Ankle Joint Instabilities: General Treatment Guidelines

Ankle Instabilities

    When you sprain an ankle ligament, or any ligament that stabilizes a joint, you always get some mechanical instability. This instability can be tested and documented by physical examination or stress x rays. But, it is functional instability that is the most important to treat. When patients sprain their ankles or knees, we try hard through strengthening exercises, bracing, and occasional surgery to remove functional instability. Functional instability feels like the joint shifts or will give out or does give out. With functional instability you have true disability. A wonderful paper written in the 1960s by a Dr Freeman clearly showed if patients could learn to balance on one foot post ankle sprain that their need for ankle ligament repair was almost zero. This paper heralded in the concept of using tendon strength to overcome the loss of ligament integrity, at a time when primary ligament repair was commonplace post sprain.    

The top 10 treatments for ankle instabilities are:

1. Re-strengthening of the muscle/tendons in the area that would protect the side of the joint of the ligament loss.    
2. Single leg balancing with gradual progression of difficulty
3. Various ankle braces
4. Various forms of ankle taping

5. High top shoes for various activities like backpacking on uneven terrain

6. Custom made orthotic devices to stabilize for the injured ligament  
7. Consider Prolotherapy (injections into the ligaments of sugar water)
8. Strength the muscles/tendons above and below the injured ligament to help with the overall function.
9. Control the overall swelling in the area which adds to the instability
10. Surgical consultation to see what the process and prognosis of surgical repair