The Problem Ankle: Chronic Instability
The ankle sprain is one of the most commonly experienced injuries during sport and recreational activities. It can even occur during daily activities around the house, garden, and community.
Whilst the many ankle sprains to the outside ligaments recover with relative rest, swelling management, physiotherapy, and a gradual return to activity, a proportion of people will continue to have problems.
Recurrent Ankle Sprains
People who continue to have issues with their ankle often report that they continue to sprain their ankle or experience ‘giving way’ episodes for at least a year following the initial trauma. Aside from the fact that the person may have their function impacted as a result of these recurrent episodes of injury, it can cause issues with the ankle joint such as cartilage damage, may increase the risk of longer-term joint changes or small fractures. This repeated and sustained experience of ankle episodes is known as chronic lateral ankle instability (CLAI).
Physiotherapy Rehabilitation for Chronic Ankle Instability
As physiotherapists we notice that people don’t attach as much emotional weight or concern for an ankle sprain as they would an acute knee or lower back injury. This could lead to sub-optimal management of the original injury and therefore increase the likelihood of evolving to become CLAI.
In the clinic setting, when assessing someone with CLAI we would ask about the number and severity of recurrent sprains, observe performance of relevant function, assess the ankles ligament stability and potentially refer for a stress X-ray if indicated.
From this point in the majority of cases would commonly include a 12-week graded exercise program containing balance, specific strengthening for the outside lower leg muscles (everters). General strengthening for the lower limb (calf, achilles, quads, hamstrings, gluteals, core), return to activity drills and a substitute for cardiovascular fitness is often included.
What if Physiotherapy isn’t Working?
If the person has completed the program and is still having problems attempting to return to their favourite activities and they have mechanical ankle instability signs on ligament testing and imaging, a referral to a good ankle orthopaedic specialist would be appropriate.
The great news is that the most common procedure (Broström-Gould Ankle Lateral Ligament Reconstruction) for CLAI has a there is a structured post-operative recovery pathway. Post-operative timelines can vary.
Below is an example of a commonly used rehabilitation pathway, depending on the surgeon and individual presentation.
Immediately post-op a rigid boot it fitted, must use 2 crutches and put minimal (10%) weight through the foot (touch weight-bearing)
Week 3 post-op: Review by surgeon, stitches removed, check wound. Start physiotherapy. Full weight-bearing allowed with crutches boot worn, wean off crutches by week 5.
Week 7 post-op: weaning out of boot to full weight-bearing while walking and progress balance and strength exercises gradually.
Week 12: can progress to jogging drills, treadmill assessment, jogging intervals
Week 14-18: may begin outside running, agility drills, training and return to play planning
If you are experiencing chronic ankle instability and need some guidance, feel free to reach out or book an appointment with our experienced physiotherapists today.
