An ankle instability is a persistent, repetitive movement of the ankle joint due to looseness of the lateral (side) ankle ligaments.
Ankle instability usually occurs after ligament damage that has not been treated properly or has not fully healed. When the leg is off, the static stabilisers of the ankle joint, i.e. the deltoid and lateral ligaments, are strained, torn or completely severed, or the entire ligamentous complex is damaged. As the torn ligament heals, scar tissue begins to form at the site of the injury, which is usually weaker than before. This significantly increases the risk of re-injury and, if the same ankle ligaments are continuously injured, instability of the ankle joint may gradually develop.
Degrees of ankle ligament damage
-Grade I lesion: Damage to the external ankle ligaments without macroscopic tear, which is characterised by moderate ankle swelling, tenderness and mild or minimal loss of function. The ankle remains stable.
-Grade II lesion: Partial macroscopic tear of the external ankle ligaments, with moderate ankle swelling, localised pain and haemorrhage over the affected anatomical structures. In case of a ligament II laxity, mobility is impaired and partial instability of the ankle joint occurs.
-Grade III lesion: Complete rupture of one or more ankle ligaments, which you will recognise by severe swelling, pain and bruising of the ankle joint. A complete tear of the ankle ligaments results in severe impaired mobility, inability to resemble the injured leg, moderate to marked joint laxity and instability.
Treatment
As the stability of the ankle joint is compromised, proper rehabilitation is necessary to strengthen the muscles and promote the regeneration of the damaged structures and increase the stability of the ankle joint. If the ankle sprain is not properly treated, the ankle sprain will recur repeatedly and each time the structures responsible for the stability of the ankle joint will become weaker.
Acute ankle ligament damage requires a rapid response and appropriate action, as ligament trauma results in haematoma (bruising) due to ruptured blood vessels, increased permeability of small blood vessels, swelling of the surrounding soft tissues, and inflammation at the site of the injury. The inflammatory phase lasts 24-72 hours, so the PRICE approach is recommended for the first three days after the injury:
-P(protection), protection - to protect the injured area from re-traumatisation;
-R (rest), rest - strictly stop any activity that causes pain;
-I(ice), icing - to freeze the injured ankle joint after 15-20 minutes. 4-8 times a day;
-C (compression)- compression helps to reduce swelling (an elastic bint or any elastic ankle splint is suitable);
-E (elevation)- keeping the injured limb elevated to reduce swelling.
The treatment of ankle instability is based on the mechanism of injury, various tests, examinations and, most importantly, the patient's activity level.
Conservative treatment
If the ankle instability is due to a sprain or minimal tear of the ligamentous structures, then conservative treatment is used. Conservative treatment methods include physiotherapy, splints and medication:
- Physiotherapy includes a range of stretching, strength and muscle-strengthening exercises, as well as amplitude-enhancing exercises, which increase the stability of the ankle joint and activate the regeneration of damaged tissue.
- Ankle splints stabilise the ankle joint, prevent ankle re-direction, stimulate blood circulation, activate lymphatic drainage, reduce swelling and promote regeneration of damaged tissue.
- It is also recommended to wear orthopaedic insoles to ensure ankle stability , which support the vault of the foot, stabilise the heel, and restore the foot to its natural position, thus avoiding unexpected ankle twists and discomfort.
If the stability of the ankle joint is caused by a severe tear or complete rupture of the ligaments, the condition is treated surgically.
