Ankle Instability Injury Overview

Your ankles are a part of the foundation of your body, and chronic ankle instability can interfere with your life. You can address ankle instability by strengthening the supporting local muscles and potentially finding a good ankle brace. Keep reading to learn about the causes and symptoms of an unstable ankle, plus easy treatments to keep you on your feet.

What is Ankle Instability?

Ankle instability involves a weakness in your ankle that causes it to buckle easily, sometimes also known as “rolling the ankle.” Any structure supporting the joint could be the culprit of ankle instability—bones, ligaments, tendons, and muscles all play a part in stabilizing the ankle.

The most common ankle injury is an inversion sprain, which often leads to lateral ankle instability. This specifically causes this outside area of your ankle to be overstretched or damaged and affects the balance of your muscle strength and innate stability from surrounding connective tissue on each side of your joint. This imbalance causes further stress on your ankle during walking, standing, and activity; leaving you feeling unsure on your feet and in pain.

Types of Ankle Instability

There are three main types of ankle instability. The type of injury determines the most effective treatment, so it’s important to seek a professional diagnosis.

1. Mechanical Ankle Instability

Mechanical instability is caused by a laxity or hypermobility in your ankle joint. Your ligaments become overstretched, and their range or motion exceeds what is healthy for your ankle, making the ankle feel wobbly with daily activities. This is common with anyone suffering from general hypermobility or a local joint sprain.

2. Functional Ankle Instability

Functional instability is characterized by muscle weakness, postural difficulties, proprioception problems (awareness of your body’s position), and faulty communication between your nerves and the muscles that control your ankle. This causes the sensation of your ankle giving way or extreme unsteadiness when you put weight on your leg. This is most common when lateral ankle ligaments are stretched from an inversion sprain.

3. Chronic Ankle Instability

Ankle instability from issues like an acute ankle sprain becomes a chronic condition after six weeks of experiencing symptoms, or after multiple injuries to the same ankle. Once you have injured your ankle, particularly with a ligament injury,  it becomes more difficult for the joint to return to normal without allowing it to heal properly.

Causes of Ankle Instability

Weakness in the surrounding muscles is one of the culprits of ankle instability. Injured peroneal muscles, calves, or tibialis anterior and posterior muscles can put the ankle or other small joints in the toes or foot out of alignment. 

An injury also affects connective tissue (particularly ligamentous) stability and your body’s mechanoreceptors—sense organs that give your nervous system feedback on tension, pressure, and your body’s position. When your ankle isn’t giving  or getting appropriate feedback from local sensors, it can feel impossible to coordinate safe ankle function.

Here is a list of possible causes of your chronic ankle instability: 

• Ankle sprain and lateral ankle instability
• Stretching, rupture, or tear of ligaments or tendons
• Strength imbalance or poor coordination
• Overuse—chronic Achilles tendinopathy or other ankle tendonitis
• Faulty proprioceptive feedback
• Injury to local nerves
• Scar tissue from past injuries
• Swelling and Inflammation
• Arthritis
• Fracture

Ankle Instability Symptoms

Ankle instability symptoms range from mildly uncomfortable to severe. Symptoms often worsen after long periods of activity. 

• Recurrent lateral ankle sprain
• Stiffness and swelling
• Ankle pain and discomfort
• Ankle impingement (pinching between the talus and tibia) with dorsiflexion
• Ligament laxity
• Tenderness in the lower leg, ankle, foot, or toes
• Balance difficulties
• Anatomic changes in ankle and foot alignment
• Trouble walking on uneven ground
• Inability to tolerate weight-bearing

Addressing Ankle Instability

Assessment

The first step in addressing ankle instability is getting a formal assessment and physical examination. This will help determine your problem areas and rule out other possible issues. If needed, your doctor can order an x-ray to rule out fractures, osteochondral lesions, and arthritis; or a magnetic resonance imaging (MRI) to assess the severity of local joint, ligament, and muscle damage.

Care

Getting the right care for your ankle instability is super important for preventing future problems. If your ankle feels unstable, it will require a personalized program to manage symptoms and restore some stability to the joint.

Most often, conservative treatment will involve a stint of physical therapy sessions with a focus on stabilization exercises to help restore strength, range of motion, coordination, and proprioception.

Treatments for Ankle Instability

You can also discuss with your doctor or physical therapist the use of an ankle brace with activities that you feel more unstable with. Finally, if symptoms and instability are severe you may have an ankle arthroscopy (surgery) recommended by an orthopedic doctor to restore stability to local ligaments that have become stretched. There are other surgical treatment options that can be utilized if necessary too.

Improve Your Ankle Instability

Now that you know what causes ankle instability and how to treat it, you can take steps to improve your joint health and prevent ankle instability from becoming chronic. Find the right brace to support your ankle, keep your ankles strong to prevent future injuries, and balance rest and activity to build stability in your joint.

Sources:

http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Ankle-Instability.aspx

https://www.hss.edu/conditions_ankle-instability-overview.asp

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164377/

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