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      Ankle Instability: Surgical and Non-Surgical Treatments

      Ankle instability is a serious condition that may result from severe or recurrent ankle sprains and/or in the setting of, particularly high foot arches. Patients don’t always complain of pain but do report feeling the ankle to be unstable or “buckling” under them when walking or exercising. The instability results from the tear or excessive stretch of the ligaments that connect 2 ankle bones.

      The first line of treatment consists of physical therapy to strengthen the ankle as well as an ankle brace to temporarily stabilize the joint. Additionally, patients with high foot arches may also benefit from orthotics that correct the excessive arch, therefore offloading the damaged ligaments. When the aforementioned treatments have not resolved the problem a ligament reconstruction may be recommended. In fact, if left untreated, chronic ankle instability might lead to tendon tears, ankle deformity, and ankle arthritis.

      There are a few ways to repair the damaged ligaments. One of the preferred methods that I am proud to have pioneered is a minimally invasive procedure consisting of a <1cm incision, as opposed to a 5-10 cm incision. With this technique, the ligaments are repaired and tightened, stabilizing the ankle. The procedure takes about 20 mins and is performed under sedation and regional anesthesia. Patients are allowed to go home the same day and are instructed to walk on the surgical foot 2 weeks after surgery (in a surgical boot). Six weeks after surgery patients are usually allowed to return to sneakers and start physical therapy.

      Recovery might be longer in patients that have ankle instability associated with high foot arches. In said patients, an additional, simultaneous, procedure to realign the foot is recommended to reduce the risk of the ligaments re-rupturing. Also, if the ankle instability is associated with tendon tears additional tendon repair surgery might be necessary. This won't necessarily affect overall recovery time, although the healing of tendons is usually less predictable than that of ligaments.

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