What is the chronic instability of the ankle?
Most of the players experience Chronic ankle stability after the ankle injury. When they return to play without proper rehabilitation, they have some posture instability issues and proprioceptive issues (Joint sense). These issues can lead them into ankle instability even in their daily activities like walking, standing. Ankle sprain identifies as a reason for the large percentage of chronic ankle stability patients. On the other hand, prolong chronic instability of the ankle can lead to ankle osteoarthritis.
There are two types of ankle instabilities which are called mechanical instability and functional instability. when mechanical factors such as impaired proprioception, impaired neuromuscular control, impaired postural control, strength deficits cause ankle instability, it is called mechanical instability. As well as when the pathological laxity of ligaments, bony structure restrictions, synovial changes, degenerative changes cause the ankle instability, it is known as functional instability
Structure of Ankle joint
The ankle joint is a synovial joint of hinge variety made by the articulation of the tibia, fibula, and talus. Anatomically, this joint is very strong. The stability of the joint is maintained by close contact between two articular surfaces, Strong collateral ligaments, surrounding muscles, and tendons. When it comes to ligaments, The anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament are involving the stabilization of the lateral aspect of the joint.
Deltoid ligament provides stability medially. The deltoid ligament is a complex of ligaments which is comprised of the anterior tibiotalar ligament, posterior tibiotalar ligament, talocalcaneal ligament, and talonavicular joint.
What is an ankle sprain?
A sprain means injury of a ligament. In the ankle, the anterior tibiofibular ligament (ATFL) is the most commonly injured ligament. Most probably, the calcaneofibular ligament is usually injured with the ATFL. This lateral ligament injury is damaged during the plantarflexed and inversed position of the leg. But sometimes Medial ligament (Deltoid complex) is faced injury due to eversion and plantar flexion of the leg. Actually, in this position, the ankle joint is more unstable and it leads to cause a sprain of ligaments. However, dorsiflexed position is the most stable position for ankle joint
What are the clinical features of chronic ankle instability?
- recurrent ankle sprains
- foot is toppled on the uneven surfaces
How is chronic ankle instability diagnosed?
This is the most significant section before moving to the treatment. First, a Doctor or Physical therapist starts their diagnosis by evaluating his condition. Here, they normally take the patient’s socio-demographic details, Mechanism of injury, Past surgical and medical history, the severity of the disability. Then they move to the observation and palpation of that affected area to get an even better understanding. Imaging tests and Special tests then come into the diagnosis process of chronic ankle instability.
How is chronic ankle instability treated?
Non-surgical treatment (conservative management)
Physical therapy is a major treatment in conservative management. Balance deficits are a common feature of ankle instability so Physical therapist focuses on increasing the static postural control and dynamic postural control by both static and dynamic balance exercises (eg: single leg stance, elastic resistance exercises).
After regaining the normal range of motion of joint movements, before you move into the normal lifestyle, ankle strengthening is a good way of improving ankle stability. So, there are two basic Ankle movements named dorsiflexion and plantar flexion. you can perform these movements as strengthening exercises by adding some resistance from Thera bands Previous studies suggests that people who have functional instability are benefited from this rehabilitation protocol than mechanical instability.
Using an ankle brace while walking or playing or ankle taping is another way of conservative management of chronic ankle instability. However, these methods are still at the research level. but physical therapist normally uses these as their treatments for ankle instability.
When the non-surgical management is not given expected results, the consultant may refer to a surgical management protocol after a deep analysis of your condition. few different procedures are used by the surgeons to fix your issues. So, After the surgery, proper rehabilitation protocol is a must before back into your daily life again.