Non-Surgical Treatment for Ankle Instability
In most cases, patients with chronic instability of the ankle are initially treated with non-surgical methods including:
- Taping or bracing of the ankle -- especially during sports activities -- which may provide some stability and allow the individual to continue to participate
- The use of a hightop work boot to provide stability for workers to continue to perform their occupational duties
- Physical therapy - focusing heavily on restoring the strength of the muscles around the ankle and retraining for balance and coordination
- The use of anti-inflammatory medications and ice after certain activities
Surgical Treatment for Ankle Instability
If patients have ongoing symptoms despite attempts at bracing or rehabilitation, surgery may be recommended.
In most cases, surgical tightening of the loose ankle ligaments can be performed with very high success rates. Research studies have shown excellent return to sports in most patients who undergo such surgery. The studies have also shown very long-term durability of this type of surgery.
It is important that any associated conditions or injuries be fixed at the same time as the ligament surgery, including:
- Removal of loose debris in the ankle joint
- Addressing cartilage damage or cysts in the ankle from the sprains
- Repairing torn tendons to assist in restoring strength
Surgery has to be considered carefully in athletes so as to allow sufficient time for recovery and rehabilitation prior to the start of the next athletic season. Likewise, workers with ankle instability that prohibits them from performing their job may need surgery to allow them to successfully return to work.
Research is ongoing to determine the effectiveness of minimally invasive techniques to tighten the ankle ligaments compared to the more traditional open method.
In cases where the standard surgery has failed or in patients with extremely poor ligament tissue, more advanced surgical techniques may become necessary. These often involve use of cadaver (allograft) tissue to strengthen the patient’s own ligaments. This surgery is more complex and requires a surgeon who is experienced and skilled in these techniques.
Rehabilitation and recovery following this type of surgery is a bit longer than the standard surgery, but still offers good results allowing many patients to return to sports and work activities successfully. The surgeon may also recommend combining other procedures along with ligament repair to improve foot alignment and repair tendon tears.