Chronic Ankle Instability Care

What You Need To Know

Understanding chronic ankle instability and when ligament repair is the right option.

Understanding Chronic Ankle Instability

Individuals who suffer from ankle instability, an untrusting feeling that the ankle will roll when stepping on any irregular surface, are candidates for ankle ligament reconstruction. This ongoing sense of the ankle giving way often follows one or more prior sprains that did not fully heal.

Ligaments on the outside of the ankle are most commonly damaged from ankle sprains. There are three anatomic ligament bands that can be damaged. If the damage is severe, the ankle bone (talus) can shift in the ankle socket producing a feeling of instability. Ligaments can be intact but loose or damaged beyond repair.

Other ligament locations are between the leg bones (syndesmosis) and on the inside of the ankle (deltoid ligaments). High energy injury mechanisms are typically needed to injure these ligaments, and damage in these areas often occurs alongside injury to other structures of the foot and ankle.

Common signs of chronic ankle instability include repeated ankle sprains, persistent swelling or tenderness, and a hesitation to step on uneven ground. If you or someone you know thinks they have suffered an ankle ligament injury, seek out the help of a podiatrist for a proper diagnosis and treatment regime.

Ankle Ligament Repair and Recovery

A Brostrom ligament repair is the simplest and most common ligament repair when performed on the outside of the ankle. It involves shortening the ligament involved and using suture to hold the ligament repair in place. Cast immobilization is needed until the ligament has healed and has adequate strength.

When the original ligament is too damaged to repair, new ligaments can be reconstructed with the use of a tendon graft, usually made from a tendon allograft obtained from a tissue bank. Bone anchors are used to place the tendon graft at locations where the ligaments attach. After healing, the tendon graft starts to function as a ligament, and stability is returned to the ankle. In time, cells called fibroblasts from the recipient enter the graft to maintain and repair the tissue.

Deltoid ligament reconstruction on the inside of the ankle is possible in many cases, but this is the most difficult of the situations. Usually, there is collateral damage to other structures of the foot at the point when the deltoid ligaments fail.

The surgery typically takes 1 to 1.5 hours to perform depending on the complexity of the repair. It requires working in an operating room and is done as a day surgery. Recovery usually requires a period of cast immobilization for 6 weeks, part or all of that time non-weightbearing, before gradually returning to normal activity.