What To Do When Your Ankles Give Out
One bad ankle sprain can linger in your life and lead to pain and the unnerving feeling that your ankle is about to give way. One-third of people who suffer an ankle sprain may experience chronic instability of the ankle.
Many people assume it’s just part of getting older or another spot where arthritis is taking its toll on the body. But ankle instability, also known as chronic ankle instability (CAI), is its own condition, and it’s one that can be addressed.
“The feeling that comes with ankle instability is unsettling, and often painful. But many people just assume they have to endure it,” said Garrett Wobst, DPM, a surgeon with Avera Orthopedics Aberdeen. “Many people try some self-treatment approaches, such as an over-the-counter brace or physical therapy. In many cases, it has little effect.”
Understanding Ankle Instability
Ankles provide the day-in, day-out support for activities from walking to sports to heavy labor.
The most common situations where ankle instability causes problems include:
- Walking on uneven surfaces
- Climbing stairs
- Engaging in side-to-side movements, especially in sports or work
- A nearly constant feeling that the ankle is weak, wobbly or unstable
“Arthritic ankle pain is not the same as instability. That pain will be dull and chronic, more like a recurring ache,” said Wobst. “Pain from instability will present quickly, especially when you’re walking on uneven surfaces or climbing stairs, or engaging in side-to-side movements.”
Instability differs, too. Functional instability may rise from injury or arthritis. “True” ankle instability can result from loose ligaments. It’s sometimes called floppy ankle, and the treatment approach will differ, Wobst said.
Arthritis is a condition itself, and can arise from infection, traumatic injury, underlying disease or wear on a joint. Instability often comes to a person’s life because of injury – think a bad ankle sprain.
“There’s really no way to predict who heals quickly and is fine after a sprain and who doesn’t,” Wobst said. “We have had older people who recovery 100% and then had someone in high school who developed ankle instability – they had one bad sprain and the ankle was never right after that.”
Wobst said any sprain should lead you to the doctor. “An acute sprain requires prompt medical treatment to minimize the damage – or the time off your feet,” he said. “If you see an expert, you can make sure a wide range of other issues, such as defects or ruptures, are not part of your injury.”
Treatments to Improve Ankle Stability
Instability of the ankle can last a lifetime – and treatment approaches can be straightforward. Physical therapy and braces for the ankle – whether custom-made or not – often are the recommendations a primary-care doctor or specialist like Wobst would recommend as first steps.
Wobst explained that experts will look at gait – how you walk – and what’s called hindfoot assessment in the process of diagnosing instability. “That assessment looks at the bones of the ankle and how they come together at various angles,” he said.
“Steroid injections have an important role in orthopedics, but for ankle instability, they can make things worse and loosen ligaments,” he said. “Imaging, such as MRI or a stress radiography imaging sequence, are likely next steps to identify the issues.”
How to Strengthen Your Ankles
The instability is most often caused by torn ligaments in the ankle that never properly heal. With a surgical procedure, these important ankle connections can be rebuilt and alleviate the underlying issue.
“What happens in a patient with instability of the ankle is that the muscles in the area are doing the work the damaged ligaments no longer can do,” Wobst said. “That’s why the pain and issues of feeling it ‘go out’ occur more often when you’re tired or after a longer day. It doesn’t tend to loosen up or feel better with activity like an arthritic ankle might.”
With an arthroscopic procedure and repair of the ligaments, the ankle can be stabilized. The symptoms will diminish Wobst said there’s minimal “off your feet” time, and most people can transition to bearing weight pretty quickly. Full activity – including sports – can occur in six to eight weeks in many cases.
“Many people face ankle instability, but unfortunately, most just tend to live with it,” said Wobst. “We can repair the tears and have it repaired for good, so that unnerving feeling of giving way is a thing of the past.”
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