Ankle Instability

What is ankle instability? 

Chronic ankle instability is the repeated giving way of the ankle because of repeated ankle injuries. The moments of instability may occur during physical activities but can also occur while you are standing or doing minimal movements. While chronic ankle instability is more common in people who perform a great deal of physical activity like athletes, anyone who experiences frequent ankle sprains can develop this condition. 

The main complications that accompany ankle instability are the repeated rolling of the ankle, continuous discomfort or swelling, pain, or a general feeling of instability. Over time with enough sprains or improper healing, the ligaments in the ankle wear down which can trigger chronic ankle stability. Around 40% of people who experience ankle sprains go on to develop ankle instability in some way. 

What causes ankle instability?

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The cause of ankle instability is usually repeated ankle sprains that did not fully rehabilitate or did not adequately heal. If the stretched or torn ankle ligament does not have the chance to restore the strength in the surrounding muscles, the ankle remains weak and susceptible to injury. Each ankle sprain makes the likelihood of another sprain increase. 

Ankle sprains can occur at any time and to any person. The most common causes of an ankle sprain include landing on the ankle awkwardly after jumping or cutting motions, running on uneven surfaces, or a fall onto your ankle. You may not develop ankle instability if you have had a sprain, but each sprain you experience does contribute to ankle instability.

What are symptoms of ankle instability?

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Symptoms of ankle instability can vary person to person. The type and frequency of symptoms you may experience depends on your activity level and the severity of the injury. If you have ankle instability, you may experience the following symptoms:

  • Discomfort and swelling: Ankle instability causes discomfort and swelling because the ankle ligament is inflamed from repeated injury and improper healing. 
  • Feeling that ankle is “giving way”: The feeling that the ankle will give out on the outer or lateral side of the ankle is a common experience for people with ankle instability. Since the ligament meant to support the ankle has been frequently damaged, the ankle does not receive as much support, creating the feeling of weakness. 
  • Pain and tenderness: Pain results from the continual weight bearing on the ankle with a damaged ligament that causes the ankle to turn and further strain the ligament. 
  • General instability or wobbliness: Especially on uneven ground, ankle instability will make you feel unstable while walking or running. Balancing with ankle instability is a challenging task. 

You may find that you have additional symptoms if you have additional injuries to your foot or leg. In addition, some symptoms may be made worse with particular physical activity or motions, so it is important to monitor what triggers your symptoms.

Are there any risk factors or groups for ankle instability?

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There are key factors that can make a person more likely to have ankle instability. Some risk factors relate to your daily life and behaviors while others relate to your health history. 

Sports involvement and physical activity level: Lifestyle choices can create risk for recurrent ankle injuries and ankle instability. High participation in sports that rely on quick ankle movements pose a higher chance of injury. Sports like tennis, basketball, and football in particular require jumping, running, and harsh starts and stops that put stress on the ankle. 

Prior history of ankle injuries: Prior ankle injuries are one of the greatest risk factors for developing ankle instability over time. Each subsequent ankle injury increases the chances for future ankle issues. As the ankle ligaments stretch and weaken over time, the opportunity for proper healing is less likely. 

Weight: Newer studies indicate that weight may play a role in the likelihood of ankle instability. Weight could be a contributing factor in the healing process of ankle injuries. People of a higher weight with ankle injuries may not restore strength as fast or as complete to the ankle, leaving the person vulnerable to repeated ankle injuries and ultimately ankle instability.  

How is ankle instability diagnosed?

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A doctor will diagnose ankle instability by a physical examination, health history review, and potential x-ray imaging. You can expect questions about previous ankle injuries or any symptoms relating to ankle instability. The doctor may also question your daily activities to assess your risk factors. After a review of your medical history, the doctor will likely utilize light manipulations on the ankle to check for areas of tenderness or stiffness. These movements may hurt if the doctor presses around a sore area, so be sure to communicate any discomfort. 

While not always required to confirm an ankle instability diagnosis, x-ray imaging can help further evaluate the ankle injury. An x-ray will show areas of asymmetry between your unaffected and affected ankle as well as for abnormalities in the anatomy of the injured ankle. 

How is ankle instability treated?

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The best treatment for ankle instability depends on the extent of the instability. There are a variety of non-surgical treatments to treat your symptoms and keep pain to a minimum. Your doctor will take into consideration your health history and activity level when developing your treatment plan. 

Common non-surgical treatments include the following:

Physical therapy: Physical therapy works to help ankle instability by strengthening the ankle ligaments to improve balance. In addition, physical therapists can help you retain range of motion and build back muscles in a controlled environment. You can also work with your physical therapist to work on movements that you need in day-to-day life to walk safely but also actions more specific to any sports you play. 

Medication: The main purpose of medication is to manage pain and inflammation that ankle instability can cause. Over-the-counter nonsteroidal anti-inflammatory (NSAIDS) are a common pain reliever for this injury. 

Bracing and ankle support: To keep the ankle secure and add more stability, some people opt to wear ankle supports. The braces can help prevent future sprains or other injuries and can give people more confidence navigating less even ground. 

While not a common treatment for ankle instability, your doctor may recommend surgery. If other treatments do not provide any relief or change in your ankle instability, surgery may be the only option to help correct the ankle. A surgery would entail reconstructing the torn ankle ligaments. There may be a recovery period after the surgery, but physical therapy and medication can help you heal. 

Should you see a doctor for ankle instability?

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You should see a doctor for any ankle injury, especially if you have had repeated ankle injuries. Symptoms that persist for more than 24 to 48 hours need medical attention to properly identify and treat the cause. Bruising, swelling, painful popping feeling, or trouble walking on your ankle should all prompt you to make a doctor’s appointment. 

Many people dismiss ankle pain, thinking the pain is just a temporary irritation. However, ankle pain can be caused by an ankle sprain, ankle instability, or something more serious like a broken ankle. Prompt medical attention for any symptoms relating to your ankle can help you catch a problem early on and start a treatment plan. 

What is the outlook for people living with ankle instability?

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Once you have chronic ankle instability, you cannot get rid of the condition. The damage to your ankle ligaments is permanent, making it difficult for your ankle to return to how it was before the initial sprain. Even though you cannot reverse the damage to the ankle ligaments, you can work to restore strength and balance. Continual exercise and physical therapy can help you become more active and feel more steady in your steps. Following your treatment plan can help manage symptoms and any irritation caused by the instability. 

Ankle instability can become chronic if symptoms of ankle instability do not improve after 6 months of the initial sprain. As noted earlier, people who sprain their ankle once are at risk of developing ankle instability. It is important to take the proper time and precautions to heal an initial ankle sprain to reduce the likelihood of another sprain. The ankles are a particularly vulnerable area of the body, so being careful with their movement is essential to keeping them injury free. You should continue participating in sports or physical activity to keep your ankle joints active and your ligaments as strong as they can be.