Ankle Instability

1. Plain radiography: AP standing, lateral 

2. EUA - Stress x-rays under anaesthesia (GA or peroneal block)

3. Arthroscopy - Cook et al found that 25% of patients arthroscoped for instability symptoms had another intra-articular pathology, usually treatable arthroscopically

Most patients with ankle instability will improve with non-operative rehabilitation.

Programme [Orth Clin N Am.- Jan '94]

Phase 1: RICE (immobilze in POP for 2-3wks)

Phase 2: Strengthening of peroneal & dorsiflexor muscles, stretching of TA. Isometric exercises using furniture or rubber bands.

Phase 3: Proprioceptive training. When pain & swelling gone. = wobble board exercises. Progress thro functional activities- walking, running, figure-of-eight running, hopping, jumping & cutting.

In severe strains protect ankle with pneumatic brace or taping for sports for 3-6mnths.

TREATMENT

Prior to considerations for surgery, ensure that subtalar instability is not present

Indications:

• Failed non-operative management
• +ve anterior drawer & talar tilt tests clinically
• stress x-rays 
  • tibiotalar tilt > 20 deg. 
  • anterior translation > 5mm.

Aims:

Restore functional stability. 

Results:

A wide variety of reconstructive techniques have had a high degree of success. 

Most authors report a good or excellent result in 80% to 85% of patients.