Ankle Lateral Ligament Instability

• May depend on the specific or associated underlying cause
• Pain – in the ankle joint if a cartilage injury is present, synovitis of the joint or impingement
• Swelling
• Recurrent instability
• Difficulty walking on uneven ground, difficulty playing sports
• Clicking or subluxation/dislocation of the peroneal tendons
• Catching within the joint

Symptoms may wax and wane, or worsen. If repetitive, there is risk of fracture, cartilage damage or injury to the peroneal tendons. Eventually ankle joint arthritis may ensue resulting in loss of articular or joint cartilage leading to progressive stiffness/pain/swelling.

• Functional instability – the feeling of the ankle giving way during activity
• Mechanical instability – when patients have excessive ankle motion, more than normal

The ankle is supported both in a dynamic and static fashion:

• Dynamic – via the peroneal longus and brevis tendons
• Static – via the lateral ligament complex:

There are other potential causes or contributing factors which may be related to your symptoms such as tarsal coalition, generalised ligamentous laxity or high arched foot.

• Anterior Talofibular Ligament (ATFL)
  • most commonly injured, weakest
• Calcaneofibular Ligament (CFL)
  • intermediate
• Posterior Talofibular Ligament (PTFL)
  • strongest, rarely injured

• Weight-bearing X-rays are required
• MRI scans may be required

• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Footwear modification
  • lateral heel wedge
  • flared sole
• Activity modification
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
• Physiotherapy
  • strengthening of peroneal tendons
  • proprioception including wobble board and stretches
• Weight loss management
• External lace up ankle brace support or taping

Surgery is considered if symptoms are progressing and function is decreasing after a trial of non-surgical treatment. Sometimes these procedures may be combined with other procedures. Depending on the extent and nature of disease, surgical options may include:

• Arthroscopy of the ankle joint +/- treatment of a cartilage lesion

Occasionally reconstructions will need extra support from a synthetic implant.

• Arthroscopic lateral ligament reconstruction
• Open lateral ligament reconstruction
• Peroneal tendon reconstruction or repair

Occasionally reconstructions will need extra support from a synthetic implant.

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Rerupture
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.