Ankle instability, also known as laxity, refers to excessive motion in the ankle joint, leading to a sensation of the ankle "giving out." This condition can involve other foot joints, and in some cases, multiple joints due to genetic factors.

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Symptoms

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Individuals with ankle instability may experience:

• Easy twisting of the ankle, especially on uneven surfaces or during rapid direction changes like in basketball.

• Chronic damage to ankle ligaments, potentially resulting in less pain during twisting episodes.

• Excessive movement of ankle bones during daily activities, often causing pain.

• Discomfort during downhill walking due to ankle bone misalignment.

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Causes

Recurrent ankle sprains are the primary cause of ankle instability. While most sprains heal with non-surgical methods, repeated injuries can stretch and weaken ligaments, compromising stability.

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Anatomy

Ankle ligaments connect bones and provide stability. Commonly sprained ligaments include:

• Anterior talofibular ligament (ATFL), connecting the talus to the fibula.

• Calcaneofibular ligament (CFL), linking the fibula to the calcaneus.

• Posterior talofibular ligament (PTFL), situated at the back of the ankle. Less commonly injured. 

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Diagnosis

Dr. Kamel identifies ankle instability through a comprehensive evaluation process. This involves reviewing your medical history and conducting a thorough physical examination. During the examination, Dr. Kamel will assess the strength and range of motion in your joint. Special tests will be performed to evaluate the degree of looseness in your ankle. Additionally, standing X-rays may be ordered to assess for any signs of ankle arthritis or changes in bone alignment resulting from instability. Stress X-rays may also be utilized to quantify the level of looseness present in the joint. While an MRI may not directly visualize ankle looseness, it can be valuable in ruling out associated issues such as cartilage damage and tendon tears.

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Treatments

Treatment approaches depend on the severity of symptoms.

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Non-surgical Treatment

• Bracing during activities at risk of injury.

• Rehabilitation exercises for muscle strengthening, Achilles stretching, and balance training.

• Pain medications

• Steroid Injections

• PRP Injections

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Surgical Treatment

• Ligament-tightening procedures or ligament reconstruction using tendon grafts.

• Additional procedures for realigning the foot in cases of high arches (cavovarus deformity).

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Recovery

Following surgery, you will undergo a period of immobilization typically with a cast or CAM boot. Subsequently, you will transition to wearing a brace. Rehabilitation will involve a combination of exercises focused on strengthening and improving balance. The duration of recovery varies depending on the specific procedure performed. While full recovery may take up to six months, many patients can resume numerous activities much earlier in the process.

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Risks and Complications

Surgical risks include persistent pain or recurrent instability despite proper reconstruction.