Expert Treatment for Ankle Instability

Lateral Ankle Surgery & Non-Surgical Solutions

Typical ankle instability symptoms will include:

• A feeling of instability or wobbliness of the ankle. Patients may feel that they do not have a solid base of support.
• Repeated spraining or turning of the ankle especially when on uneven ground. We are often told that such ankles can give way when stepping on a rock or similar object and one needs to be careful how they step.
• Persistent swelling or soreness on the outside of the ankle. One often sees a “pocket” of swelling or fluid on the outside of the ankle. That is termed, more accurately, “effusion,” which is a leakage of joint fluid from the ankle joint into the surrounding tissues. The damaged ligaments on the outside of the ankle joint allow ankle joint fluid to escape.

When it comes to unstable ankle ligaments, treatment usually includes: 

• Ankle braces. There are ankle braces used for the treatment of ankle sprains but a different type of brace used to prevent sprains.
• Physical therapy and exercises. This treatment falls into two categories:
• Ankle strengthening exercises. Such exercises focus on strengthening of the peroneal muscles, peroneus longus and peroneus brevis which are muscles that run down the outside of the leg, ankle and foot. Strong peroneal muscles can help prevent ankle sprains but do not make up completely for damaged ligaments.
• Proprioceptive exercises.  The term “proprioception” refers to one's ability to perceive the position of body parts at any given time.  For example, if the ankle is about to turn, the body senses this and automatically starts contracting the peroneal muscles to prevent a sprain. The faster the body does this, the more likely the ankle sprain will be prevented. Proprioception exercises are designed to “speed” the body's ability to respond to motion that can cause injury.
• Foot orthotics and ankle foot orthotics.  Prescription foot orthotics can be designed with features such as lateral flanges to keep the foot from rolling outward. 

Ankle foot orthotics are foot orthotics which have sections that come up the ankle to provide the additional needed support. Many such devices are sport specific. For example, an AFO designed for soccer players may have a shin guard added.

In some cases, surgical treatment of lateral ankle instability may be necessary. The ligament most affected in lateral ankle instability is the anterior talofibular ligament (ATFL). It is possible, in many cases, for the podiatric surgeon to simply sew up the ends of the ligament, restoring strength.  Use of sonography or diagnostic ultrasound allows us to determine the condition of the ligament to see if such a repair is possible ahead of time.

The ATFL is often frayed or too weak to be repaired but there are a number of techniques to reinforce the ligament either using suture or a graft material. Repair of the ATFL is often termed a “Brostrom'' procedure. There are various modifications of the Brostrom procedure such as the Brostrom-Gould procedure in which tissue from the surrounding joint capsule is brought in to reinforce the ligament. Additionally, a number of manufacturers have created products to enhance and strengthen the repair.