The anterior area of the ankle is the front, or top of the ankle. The ligaments in this area include the anterior talofibular ligament and that anterior tibiotalar ligament. These ligaments can become damaged, causing subsequent instability of the ankle.

  • Weakness of the lower leg or ankle muscles and laxity of the anterior ankle ligaments are the most common cause of anterior 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 anterior ankle instability.
  • Sudden trauma or accident like a fall on the ankle
  • Tenderness of the ankle area, especially in the anterior 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 anterior 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 anterior 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 anterior 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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