The unstable and painful ankle joint: what is new?

Abstract

The treatment of grade III ligament injuries should be early mobilization followed by early weightbearing. The mechanism of injury is complex. The results after nonsurgical treatment are satisfactory in most cases, and if problems due to chronic instability persist, several different surgical reconstructions are available and produce good results in many patients. A major concern after tenodesis is the increased risk of development of osteoarthrosis, as well as reduced range of ankle motion. Several studies have shown superior results after anatomic reconstruction of the ligaments compared with tenodeses. The incidence of subtalar injuries is unknown, but these injuries should be evaluated if surgical intervention is necessary in case of chronic functional instability, which may be caused by prolonged peroneal reaction time. Balance training may be an effective means of improving joint proprioception and single-leg stance in unstable ankles. Abbreviation:AOFAS American Orthopaedic Foot and Ankle Society Lateral ligament injuries are one of the most common injuries and may, in the active population, lead to chronic instability and, in some cases, pain. The instability pattern may even progress to chronic problems that interfere with activities of daily living. Lynch and Renström [1•] stated that sequelae of lateral ligament injuries are common. After nonsurgical treatment, 10% to 30% of patients develop chronic symptoms, including persistent synovitis or tendinitis, ankle stiffness, swelling, pain, muscle weakness, and giving-way. These authors stated that secondary surgical repair, even several years after the index injury, produces satisfactory results in most patients, but subtalar instability should be evaluated when surgery is indicated. Milner and Soames [2•] investigated the anatomy of the collateral ligaments of the ankle joint. They found that the anterior talofibular ligament was 13.0 ± 3.9 mm in length and 11.0 ± 3.3 mm in width and the calcaneofibular ligament was 19.5 ± 3.9 mm in length and 5.5 ± 1.6 mm in width. These results were in line with those of previous investigators and are potentially valuable in cases in which surgical reconstruction is indicated. Wilson et al.[3••] studied the motor activity and perceived athletic ability and found that the athletes' self-reported responses to motor activities were as useful as objective measures to assess treatment response after acute ankle sprains in the athlete.