Picture during surgery showing a torn ligament of the ankle
stress xrays to show ankle instability
Ankle instability is a condition characterised by the ankle "giving way" or feeling unstable particularly when walking on uneven surfaces. The stability of the ankle is supported by ligaments on the outer aspect of the foot named the anterior talo fibular ligament and the calcaneo-fubular ligament. These ligaments arise from the fibular bone (next to the shin) and the to talus and calcaneum (heel) respectively. Ankle sprains damage these ligaments to varying degrees.
Instability is characterised by the foot giving way. The feeling that the ankle is not reliable and loose. It may also be associated with pain and swelling to the outer aspect of the ankle.
Chronic instability of the ankle is the result of the ligaments not healing after a severe sprain or more commonly, repeated sprains. This is a very common occurence during sporting activities such as football, futsal, rubgy and badminton. These injuries may range from stretching of the ligament to complete tears.
When this occurs, small nerve in the ligament are damaged. This does not allow the brain to sense instability. Therefore the surrounding muscles are not reacting to the unstable condition. With this, you are more prone to strains and repeated trauma to your ankle.
If your ankle feels unstable or you have sustained repeated ankle sprains, please consult you Consultant Foot and Ankle Surgeon for a full assessment.
The diagnosis is usually achieved simply from the history and examination. The clinical examination will show that the ankle in unstable (positive anterior drawers test). The foot is able to be drawn forward on the ankle joint beyond normal. The ATFL and CFL tendon may be tender.
Stress radiographs (xrays) are best to demonstrate that the ankle joint is unstable. This is best done under anaesthesia. An MRI may also be taken if there is a suspicion of cartilage damage to the ankle joint.
Treatment is dependant of the level of one activity.
1. Simple ankle sprains are treated with physiotherapy. This is to retrain the ankle to gain its nerve functions again. This also allows the surrounding muscles to strengthen.
2. Surgery may be of 2 types:
a) Damaged ligaments maybe tightened and reattached to the bones. This is a very successful procedure and is usually performed in active individuals and athletes.
b) If all has failed, tenodesis surgery can be performed. This involves ligament reconstruction using a tendon harvested from another part of the body. This is very durable but it will lead to stiffness of the ankle.
Should you have any of the symptoms above, please consult your Consultant Foot and Ankle Surgeon
Dr Khairul Faizi Mohammad
Consultant Foot and Ankle Surgeon
Kuala Lumpur Foot Ankle Clinic
(CHERAS (HQ), KUALA LUMPUR, AMPANG)