Medical treatment for ankle instability and arthritis helps patients regain a confident stride.
Ankle instability occurs when ankle ligaments loosen or weaken. This problem can create a feeling of insecurity while walking, increasing susceptibility to turning and twisting an ankle and causing difficulties for patients. In the long term, frequent ankle sprains can lead to ankle osteoarthritis, diminishing patients' quality of life.
In this article, Dr. Krit Prugsawan, an orthopedic surgeon specializing in Foot and Ankle Surgery, shares his experience treating patients with ankle instability, offering valuable insights for readers.
From ankle instability to osteoarthritis
“This condition will negatively impact a patient's life, potentially leading to chronic pain and swelling. It can prevent some people from resuming sports, while some may have diminished performance as their ankle instability is ongoing and progressive.”
Dr. Krit added that a loose ankle is prone to recurrent ankle sprains. Each time you sprain your ankle, it inflicts damage to other parts of your ankle, especially the ankle cartilage. Damaged ankle cartilage degenerates, leading to pain. In addition, the lateral ankle ligaments may tear as well.
Dr. Krit, based on his experience treating patients with ankle instability, responded to the question about its causes.
“The most common and primary cause of ankle instability is untreated or improperly treated ankle sprains. These can be due to a lack of experience or expertise, which results in ligamentous laxity instead of firm, healthy healing of the ankle ligaments.”
When damaged ankle ligaments do not heal properly, 20 - 25 percent of ankle sprains will progress to ankle instability. Proper treatment of ankle sprains helps prevent future ankle instability.
But how exactly does it progress to ankle osteoarthritis?
“Ankle laxity is prone to recurrent ankle sprains. Some sprain their ankles a dozen times. Each time you sprain your ankle, the cartilage in the ankle is affected and damaged, causing it to wear away. The cartilaginous damage gives rise to future ankle osteoarthritis. Sometimes, there are torn lateral ankle ligaments, causing pain. When the lateral ankle ligaments are loose, the foot loses the balance in weight-bearing.”
In addition, patients with ankle instability can develop deformities, such as forefoot abduction, turning into dual problems of ankle osteoarthritis and deformity caused by an incorrect anchoring of ankle ligaments. With weight bearing, the foot will assume an awkward configuration, leading to uneven weight distribution. The load tends to be distributed off-center toward either side. As a result, the structure of the ankle becomes deformed, which requires treatment.
What is the treatment for ankle instability and ankle osteoarthritis?
Treatment options for ankle instability comprise non-surgical and surgical modalities. According to Dr. Krit, for mild ankle instability, non-surgical treatment options are recommended as the initial treatment and include:
- Physical therapy: Strengthening ankle ligaments, as well as exercises for increased flexibility, balance training, and enhanced proprioceptive sense of the ankle for better weight bearing. Secured ankle movement requires ankle ligaments and nerve coordination.
- Laser therapy: This treatment can help reduce pain and swelling and expedite the healing of ankle ligaments.
- Ankle supports and braces: Correcting the mal-aligned ankle requires additional orthotics or tailored shoes.
- Medications: Pain relievers and anti-inflammatory medications can help with pain.
- Kinesthetic and lifestyle modifications under a doctor's guidance
If ankle instability persists after 3 - 6 months of the abovementioned treatment, the doctor may consider an MRI scan to look for other injuries in the ankle. For example, the doctor will check if the cartilage is wearing out or if the ankle starts to degenerate, which are indications for the escalation of treatment to surgery.
“There are many surgical procedures (for ankle instability), from minimally invasive techniques to arthroscopic ligament repair. Each technique serves different purposes. For example, if the patient is an athlete who wants performance, surgical repair as the sole treatment does not suffice, additional synthetic materials may be stitched in to strengthen the ankle. Most have good treatment outcomes: over 90% percent can return to playing sports.”
To decide which surgical procedures to perform, doctors will decide based on the condition of the patient's ankle; surgical approaches vary from person to person. For instance, in patients with foot deformity, ligament repairs alone may not provide an effective treatment outcome as realignment of the feet is also necessary, complicating the surgery.
“For mild ankle instability, arthroscopic surgery may be performed. Patients require a few weeks of recovery before resuming full weight bearing. In the case of open surgery with synthetic ligament implantation, the recovery period takes up to four weeks before resuming weight bearing, and 3-5 months for sporting activities.”
As a foot doctor, how far advanced is the treatment for foot diseases?
“Knowledge about feet was very limited back in the day. The sole treatment for ankle injuries was casting, letting the broken or damaged parts heal themselves. However, self-healing does not guarantee that the affected parts will fully return to the same condition or perform as they used to. For example, a sprained or loose ankle can heal naturally, but the strength or stability does not recover fully. Plus, stiffness can result from casting, and complications abound.”
“In the old days, success was just to relieve pain and help patients continue their lives. However, these are not good enough in modern times; patients expect a complete return to their lifestyles before an injury occurs. They want their sports performance to be as good as it used to be.”
“With continuing development of surgical techniques, from open surgery to minimally invasive and endoscopic techniques, patients recover more rapidly, with minimal complications. Instead of letting affected ligaments heal on their own accord, with unpredictable healing and alignment, with today's techniques, a doctor can direct ligament repairs with proper tightness, no laxity, correctly addressing the cause of ankle instability.”
With the advancement of medical know-how, treatment goals are not limited to symptomatic treatments or helping patients to merely get by in leading their lives. Treatment should allow patients to return to their previous lifestyle as much as possible. Aiding patients in regaining their previous daily activity levels is the criterion for success Dr. Krit sets out to achieve.
In treatment for ankle instability or osteoarthritis, 80 percent depends on the specialist performing the surgery, and the remaining 20 percent on the physical therapist. The ankle needs a range of training, including weight bearing and balance training, and proprioceptive training to regain complete foot and ankle functionality.
Helpful tips from the foot surgeon
Since 1 in 4 ankle sprain patients develop ankle instability, Dr. Krit recommends seeking medical attention when you sprain an ankle.
“Patients should observe for unusual signs after an ankle sprain. If chronic pain and swelling persist longer than two months, for example, you should see a doctor. Such an injury requires proper treatment by a specialist to forestall further issues.”
If there is ankle instability, Dr. Krit recommends minimizing the use of feet, maintaining a healthy weight, cutting down on activities, and wearing ankle supports or braces for a walk based on the doctor's advice. In chronic cases with ankle osteoarthritis, a doctor may consider ankle fusion or ankle replacement surgery, considering the treatment modality best suited for the patients based on their lifestyles.
Ankle sprains may not sound serious, but patients' quality of life is compromised once they progress to ankle instability and osteoarthritis. Under these circumstances, the foot surgeon's role is to step in to care for, treat, and educate patients. An ounce of prevention is better than a pound of cure.
