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Ankle Stabilization Procedure

Ankle Instability
In a small number of cases, the ligaments will not heal back as strong as normal. This results in an ankle that is unstable and has a tendency to give away, or twist again very easily. Ankle instability can lead to an ankle that is sore and painful, sometimes swollen, and untrustworthy on rough terrain. If your ankle ligaments do not heal back adequately following an ankle sprain there are several things that may be suggested by your doctor.Ankle Instability

A physical therapy program (see below) may help strengthen the muscles around the ankle to help make the ankle more reliable. The therapy is also necessary to "retrain" the proprioceptive nerves around the ankle that have been torn with the ligament. These nerves are important in telling our brains how to use the muscles to allow the joints to properly function. An ankle brace may also help control some of the
instability and prevent the ankle from giving way.

If all these simple measures fail, surgery may be suggested to reconstruct the ligaments that have been torn. Surgery involves making an incision on the side of the ankle. A portion of the tendon called the peroneus brevis is used to reconstruct the lateral ligaments. A drill hole is made in the fibula, near the attachment the original ligament. A second drill hole is made in the area where the ligaments attached to the talus. The tendon graft is then woven these holes to recreate the ligament complex. After surgery, you will usually be placed in a cast or brace for about 6 weeks to allow the tendon reconstruction to heal. Following removal of the cast, physical therapy will be required to regain full use of the ankle.

Whether you have had an ankle sprain that did not require surgery or whether you are recovering form surgical reconstruction of the ankle ligaments you will probably benefit from physical therapy. Your physical therapist will evaluate your foot and ankle on your first visit to therapy. This will enable your therapist to locate the sore tissue and to develop a treatment plan. The outside ligaments of the ankle are hurt most often in an ankle sprain. This is because most ankle sprains are from an inward twist (an inversion injury). When this happens, the force from the twist may also compress the tissues on the medial, or inside, of the ankle. This can be a source of pain and inflammation on the inside area of the ankle. A grade of I, II, or III is usually given depending on whether you had a slight sprain (I), significant tearing and bleeding (II), or a complete rupture of the tendon (III).

Acute Treatment
Treatment may vary depending on which grade sprain you've had. In each case, the first line of treatment is to calm the inflammation and halt the swelling. The RICE principle can help address each of these needs.

Rest: A brace or splint will keep the ankle in a safe position, helping you avoid more strain to the sore area. In severe cases, you may require a pair of crutches to limit weight through the foot.

Ice: Cold therapy in the form of ice towels, bags, or wraps can aid in slowing the inflammatory process and in limiting pain. Apply as directed by your therapist.
Compression: An elastic wrap or an air-type brace can compress the sore area, keeping the swelling to a minimum.

Elevation: Keep your ankle elevated above the level of your heart. This will help drain the extra fluid (edema) back into the lymph system.

Other treatment choices may be used to further limit pain and inflammation. Examples include contrast baths with hot and cold applications, cold whirlpool, or electrical stimulation.

Early Healing Phase
Range of Motion Exercises: As healing gets underway, it is important to begin a series of movement exercises for range of motion (ROM). At first, you'll work on bending and straightening the ankle. Later, diagonal motions can be used.

Strength Progression
Next, you'll begin a strengthening progression for the muscles around the ankle. Emphasis should be placed on the muscles that pull the foot up and out (evertors), up (dorsiflexors), and that raise the heel (plantarflexors). Isometrics may be chosen in the early stages of rehabilitation. These are strengthening exercises in which the muscles are working but the joint stays stationary. They allow you to exercise with the ankle at different angles, helping you stay away from painful positions of the ankle. These exercises provide the benefit of reducing overall pain and swelling. They also help the muscles remember what they're supposed to be doing.

Early resisted exercises
Some types of equipment are helpful in reducing the effects of gravity, allowing you to begin strengthening without causing pain. One example is the sled. It can be set at lower angles at first and then gradually progressed over the course of physical therapy as pain eases. Therapeutic band, pulleys, or isokinetic device may be used to apply progressive resistance to the muscles around the ankle.

Balance exercises
These exercises are especially important following a ligament injury. Healthy ligaments send information to the central nervous system about the position of a joint. That's partly why when we close our eyes we know precisely where our limbs are positioned. Once a ligament has been injured, these receptors are unable to receive and send the needed information to the brain. This increases the possibility of injury in the future. Balance exercises help restore this position sense by heightening the sensitivity in the remaining intact receptors. Examples of these types of exercises involve standing and walking on uneven or very soft surfaces, single leg balance, mini trampoline balance, and progressive agilities.


Information Prepared and Provided By Dr. Craig H. Thomajan DPM


Dr. Craig H. Thomajan
Founder and Managing Partner of Austin Foot and Ankle Specialists