When someone experiences repeated ankle sprains without the right rehabilitation, it can damage and weaken the ligaments, leaving the ankle in a weakened and unstable state. This leads to chronic ankle laxity or instability (CAI).  Incomplete healing after an ankle injury may result in continued deterioration of the ligaments and a cycle of chronic instability and recurring ankle sprains. Chronic ankle laxity is a long-term condition that may not heal on its own.  That’s why it is so important to see an orthopedic specialist at OCC – Advanced Orthopedics & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado before It can affect the quality of life, cause individuals to stop engaging in physical activity, and lead to post-traumatic osteoarthritis.

OVERVIEW

Acute ankle injuries and ankle sprains account for more than 2 million cases of chronic ankle laxity per year. Chronic ankle laxity is a condition where the ankle is unstable, has too much “looseness,” and easily gives out. The ligaments in the ankle normally hold it together and keep it stable. In some instances, the ankle may give out even though the ligaments are stable. This is referred to as “functional instability” and may be due to tightness or pain in the Achilles tendon. Other joints in the foot may also be involved. Some people have looseness in multiple joints due to genetic conditions.

ABOUT THE ANKLE JOINT

The human foot and ankle are comprised of 26 bones, 33 joints, and 100 muscles, ligaments, and tendons. The ankle joint connects the bones in the lower leg to the foot bones. It is where the shin bone (tibia), calf bone (fibula), and talus bone meet. The ankle has two joints: the main ankle joint and the subtalar joint (the joint below the ankle). The main ankle joint allows for the up-and-down motion of the foot. The subtalar joint allows for the side-to-side motion of the foot.

WHAT IS CHRONIC ANKLE LAXITY?

With chronic ankle laxity, an initial ankle sprain occurs when an individual rolls, twists, or turns the ankle inward in an awkward way, causing one’s weight to shift to the outside of the ankle. This forced rotation of the ankle causes the supporting ligaments to stretch or tear. Stretched and torn ligaments are weaker and may not heal properly. Unable to play their role supporting the ankle joint, the ligaments “give way” easily, resulting in more sprains. Each subsequent sprain leads to further weakening or stretching of the ligaments and greater instability. The result is chronic ankle laxity and an unending cycle of ankle sprains. “Giving way” can occur while walking or doing other activities, but it can also happen when just standing.

CAUSES

The most common cause of chronic ankle laxity and instability is recurrent ankle sprains. However, a sprain is not the only cause. A bone fracture, swelling or scar tissue in the joint, or even arthritis can all contribute. Chronic ankle laxity can be influenced by an interaction of intrinsic and extrinsic risk factors. Intrinsic factors such as advanced age, poor neuromuscular control, and previous history of trauma may interact with extrinsic factors such as in a sports event or a simple daily activity. This interaction can predispose a person or an athlete to ankle sprains. Some ankle sprains are even due to the shoes one wears. Over 120,000 injuries a year are estimated to be caused by high heels. All repeated sprains, no matter how they occur, can lead to chronic ankle laxity.

CHRONIC ANKLE LAXITY IN SPORTS

The incidence of ankle sprain is one of the most common sports-related injuries, accounting for approximately 25% of all this type of injury. Sports that involve running, jumping, or quick starts and stops increase the likelihood of ankle sprains. These include tennis, basketball, volleyball, track and field, and gymnastics. Soccer has the highest percentage (61%) of athletes with recurrent sprains, mechanical instability, and chronic ankle laxity. Recurrent ankle sprains that cause the development of chronic ankle laxity are not just the result of injury. They can be caused by being born with joint looseness, poor warm-up before practice or play, poor physical conditioning (strength and flexibility), or returning to sports too soon after injury.

SYMPTOMS

• Persistent (chronic) pain and discomfort
• Swelling
• Tenderness
• Loss of balance
• Difficulty with activities
• Limited range of motion in the ankle joint
• The ankle feels wobbly

NON-SURGICAL TREATMENTS

Many non-surgical treatments may help rehabilitate chronic ankle laxity. The goal is to restore the ankle’s range of motion, strength, balance, and coordination to what it was before the injury or, if possible, even stronger to decrease the risk of reinjury. Many effective treatments are:

• Physical therapy: exercises to strengthen and improve balance and range of motion, and as one progresses, training that relates specifically to their activities or sport
• Bracing: bracing helps to gain support and keep the ankle from turning. It also prevents additional sprains
• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can often help reduce pain and inflammation
• Custom orthotics: research in patients with acute and chronic ankle laxity has shown the positive effects of orthotics on postural control

WHEN IS SURGERY INDICATED?

If conservative treatment does not restore or repair the ankle, surgery may be required. The modified Brostrom-Gould procedure is the gold standard treatment for chronic ankle laxity. This procedure involves reconstructing or tightening the ligaments on the outside part of the ankle so that it is no longer loose or unstable. A minimal ankle arthroscopy procedure is often used, which involves placing a small camera inside the ankle to assess for other injuries and clean out scar tissue. This procedure is recommended, given that a significant portion of patients with ankle instability have other problems with the ankle joint.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

The highly skilled and experienced ankle specialists at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, diagnose chronic ankle laxity by going through a detailed medical and injury history, looking particularly at your history of ankle sprains and the measures taken to rehabilitate your ankle following these incidents. A balance test can be used to determine the severity of the instability and if it affects your everyday movements. Depending on the outcome of this examination, an X-ray may be taken while the ankle is under stress, which will show whether the ankle bones are loose. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may also be taken to see the ankle in greater detail. The foot and ankle surgeons at Advanced Orthopedics have more education, training, and experience specific to the foot and ankle than almost any other healthcare provider. They are there for you in every way possible, from helping reduce the likelihood of ankle sprains in the future to restoring your confidence to participate in both sports and everyday activities. If you think you are experiencing chronic ankle laxity, schedule an appointment today.