| The unstable ankle Why is it important to know which of these it is?
It is generally only important to know if you have failed to resolve with physiotherapy rehabilitation(see 'The sprained ankle'), and have given the injury an accepted time to settle. (How long is open to debate and discussion depending upon requirements, perhaps six months).
Can the ankle be unstable without an injury?
Yes, mechanical instability can be a manifestation of more generalised problems without any injury having occurred to the ligaments. In particular generalised ligamentous laxity syndromes (where many ligaments may be inherently lax). Also neurological/neuromuscular conditions (eg polio and HSMN ) may result in weakness of the muscle groups on the lateral (outer) side of the ankle(peroneals) and result in a tendency to inversion and instability.
Occasionally as a symptom of arthritis the ankle may feel subjectively unstable. When to reconstruct the ligaments? - If a patient is symptomatically unstable, despite adequate rehabilitation, and the lateral ligaments are demonstrated to be lax to examination (often under anaesthetic).
- If a patient is symptomatically unstable, despite rehabilitation, and the ligaments are stable but the ankle has failed to improve despite removal of synovitis/chondral flaps etc.
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