Lateral Ankle Instability

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Submitted By David A. Porter M.D. PhD.
01.05.2010

The ankle joint is quite fascinating in that it is both weight-bearing like the knee, yet has a wide range of motion similar to the shoulder. Biomechanical demands require the joint to be stable and strong, yet flexible and capable of motion. However, it is possible for one of these factors to encroach on the other.
Imagine a soccer player dribbling down the field, setting up to shoot a winning goal. He plants his foot next to the ball, preparing to power the ball past the goalie and into the net. But, instead of the ankle providing a firm support, it slides a fraction to the side, throwing the player off balance and rendering him unable to utilize the force stored throughout the rest of his body. Or, imagine a mother of three, walking out of the supermarket with her kids. She is carrying both her youngest child and an armful of groceries. As she is walking she missteps on an uneven part of the street and her ankle “gives out.”
Occurrences such as these take place in many different sports and daily activities and are the result of and/or the cause of lateral ankle instability. There are bands of connective tissue called ligaments that attach one bone of the ankle to another (the fibula to the talus-ATFL; fibula to the calcaneus-CFL). These ligaments allow movement of the ankle but keep that movement within a normal, stable range of motion. When the ligaments of the ankle are chronically stretched or stressed, the ankle is unstable and will often slide in and out of place. Typically, the ligaments are overly loose as a consequence of repeated ankle sprains.
During an exam, patients will usually be asked to describe the injury in detail in order to help the orthopedic surgeon understand the direction of the injury and the ligaments that may be affected. In most cases, ankle instability can be treated without surgery. Treatments may include shoe inserts, ankle braces, strengthening exercises and special balance training.  However, if the injury is more severe, the athlete has suffered past sprains, or is involved in high impact sports there are two surgical measures that may be used.
One procedure utilizes a graft, where a section of healthy ligament tissue is taken from the hamstring and used to replace some of the damaged ligament tissue. Another less drastic operation tightens the ligaments and stabilizes the ankle. This is the most commonly utilized surgical procedure to treat an ankle injury.
Ultimately, your orthopedic surgeon will evaluate your injury and lifestyle to determine the best course of treatment to ensure you are back on the field in no time.

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