Ankle instability
A common complaint is that 'my ankle keeps going over'. This can be the consequence of a bad ankle sprain where the ligaments holding the ankle in line are torn and fail to heal with the same tightness they had before. However there are often other factors contributing to the episodes of going over, each of which must be checked for if treatment is to be successful. Physiotherapy plays a major part, especially to train up the subconscious sense of control and balance in the joint (proprioception) since this mechanism becomes weak and slow to react to uneven ground after a bad sprain. Only if the ankle keeps failing after a good intensive programme of physiotherapy treatment should surgical repair of the ligaments be contemplated. Temporary use of a simple ankle brace can be helpful to prevent further injuries while the strength returns. Often a special x-ray is done with the ankle turned in to see if the bones separate to an abnormal degree, thereby demonstrating that the ligaments are indeed lose.
The types of ligament fall in to two categories. The first is to find and repair the original ligaments (modified Brostrom procedure) which were torn. Even months or years after the event this is usually possible and restores the ligament to as close as possible to its orginal state. If this fails, or if for some reason repairing the original ligaments is not possible, use is made of the tendons which run around the outside corner of the ankle (Evans or Crinssman-Snook procedure), fixing them to the bones where the ligaments used to be.
This is a larger scale procedure which necessitates sacrifice of some of the muscle power to achieve a stable reliable ankle. Using tendons also has more potential for over tightening the ankle and repairing the original ligaments. Both types of procedure can however be extremely successful under the right circumstances.
Some feet are built with the ankles already turned in, thus rendering them prone to twisting injuries. This is called a cavo-varus posture and often occurs with a very deep arch and sometimes clawed toes. If an ankle like this begins going over, just repairing the ligaments is sometimes not enough since the pre-disposing abnormal posture persists. Under these circumstances surgery to reshape the heel to reverse the turned in shape is necessary (calcaneal osteotomy).