Chronic Ankle Instability – Rebecca Kashdan

Ryan LaCorte Publications, Rebecca Kashdan

With every step you take, your feet are the only connection between your body and the ground. Your feet support you and transmit the force from each step through your ankles, through your lower leg, and to the rest of your body. Many people have, or will have, a sprained ankle at some point throughout their lifetime. An ankle sprain can impact the way you move whether you are a competitive athlete or simply walking around the grocery store and can lead to a chronic condition called ankle instability.

What is a sprained ankle and why is chronic ankle instability a big deal?

Your ankle is made up of several bones that not only allow you to point and flex your ankle, but also allow you to tilt your foot inward (inversion) and outward (eversion) so that you can adjust to uneven surfaces such as cobblestones, a sandy beach, or divots in your back yard. The bones in your ankle are connected by several ligaments, a type of connective tissue, on both the inside and outside to increase the stability of the joint.

When you experience a sprained ankle, usually the ankle rolls inward resulting in over-stretching the ligaments on the outside of the ankle. Occasionally the ankle is forced outward resulting in over-stretching of the ligaments on the inside of the ankle; however, that is much less common. Ankle sprains are often graded based on the severity of over-stretching with grade I meaning the ligaments are overstretched but not torn, grade II meaning there is a mild to moderate tear, and grade III meaning there is a significant tear in the ligaments. Symptoms may also include swelling, pain, bruising, and difficulty putting weight on the affected foot. If you have experience a sprained ankle with any of these symptoms you should see your doctor.

Chronic ankle instability is the result of several factors causing a person to sprain their ankle repeatedly. The first factor is over-stretched or torn ligaments resulting in decreased ankle stability. The second factor is muscle imbalance. When the ligaments are stretched or torn, the muscles and tendons surrounding the ankle may also be stretched and irritated, resulting in muscle weakness. The third factor is impaired proprioception. Proprioceptors are tiny nerve receptors located in soft tissue throughout the body that sense your position in space (these receptors allow you to touch your pointer finger to your nose with your eyes closed). The proprioceptors in the ankle are extremely important when it comes to balance and the ability to adjust your ankle on uneven surfaces to prevent falling. When the tissues surrounding the ankle are disrupted the proprioceptors do not collect the information that they need to help you adjust. All of these factors combined make up an ugly recipe for repeated ankle sprains as well as increasing the risk for falling. An unstable ankle can change the way the forces are transmitted from the foot through the rest of your body causing problems beyond your foot and ankle.

Physical Therapy can help!

Physical therapy can help to break the cycle of chronic ankle instability by preventing future ankle sprains. We use exercises that focus on normalizing muscle imbalances, restoring normal motion, and improving ankle proprioception. Your physical therapist will evaluate your imbalances in order to create a program specifically designed for you. For instance, if you feel fine while standing on flat stable surfaces but you have difficulty on a plush carpet or an uneven sidewalk, your therapist may have you practice standing and walking on unstable surfaces to functionally strengthen your ankle stabilizing muscles. Physical therapy will not repair a torn ligament; however, the therapists at All-Care are trained to develop a program that will promote healing as well as maximize the stability in your ankle by strengthening the surrounding musculature.

Is bare foot exercise good for me?

While proper footwear can provide excellent support for a person with chronic ankle instability, exercising barefoot in a controlled environment helps build natural stability. Often patients with ankle instability perform physical therapy exercises without shoes to increase reliance on the natural stabilizing muscles instead of relying on support from your shoes. You may notice that if you stand on one foot with a supportive sneaker and compare it to standing on one foot without shoes, you tend to “wobble” more without the shoes. That is exactly why we focus on barefoot stability. While barefoot exercise in a controlled environment can be beneficial, high impact barefoot training such as running or jumping without proper conditioning can lead to many other injuries. Make sure to speak with your doctor or physical therapist before beginning your own barefoot program.

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