Never Treated Ankle Sprains Properly? Five Signs You Have Chronic Ankle Instability
Ever taken a "it'll be fine in a day or two" approach when you've sprained your ankle? Then proceeded to keep walking on and using your ankle normally without a second thought? So have a lot of Kiwis. After all, ankle sprains are are one of the top most common musculoskeletal injuries in those physically active, so do you really need to rehabiliting them properly after every sprain?
As Podiatrists, after seeing and treating many people with weak and unstable ankles each week, we can confidently confirm the answer is yes. Without the right care to allow the ligaments supporting your ankle to heal, repair and regain their strength (the ligaments are what are damaged during an ankle sprain), you become vulnerable to longstanding consequences for your feet and ankles. Specifically, in the form of chronic ankle instability. In fact, research shows that up to 70% of people that have an ankle sprain will develop residual physical disability, which may include chronic ankle instability. Here's what you need to know.
What is Chronic Ankle Instability?
Chronic Ankle Instability is a diagnosis given to those who experience ankle "laxity and mechanical instability that interferes with activity". In simple terms, this means that if your ankle ligaments are loose and weakened to the point they can no longer do their job of keeping your feet and ankles stable and moving well throughout your day, whether it's on the sports field or on your way to work, then it is likely that you have developed chronic ankle instability.
'Developed" is a key word here, because unless you were born with a connective tissue disorder that leaves you with weakened tissues and ligaments (that would be present across the body), then chronic ankle instability is something that develops due to specific causes. And one of the most common causes? Repeated ligament injury and damage from ankle sprains that were no effectively cared for and rehabilitated, leading to these ankle-supporting ligaments growing weaker and less stable over time. And it means you have greater risk of more ankle sprains, which leads to further ankle weakening without the right care. The end result after many ankle sprains over many years? Feeling unsteady and unstable on your feet on a regular basis.
It's important to note that there are other factors that can hasten the pace at which chronic ankle instability develops - or worsen the problem. Inflammation is one example. With any sustained or lingering inflammation around the ankle, whether that's following a sprain, from stress on the ankle, or from an inflammatory condition like rhuematoid arthritis, the problem of chronic ankle instability can become worse as prolonged periods of inflammation can impair healing and hav degenerative effects on our tissues. So, how do you know if you might have chronic instability? Here are five red flags that tell you that you should get in to see your podiatrist, pronto.
Walking Over Uneven Ground Makes You Nervous
If a friend inviting you for a walk along the beach, a rocky-shored lake, out for a hike, or even a park walk with some uneven ground makes you think twice about saying yes to going - then you may have chronic ankle instability/ We classify this as a red flag because under normal circumstances and with healthy, strong ankles, walking over uneven surfaces isn't something that most people think twice about - unless they're older, have balance or instability issues for other reasons, or have a history of falls or fractures.
When your ankle is significantly unstable, it is much more difficult for your foot to confidently adapt to irregularities in the ground - like loose stones, dips in the sand at the beach, hils and more. This can cause your ankle to give out unexpectedly, causing you to fall and get injured, or even face another ankle sprain. The fear and anticipation of these mishaps can make walking on anything other than flat, smooth surfaces feel like a perilous task.
You Reguarly Watch The Ground When You Walk
Has watching the ground while you're walking become so commonplace that it feels normal to be constantly staring down and scanning for anything that may make you trip and fall? Don't get us wrong - it's normal to scan the footpath ahead for anything dangerous or potholes to avoid, but with healthy ankles, you can do this while maintaining a conversation, focusing on the dog you're walking or staring straight ahead and enjoying the sights around you - instead of reguarly (or constantly) having to be staring down at your feet.
Having Chronic Ankle Instability means that your proprioception - which is your body's ability to sense its position in space - has been compromised. With each step, your ankle joint must make minute adjustments to keep you balanced, this means that with weak ligaments and ankle instability, your ankle may not be able to do this properly. You'll also be more vulnerable to your ankle rolling, twisting or giving way (leading to you falling) because of the reduced ankle strength and when the ligaments are weak, these adjustments become erratic and unreliable. This is why people with chronic anle instability tend ti be more mindful and focused on the ground as they're walking.
You're A Lot Less Active Than You Used To Be As Going Out Makes You Feel Anxious
If you're reguarly worried about falling or your ankle giving way for no apparent reason when walking, it's natural that you may, over time, choose to walk less and be less active. While we often talk about the physical consequences of ankle instability (like the injuries you sustain from falling), living in fear of falling whenever you're out and about can also lead to reduced activity levels and a more sedentary lifestyle, which, in turn, can worsen the problem. Avoiding physical activity can cause the muscles around the ankle to weaken further, exacerbating the instability. It's a viscious cycle where the fear of walking on uneven ground leads to less movement, which then increases the risk of instability and injury. Thankfully it's one your podiatrist can help break.
