Chronic ankle instability is recurrent giving-way of the ankle following one or more ankle sprains. The condition develops when the lateral ligaments fail to heal back to their normal length and tension, leaving the ankle mechanically unstable in inversion. Treatment begins with proprioceptive rehabilitation and functional bracing; refractory cases benefit from surgical reconstruction.
What Is Ankle Instability?
Ankle instability has two related but distinct components:
- Mechanical instability: structural laxity of the lateral ligaments, particularly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), demonstrable on examination and stress testing
- Functional instability: the patient’s experience of giving way, with or without demonstrable mechanical laxity, often related to proprioceptive deficits and peroneal weakness from prior sprains
Many patients have both components. Recurrent ankle sprains, the strongest predictor of future sprains, often progress to chronic instability when proprioceptive rehabilitation is not completed after the initial injury.
Causes and Risk Factors
- One or more prior ankle sprains
- Failure to complete proprioceptive rehabilitation after initial sprain
- Generalized ligamentous laxity
- High-arched feet (cavus foot) with hindfoot varus
- Sports requiring cutting and pivoting
- Repeated participation in sport while still recovering from a prior sprain
Symptoms
- Recurrent giving-way of the ankle, often with minimal energy
- Repeated ankle sprains
- Swelling or pain after activity
- Sense that the ankle does not feel trustworthy with cutting or uneven surfaces
- Decreased confidence in the ankle during sport
Diagnosis
Dr. Chudik’s evaluation includes the prior sprain history, the activities that produce instability, and a focused examination. Anterior drawer test and talar tilt test assess mechanical laxity of the ATFL and CFL. Stress X-rays may be added to quantify laxity. MRI evaluates the lateral ligaments and rules out associated cartilage or peroneal tendon injury. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is the first line for chronic ankle instability:
- A targeted physical therapy program emphasizing proprioception, peroneal strengthening, and balance
- Functional ankle bracing during sport
- Activity modification during the rehabilitation period
- A six-month commitment to dedicated rehabilitation before considering surgery
Surgical treatment is considered for patients who fail rehabilitation and continue to have functional instability. Dr. Chudik performs lateral ligament reconstruction, most commonly the modified Brostrom procedure, which advances and reinforces the native ATFL and CFL. For patients with poor tissue quality, a tendon graft is used to reconstruct the ligaments.
Recovery and Outcomes
Non-surgical recovery typically requires three to six months of dedicated rehabilitation. Outcomes are good when proprioceptive rehabilitation is completed.
Recovery after lateral ligament reconstruction typically includes four to six weeks of brace protection, progressive motion and weight-bearing, strengthening over three months, and return to sport at four to six months. Outcomes are very good in appropriately selected patients with appropriate rehabilitation.
When to See Dr. Chudik
Schedule an evaluation if your ankle gives way recurrently despite prior treatment, if you have repeated ankle sprains, or if instability is interfering with sport or daily activity. Call 630-324-0402 or request an appointment online.