Our eldest 8 year old son returned home from Scouts last night, limping in pain. He had sprained his ankle during a game, and was in a lot of discomfort and wouldn’t trust his podiatrist Dad to even let me touch it. It was the second time he had done a sprain to this ankle over the past couple of years, and he desperately wanted a “plaster cast and crutches” – more so to make an impression at school. However his injury wasn’t too severe, and a supportive bandage and some simple pain medication would suffice this time.
Many patients see us with either an acute ‘one-off’ ankle sprain, which is the result of an unfortunate accident. This is far more common on the outside of the ankle, rather than the inside. With time and some rehabilitation, they usually resolve uneventfully. However, the sprain always involves some degree of stretching or tearing of one or more ligaments that hold the outside of the ankle together. Once they are damaged, there will be residual weakness that will always exist to some degree.
If there is a history of two or more sprains to this area, then these ligaments are often considered to be unstable, or attenuated. That means they no longer offer any support or control over the movement of the ankle. This situation is then considered to be chronic ankle instability.
Certain foot types, such as those who have very high arches where the heel is tipped towards the outside of the leg, are predictably the most likely to go on to develop chronic ankle instability. I often say they are half-way towards an ankle sprain standing still, so it takes very little additional force to move the ankle beyond its physiological limits. The patients often require foot orthoses to try and reduce the unstable position of the ankle, and position the foot and ankle in a more neutral position.
Other measures involve the issue of different styles of ankle bracing, particularly for ‘lateral motion’ sports – such as tennis, netball, soccer or basketball.
Where the instability is too severe, or these measures are not adequate, then lateral ankle reconstruction surgery may be indicated. This involves a repair of the ligament/s which are damaged, and sometimes addressing some of the bony structural issues which may be associated with an abnormal aligment of the hindfoot and ankle.
Author: Anthony Short, Podiatrist