You Feel Much More Stable And Supported In Certain Shoes
Where your ankles lack stability, you're likely to notice that wearing good, stable shoes that wrap around the ankle (or just below the ankle) can offer some much-needed support to your ankles and make you feel much better and more confident on your feet. This is because these shoes will keep your ankle stable and in place, reducing the amount of side-to-side movement at the ankle, essentially fulfilling a similar function that your (weakened) ankle supporting ligaments should have in the first place. This leaves your ankles no only feeling much more secure, but you'll likely experience a lot more confidence when walking in these shoes, easing at least some of the concern or anxiety about your ankles suddenly giving way.
Alongside shoes, certain ankle strapping techniques (that our podiatrists can show you) as well as ankle braces can also achieve the same function.
You Suffer With Regular Ankle Sprains
Finally, you may not feel like your ankles are weak, but if you're experiencing regular or recurrent ankle sprains, this is a big red flag for us. Unless you're constantly walking over uneven ground that is putting you at significant risk, there's no reason to be rolling and spraining your ankle often. It is likely that when we look at the underlying causes of these sprains, we'll find some degree of ankle instability.
Your Podiatrist Can Help. Heres How
The Good News is that there are so many approaches to leaving your ankles in a much stronger and better-supported place - even if you've had ankle instability for years. While we customise each person's management plan to best match their unique circumstances, we may recommend:
- Ankle Bracing: the good things about ankle sprains being such a common problem, is that there are a wide range of braces, ankle-foot orthotics, and other devices that are designed to help restore strength and function back to your ankle. We'll run through your bracing options, if suitable, and discuss whether a brace could help you enjoy a more comfortable and carefree quality of life.
- Ankle Strengthening Exercises: part of your treatment will likely involve a program to work on your ankle ligament strength. Completing your excersizes means that over time, you'll start experiencing noticeable differences to your ankle strength and function, and your confidence on your feet. There are very few circumstances where this may be less suitable or must be modified noteably, such as for those with arthritic changes in their ankles (to a more suitable degree).
- Proprioception Training: working on your proprioception enhances your body's ability to sense the position and movement of its joints and structures at any given moment, thereby improving balance, coordination, and muscle strength around the ankle. Proprioception training is often overlooked in the management of chronic ankle instability - yet it's incredbibly important alongside neuromuscular training to help retrain how your muscles activate - and how stable and confident you feel on your feet.
- Custom Foot Orthotics: Foot Orthotics are prescription medical devices that sit inside your shoes and can contain specifically-prescribed features, such as a raised lateral border and an increased heel cup depth, that best support the ankle, add stability during movement, and reduce the liklihood of a sprain. All of our orthotics are custom-made from a 3D scan of your foot paired with a comprehensive assessment, so we can prescribe the best features for your ankles and feet. This is a great way to give you back some stability and confidence on your feet.
- Footwear Assessment: Your Footwear can help ass a great deal of stability to your daily life as we discussed earlier, which is why we'll review your footwear and provide recommendations of the best footwear to help support your ankle in light of your foot type and characteristics.
Before you're able to get in to see your podiatrist, something you can do immediately at home to help best support your ankle is switch to a supportive pair of shoes like running shoes that wrap around the ankle and support the ankle so it cannot freely roll.
Remember: Don't Ignore Ankle Sprains
Ankle Sprains can feel so commonplace that it may feel fine to just shrug them off, knowing the pain will typically subside within a few days. However, according to the 2016 consensus on the long-term consequences of ankle sprains, heres what you should know:
- If you've already had one ankle sprain, the chances of you having at least one other sprain is high, with factors such as your footwear, tendency to walk over uneven ground, your foot type and gait also influencing this risk.
- The majority of people with recurring ankle sprains are shown to develop chronic ankle instability over time.
- Ongoing ankle instability is associated with sensorimotor deficits, such as diminished reflexes, poorer motor control skills at the ankle, and difficulty percieving touch, pressure, pain, and the position of the ankle at any given time.
- Ankle Instability can lead to the lead to the early onset osteoarthritis of the ankle joint, linking back to the trauma sustained from the sprain.
- Both Ankle sprains and chronic ankle instability are associated with decreases in physical activity levels, leading to a decrease in a person's quality of life.
- The earlier that ankle sprains are treated with the help of an experienced health professional - the better the outcomes.
- Late treatment is always better than no treatment.
To Book an Appointment with our Podiatry Team here at Waikato Podiatry, call us on 07 838 0003, or use our Online Booking Portal.
