Ankle Instability
What chronic ankle instability is
Chronic ankle instability is what remains when the ligaments on the outside of the ankle heal stretched out rather than tight after one or more sprains. The ankle loses its restraint at the end of its range, and it rolls with far less provocation than it should — stepping off a kerb, walking on grass, turning quickly.
Many people describe it less as pain than as distrust: the ankle feels unreliable, and they find themselves watching the ground.
Why it matters beyond the sprains
Each episode of giving way loads the cartilage of the ankle abnormally. Over years, that repeated abnormal loading contributes to arthritis, and cartilage lesions on the talus are common findings in ankles that have been unstable for a long time. Treating instability is as much about protecting the joint as it is about stopping the sprains.
Diagnosis
The diagnosis is made mostly on examination — how far the talus shifts forward and tilts when the ligaments are tested, compared with the other side. X-rays check alignment and look for old fractures or bone spurs. MRI is used when there is reason to suspect damage inside the joint or to the peroneal tendons, which frequently accompany long-standing instability.
Treatment
Physical therapy comes first and succeeds for many people. Strengthening the peroneal tendons and retraining balance can compensate for a good deal of ligament laxity, and a lace-up brace helps during sport. Surgery is considered when instability persists after a genuine course of therapy, or when the ankle is giving way in ordinary daily life rather than only in sport.
The operation is ankle ligament reconstruction, usually performed together with arthroscopy so that any cartilage damage inside the joint is treated at the same time.
