Chronic Lateral Ankle Instability
Ross Hauser, M.D.
Most ligament injuries do not totally heal. Even if the pain resolves, the ligament will not be as strong as it was prior to the injury. Since ligaments stabilize the joints, ligament injury then produces a loose joint. If the ligament never heals, chronic joint looseness or instability results.



The symptoms of chronic ankle instability are feelings of the joint giving way, swelling, pain, decreased range of motion or excessive motion, and recurring sprains. The pain is usually chronic or recurrent. Other symptoms include complaints while wearing high heels, increased symptoms after walking or sports, and, as stated, recurrent sprains.

If the ankle instability is not treated, cartilage deterioration with resultant degenerative arthritis develops. This sequence of events occurs everywhere in the body. If a ligament does not heal, instability of the joint occurs-and the end-result is arthritis with good prospects for fusion or joint replacement surgery.

Studies on injured ligaments show that at least one year is required before healing has been completed or the total amount of healing occurs. Injured ligaments do not entirely regenerate. Rather, they repair with scar tissue. Repair and regeneration begin at 48 hours to 72 hours post-injury, and continue maximally for six weeks.

From six weeks to 12 months the ligament tissue remodels, contracts, and gains tensile strength. After 12 months the ligament and scar tissue generally matures and achieves 50 to 70 percent strength of the original ligament. Do you understand the magnitude of this statement? On average, ligaments only heal to 50 to 70 percent strength when they are injured.

Pain relief is not a reliable sign that a ligament has healed; perfect function is the sign. A joint that is strong, without swelling or signs of weakness, is a better measure.

Do you have ligament irritation of the ankles?
To test for ligament irritation in the area of the right ankle, cross your right ankle over the left knee. Your right hand should be placed over the right ankle. The left hand then pulls on the toes of the right foot, inverting the ankle. If pain is felt in the right ankle with this maneuver, most likely injury to the ligaments on the outer part of the ankle has occurred. The same maneuver can be used for testing the left ankle.
 

An inner ankle sprain usually involves the deltoid ligaments. The test for this ankle sprain involves eversion of your foot (the opposite direction from inversion) by turning your foot out. If this causes increased pain on the inner part of your ankle, then there is a high likelihood of ligament injury to the deltoid ligaments. Unfortunately, many times the stability tests are negative, in that they do not reproduce pain. A better measure of ligament injury is by direct palpation. Often, when the stability test is negative (no pain), direct palpation over the injured ligament will be very painful. This is where the Prolotherapy is given.