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Ankle Instability

1. Plain radiography: AP standing, lateral 

2. EUA - Stress x-rays under anaesthesia (GA or peroneal block)

3. Arthroscopy - Cook et al found that 25% of patients arthroscoped for instability symptoms had another intra-articular pathology, usually treatable arthroscopically


Most patients with ankle instability will improve with non-operative rehabilitation.

Programme [Orth Clin N Am.- Jan '94]

Phase 1: RICE (immobilze in POP for 2-3wks)

Phase 2: Strengthening of peroneal & dorsiflexor muscles, stretching of TA. Isometric exercises using furniture or rubber bands.

Phase 3: Proprioceptive training. When pain & swelling gone. = wobble board exercises. Progress thro functional activities- walking, running, figure-of-eight running, hopping, jumping & cutting.

In severe strains protect ankle with pneumatic brace or taping for sports for 3-6mnths.


TREATMENT

Prior to considerations for surgery, ensure that subtalar instability is not present

Indications:

  • Failed non-operative management
  • +ve anterior drawer & talar tilt tests clinically
  • stress x-rays 
    • tibiotalar tilt > 20 deg
    • anterior translation > 5mm.

Aims:

Restore functional stability. 

Results:

A wide variety of reconstructive techniques have had a high degree of success. 

Most authors report a good or excellent result in 80% to 85% of patients.



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Accessory Bones
Adult Hallux Valgus
Amputations of the Foot & Ankle
Anatomy of the Foot & Ankle
Ankle Arthritis
Ankle Fractures
Ankle Instability
Ankle Sprains
Arthritis in Children
Arthrodeses of the Foot & Ankle
Arthroscopy of the Foot & Ankle
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Biomechanics of the Foot & Ankle
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Compartment Syndrome
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Hyperkeratotic Pathology of the Pla...
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