Lateral Ankle Instability
The Highlights
Lateral ankle instability involves a repeat history of going over on the outside of the ankle or feeling as if this is regularly going to happen.
Our team can assess all the mechanical factors causing the problem in your case and look a the structures involved, both physically and with the use of diagnostic ultrasound.
Treatment involves building strength and balance back into the foot, ankle and lower limb and looking at ways to support them through taping and foot orthoses (specialist insoles).
What is it and what are the symptoms?
Lateral ankle instability is characterised by persistent and recurring problems "going over" on the ankle or having the feeling this is going to happen. It usually follows a history of a painful ankle sprain but other factors can be at play which we'll get to. Hikers, trail runners, football players and rugby players often visit our practice for this problem. In fact, ankle sprains are widely thought to be the most common sporting injury full stop. But that's not to say it can't happen to people of any level of activity or age.
Patients with lateral ankle instability, as we've already mentioned and name gives away, have a repeat history of either "going over" the ankle (an inward and downward turn of the foot) or have a persistent feeling of instability, especially on uneven ground. Depending on the cause and the tissues affected, patients may often report having poorer balance on the affected side as well as pain around the lateral (outer) part of the ankle.
Why does it happen?
Most lateral ankle instability can be thought of as "mechanical" - following from an ankle inversion injury or "sprain" involving a high-force, high-speed inward turning of the foot on the ankle, resulting in varying degrees of damage to the structures that support the ankle. The number one predictor of an ankle inversion injury is drum roll a previous ankle inversion injury. Because the stabilising structures like ligaments will tend to heal in an elongated shape and provide less robustness going forward.
Part of the challenge of lateral ankle instability is that when we talk about the ankle complex, we can really be talking about three joints; the talocrural joint (the one we'd all recognise as the ankle joint), the subtalar joint (which sits below it) and the tibiofibular syndesmosis (which sits above it)...couple this with all the ligaments, fascia, tendons and nerves related to them and it starts to get complicated very quickly doesn't it!? This is why we always recommend seeing a Podiatrist with an excellent knowledge of anatomy (we like to think that's us!) to help you get to the bottom of things.
It's also important to recognise the idea of a "functional" lateral ankle instability; this is relates to predisposing factors such medical conditions involved in proprioception (balance) like Parkinson's or Diabetic Neuropathy, or conditions that affect ligament laxity like Ehlers-Danlos Syndrome.
What are the treatment options?
The first step is to rule out more serious injuries like fractures which would likely require orthopaedic involvement. There are well-validated clinical tests our team can carry out which can give us a very good indication of whether it is appropriate to send you for an X-ray to rule out fractures. If these tests don't suggest this, we will often still recommend our in-house diagnostic ultrasound service; this can still be useful in evaluating bone injuries but has the other advantage of being able to assess the ankle's soft tissue structures (to check for ligament damage for example) which can be helpful to guide the next steps of your rehab or decide if surgical referral is appropriate.
We have a lot of experience in helping people to rehabilitate from ankle injuries and the programme put in place will be highly individualised to your abilities, activity goals and of course the degree of injury. In all case though there are likely to be elements of strength training, proprioceptive (balance) training and a progressive move towards more dynamic activities (hurdle jumping and cutting drills for example).
There are also lots of options in terms of taping techniques and foot orthoses (specialist insoles) or braces to go alongside appropriate footwear advice which can all provide both support and symptom relief. In most cases these are only needed in the short- to medium-term but some people with underlying medical conditions as described above may need these as a more permanent tool to aid mobility.
