Ankle instability is a condition in which the joint lacks sufficient support and stability. It can be manifested by partial or complete loosening of the articular surfaces, ligaments or muscles responsible for stabilizing the joint.
Such pathology significantly affects the mobility of a person and increases the frequency of injuries. Ankle instability reduces the joint's ability to adequately absorb shock loads and maintain proper biomechanics during movement, which increases the risk of sprains, dislocations and other injuries.
In chronic instability, there is a risk of recurrent injury as the joint becomes less able to stabilize itself, which requires additional prevention and treatment measures.
Types of Ankle Instability
There are two main forms of ankle instability - acute and chronic and categorized by various criteria including functional, mechanical and neuropathic instability.
- Acute instability: when the ankle joint suddenly becomes unstable due to an injury such as a sprain or ligament tear.
- Chronic instability: occurs when the ankle joint remains unstable for a long time after an injury or due to conditions such as muscle weakness or cartilage damage.
- Mechanical instability: is a condition in which the joint has structural changes that reduce its ability to stabilize. These can be ligament injuries, cartilage tears, bone deformities, or other anatomical abnormalities. It occurs when the anatomy of the joint is compromised, such as due to a fracture or dislocation.
- Functional instability: the ankle joint may appear or feel unstable in certain movements or situations, but actually has no structural damage. It may occur due to insufficient muscle strength, inadequate muscle control, or previous injuries, which can lead to psychological fear of re-injury.
- Neuropathic instability: occurs when the nerves that control the muscles of the ankle joint are damaged.
Each type can have different causes, symptoms, and treatment approaches, so it is important to perform a thorough diagnosis to determine the type of pathology and develop an effective treatment plan.
Causes of Ankle Instability
The causes of the disease are due to various factors, which can be divided into two categories: internal and external.
Internal factors are:
- Muscle weakness: an anatomical feature.
- Abnormalities of the joint structure: cartilage, ligament tissue and bone.
- Damage to cartilage: covering the surfaces of the bones in the joint,
- Overweight: additional stress on the ankle.
- Neurological problems.
- Conditions affecting connective tissue: joint hypermobility or Ehlers-Danlos syndrome.
- Inadequate rehabilitation after injuries.
External factors:
- Injuries resulting in sprain or tear of ankle ligaments (fall, tuck, ankle strike).
- Repeated sprains and microtrauma: from running or jumping.
- Improper footwear: wrong size, high heels.
- Unstable surfaces: walking or running on uneven or slippery surfaces.
These factors can work in combination to increase ankle instability and increase the risk of injury.
Symptoms and Signs
Symptoms and signs of ankle instability can vary depending on the cause and severity of the condition. They manifest as:
- sharp or aching pain in the ankle area that increases with movement or pressure on the joint;
- visible swelling and bruising around the problem area;
- weakness, stiffness and unsteadiness of the joint;
- inability to step on the injured leg;
- clicking in the joint when walking;
- decreased range of motion;
- feeling of the foot slumping;
- feeling of fatigue and weakness in the ankle;
- deformity of the ankle joint.
These symptoms can vary depending on the degree of instability of the joint and the individual patient. It is important to pay attention to these signs and see a doctor for diagnosis and treatment to prevent further deterioration of the joint and reduce the risk of re-injury.
Diagnostics: Understanding the Condition
Various methods can be used to diagnose ankle instability, including:
- Physical diagnosis: visual and tactile examination of the joint to assess its stability, presence of swelling, pain points, and limitations of motion. Checking stability with various movements and loads.
- Radiography: to evaluate the structure of the joint bones, to detect deformities, fractures or changes associated with arthritis.
- MRI: to detect injuries and abnormalities of ligaments, cartilage, and vessels that may be associated with the development of the disease.
- CT scan: to evaluate bone structures and their abnormalities (if bone deformities are suspected).
In some cases, the doctor may prescribe other tests
- Blood tests: for infections and comorbidities that may serve as a trigger for the development of pathology.
- Electromyography (EMG): to evaluate the function of the nerves that control the ankle muscles.
- Ultrasound: to visualize the ligaments, tendons, and other soft tissues of the ankle joint.
- Bone scintigraphy: to detect fractures or bone damage that may not be visible on x-rays.
These diagnostic methods are often used in combination to get a complete picture of the condition of the ankle joint. The results of these tests help your doctor determine the cause of instability in the joint, develop an individualized treatment plan, and decide whether additional procedures or surgery is needed.
Treatment Options for Ankle Instability
Treatment for ankle instability depends on the severity of the condition, the cause, and the individual patient.
Treatment options
- Conservative treatment
- Rest: the joint should be given time to heal after injury.
- Applying ice to the joint: to reduce pain and swelling.
- Compression: wearing an elastic bandage or dressing.
- Medication: anti-inflammatory and analgesic tablets and injections.
- Physiotherapy
A physical therapy program includes exercises to strengthen the muscles around the joint, improve balance and coordination, and stretching and massage to reduce pain and improve mobility.
Depending on your symptoms, your physical therapist may use treatments such as: electrical stimulation, heat, cold, or ultrasound therapy
- Оrthotics
- Wearing orthotic devices: bandages or orthopedic shoes.
- Use of taping: to provide additional ankle support.
Surgical treatment
In complex cases where conservative treatment fails or where the joint is severely damaged, surgical intervention may be required. Surgical techniques may include:
- Ligament reconstruction.
- Restoration of damaged tissue.
- Arthroscopy.
- Open surgery to repair joint structures.
- Osteotomy to reposition joint bones.
Each patient requires an individualized approach to treatment, and the therapy plan may include a combination of the above methods depending on the specific situation. Treatment options should be discussed with your physician to determine the most appropriate approach.
If you are struggling with ankle instability, schedule an appointment with Dr. Alex Yanovskiy, DPM our experienced specialist located in Des Plaines.