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There are three major ligaments on the lateral (outside) aspect of the ankle; they are the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament. They provide lateral stability to the ankle joint, which is more sophisticated than a simple rolling hinge joint. Lateral Ankle Instability often occurs due to an injury or damage to one of the lateral ankle ligaments.

  • Weakness of the lower leg or ankle muscles and laxity of the lateral ankle ligaments are the most common cause of lateral ankle instability.
  • General ligamentous laxity may predispose an individual to instability or dislocations.
  • Repetitive strain injuries (RSI) at work, or overuse activities are common in people who participate in sport activities and individuals who have jobs that require performing activities of a repetitive nature.
  • Those participating in activities characterized by repetitive motions (jumping, running, etc.) that may aggravate the ankle, resulting in lateral ankle instability.
  • Sudden trauma or accident like a fall on the ankle
  • Tenderness of the ankle area, especially in the lateral region
  • Discomfort with movement, especially with flexing the ankle
  • Feeling that the ankle is “dead” after repeated activity
  • A feeling that the ankle will “go out” when moving in certain positions. This is called the Apprehension Sign.
  • Significant pain of the ankle
  • Swelling, weakness, numbness and occasional bruising of the ankle area

Conservative treatment of lateral ankle instability is the first line of action. This includes physical therapy to reduce inflammation and associated pain. In addition, a regiment of exercises to improve muscle strength and ankle stability should be initiated. Bracing and the use of ankle supports may be indicated during rehabilitation and as a preventive measure. In more severe cases of instability involving other joint structures, surgical intervention may be necessary.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client.

Common interventions in the treatment of lateral ankle instability include:

  • Manual Therapeutic Technique (MTT): hands on care, including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation.
  • Therapeutic Exercises (TE) including strengthening exercises to improve strength of the lower leg muscles in the ankle and increase stability.
  • Neuromuscular Reeducation (NMR) to restore stability, begin retraining the lower extremity, improve joint stability and improve movement technique and mechanics (for example, jumping or running) in daily use of the involved lower extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the ankle and tendons.
  • Home program that includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy include:

  • Initial immobilization of the instable ankle with boot or air-cast
  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal Injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Physical Therapy to include strengthening and work on balance and proprioception for ankle stability retraining
  • Surgery to correct underlying pathology and avoid instability and repeated dislocations. This may include surgical repairs or procedures to tighten the lateral ankle ligaments.

Prognosis

Most people recover full function following a course of conservative care of physical therapy to strengthen and stabilize the ankle. Those with more involved situations such as lateral ligament tears, or chronic dislocations will require surgery and intensive physical therapy afterward to restore full function.

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"Twin Boro Piscataway/South Plainfield is great! I was treated for occipital neuralgia and posture issues. Aside from performing wonderful treatment, everybody there is super friendly and accommodating (you will always be greeted with a smile) and also very focused and helpful! Bri is a knowledgable and experienced physical therapist who is not only a great PT, but also one of the friendliest people you will ever meet. Her pacing with my various exercises was perfect, as she pushed me, but not to any point that was uncomfortable for me. I enjoyed the variety of exercises and treatments, from heat and stim to exercises with weights and stretch bands. I thoroughly enjoyed going in 3 times a week to be treated by Bri. It is clear that she cares about and wants the best for her patients, with her passion and expertise for physical therapy! My posture has gotten much better and the headaches and pain I used to experience have completely disappeared after 3 months at Twin Boro. 5/5 I would recommend Twin Boro Piscataway/South Plainfield to anyone seeking physical therapy."

Stephanie M.

The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

Constance C.

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Carl

“After a major fracture and surgery of my right arm, the therapists at Twin Boro helped me return to normal activities with my right arm. Their patience and caring have been positive and encouraging to me!”

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