ankle can also help with recovery.

Medication

Anti-inflammatory medication such as tablets and creams can be prescribed by your doctor to assist in reducing pain in the ankle.

Physiotherapy

Physiotherapy is useful to regain range of movement, strength, balance and joint position sense.

Ankle Brace

An ankle brace may be useful for people who have tried all the above measures and experience ongoing problems with daily or sporting activities.

Cortisone Injection

A targeted corticosteroid injection may offer relief from ankle inflammation and help settle symptoms, so that physiotherapy can continue.

Treatment – Surgery

With severe injuries or when all these non-operative measures fail, and recurrent ankle instability becomes an ongoing problem, surgery is indicated. While the diagnosis is usually made without radiologic imaging, an MRI scan may be necessary to identify any problems within the ankle joint itself, or with other ligaments or tendons around the joint.

There are two components to the surgery.

  • An incision is made over the outside of the ankle where the ligaments have been torn away and the ligaments are reconstructed in an anatomical fashion and reinforced with overlying tissue (modified Bröstrum-Gould repair). The tendons behind the ankle are inspected routinely and inflammed tissue is removed (tenosynovectomy) or repaired as necessary.
  • An arthroscopy is then performed through 2 small (keyhole) incisions at the front of the ankle. The joint surfaces are inspected, inflammatory and scar tissue is removed, and any bony spurs (osteophytes) are trimmed away.

SURGERY – RISKS AND COMPLICATIONS

No surgery is completely risk free. The risks and complications will be assessed and discussed with you. There is always a small risk of infection, blood clots and anaesthetic problems and measures are taken to reduce these. There is approximately a 1% chance of experiencing problems with recurrent instability and this is usually due to a fresh injury or sprain. The ankle may always be a bit stiffer than the normal side, with a slight reduction in range of motion not uncommon, but this is rarely a significant problem. Rarely, if the ankle remains too stiff, cortisone injections or arthroscopic debridement may be required.

RECOVERY TIMES

Hospital stayDay surgery
Rest and elevation7-10 days
Crutches5-7 days
Weight bearing
– As tolerated
– Full
Day of surgery
7 days post-operation
Rehabilitation
First 3-4 weeks (pain restricting)
– Gentle active range of motion
– Calf stretch and strengthening
– Static peronei strengthening
Weeks 3-4 onward (with physio)
– Proprioceptive
– Theraband
– Range of motion and strengthening
Time off work
– Seated
– Standing
1-2 weeks
3-4 weeks
Gym (fitness)4+ weeks
Running6+ weeks
Sport8+ weeks

Note: Braces, camwalker boots and plaster casts are not routinely required following surgery. Active involvement by you in a physiotherapy program following surgery is essential however.

Contact

This fact sheet is a brief overview of ankle instability, produced by our Foot and Ankle Surgeon Dr James Clayton. To make an appointment or enquiry with Dr Clayton or a member of our foot and ankle team, contact 08 8362 7788 or email ortho@sportsmed.com.au.

Foot and Ankle Team