Don’t trust your ankles?

David Redfern

Do your ankles often give way, making playing sport, wearing high heels or simply walking on uneven ground a risky business? Specialist foot and ankle surgeon David Redfern from Spring Orthopaedics has some advice for the condition known as ankle instability.

Ankle instability usually starts with a sprain that doesn’t heal properly. Typically you twist your ankle, more often than not while playing sport or walking on uneven ground. Your foot bends too much or in the wrong direction, which stretches the ligaments that keep the ankle joint stable. Sometimes the ligaments tear either partially or completely, depending on the severity of the sprain.

On tearing the ligaments, the tiny nerve fibres within the ligaments will be damaged. These are called proprioceptive nerve fibres and their job is to constantly report back to the brain about where your ankle is in relation to the rest of your body and the environment around you – a kind of GPS system, which helps the brain co-ordinate muscle function to keep you balanced and your ankle stable. When these nerves are damaged, they don’t relay messages so well, which means your brain isn’t as effective at keeping you stable.

Ankle instability is a bit of a vicious circle - you are more prone to sprains, but with each sprain the ligaments become increasingly weakened, which in turn makes your ankle more unstable and so on…

There are, however, other causes of the ankle giving way which are not necessarily due to problems with the ligaments themselves. Therefore it is important that you undergo a detailed examination by a specialist who will advise on the best treatment. This will depend on several factors: the exact cause of the instability, the severity of the symptoms, treatments already tried and your lifestyle and level of activity.

Physiotherapy is the first line of treatment and is often very effective. It is directed at retraining the damaged proprioceptive nerve fibres and encouraging the ligaments to heal, as well as strengthening the muscles around your ankle with specific exercises and activities.

Sometimes your foot shape can make you prone to suffering sprains and can increase the stress on the ankle ligaments. In this circumstance, a custom made corrective inner sole for your shoe may be advised. There are also various ankle supports worn inside your shoe that restrict certain movements in the ankle, improving stability.

Surgery may be considered if non-operative treatments have not worked. The most common procedure is to tighten and re-attach the damaged ligaments to the bone. This type of operation is very effective and is usually performed through a small incision on the outside of the ankle. It is often combined with arthroscopy (keyhole surgery) to inspect the ankle joint and treat any other associated problems.