Chronic ankle instability is a condition characterized by a recurring giving way or “rolling” of the outside of the ankle. This condition often develops after repeated ankle sprains. Usually, the giving way occurs while walking or doing other activities.
People with chronic ankle instability often complain of:
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- Repeated turning of the ankle, especially on uneven surfaces or when participating in sports
- Chronic lateral discomfort and swelling
- Pain or tenderness on the outside of the ankle
- The ankle feeling wobbly or unstable
Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.
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Repeated ankle sprains often cause chronic ankle instability. Each subsequent sprain leads to further weakening/stretching of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.
Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient’s level of activity. Nonsurgical treatment may include:
- Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion and retrain your muscles.
- Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation. A PRP (platelet-rich plasma) injection may also be useful in reducing pain and healing the injured tissues.
If conservative treatments have failed then surgical intervention in the form of ankle arthroscopy and ligament reconstruction may be necessary to increase stability and improve symptoms. We talked to Kurt Hofmann, MD, New England Baptist Hospital orthopedic surgeon and specialist in minimally invasive foot and ankle surgery, to find out what surgical options exist for treating these chronic ankle conditions.
What is an Ankle Arthroscopy?
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Ankle arthroscopy is an outpatient surgical procedure that is minimally invasive and used to treat various problems in the ankle joint. It uses a thin fiber-optic camera that magnifies the images of the ankle onto a video screen. Two or three small incisions are used during the procedure which allow excellent visualization of the entire ankle joint.
What Ankle Injuries are Usually Treated with an Ankle Arthroscopy?
Some of the more common ankle problems that ankle arthroscopy is used for are:
- Ankle impingement – scar tissue may form after an ankle sprain/injury and cause subtle pain and inability to return to prior level of function without pain
- Loose bodies – free floating tissue (bone, cartilage, scar tissue) in the joint can be a source of pain and mechanical locking/catching
- Synovitis – the soft tissue lining of the joint can become inflamed after an ankle sprain or repetitive overuse/trauma
- Osteochondral defects (OCD) – these are areas of cartilage and bone damage in the ankle joint that may result from an ankle sprain or fracture.
- Ankle instability – patients with chronic injuries to the ankle may develop ligament instability which can affect either the medial or lateral side of the ankle.
Each of the above diagnoses can be treated with minimally invasive surgery, a significant improvement over traditional open surgeries. Recover after surgery will include weight-bearing as tolerated in a medical boot for about 2-4 weeks post-op then starting physical therapy. Full recovery and return to activities is usually around 6-8 weeks post-op. Most athletes are able to return to full sporting activities within 3 months after their surgery.
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