Do your ankles seem to have a mind of their own sometimes? Do you trip easier than you should when walking on trails or uneven ground? If so, there is a chance that you have a condition known as chronic ligamentous instability of the ankle.

Ligaments are the tissues that attach bones to each other. It may help to picture them like a dock-line on a boat; they keep the bones from drifting too far apart. The tightness of the ligaments determines how well the bones are held together. Just like muscles, the tautness of the tissue is determined by both genetic and environmental factors. If you’ve always been “double-jointed,” chances are that your ligaments are on the more-stretchy end of the spectrum.

Other factors can contribute to instability. If you have normal tautness in your ligaments but have had multiple ankle sprains, the ligaments can become permanently stretched out. Unfortunately, they do not return to their normal length. Think of them like taffy as opposed to rubber bands; once they’re stretched, they stay that way. So, a few bad sprains at 16 years old can affect stability into the 40s and beyond.

The good news is that there are things you can do to reduce your chances of falling or re-injuring the ankle:

  • Footwear — shoes that fit well are obvious, but you should also consider the stability built into the shoe. Very-flexible shoes or sandals might not be a great idea if you’ll be walking a trail or on the beach.
  • Exercise — The stability of a joint can be greatly influenced by two things: strong muscles and good reaction time (called proprioception). Fortunately, both of these can be improved with the right kind of exercises. Improvement can be maintained with just a few minutes of exercise each day.
  • Braces — There are a few types of ankle brace that can be helpful, but physical therapists usually don’t like patients to rely on them. While we prefer patients to avoid wearing them all day every day, pulling one on for a beach volleyball game is smart prevention.

If all else fails and significant instability interferes with function, there are surgical options. To learn about the surgical possibilities for a chronically unstable ankle, we spoke with Dr. Scott Nemec, DO from Bay Street Orthopedics. Dr. Nemec is a general orthopedic surgeon who specializes in foot and ankle pathologies. He treats patients in Petoskey, Charlevoix and Cheboygan.

1. When should surgical intervention be considered for a patient with chronic ankle instability?

Surgery should be considered when non-surgical methods of treatment have failed (physical therapy, bracing etc.). Instability that limits a person’s ability to perform the activities they want to perform is the indication for surgical intervention.

2. What are some factors that can influence surgical outcome?

Overall general health condition is very import for successfully recovering from ankle surgery, or any surgery for that matter. Smoking is also horribly detrimental to successful recovery. Following your surgeon’s recommendations as well as post-operative protocol is very important to have a good outcome.

3. What are some risks of not getting surgery when it has been recommended by a specialist?

The major risks of not following through with surgical correction are recurrent injury resulting in accelerated wear on the ankle. This can result in early onset arthritis and decreased ability to perform activities.

4. In general, what is the typical recovery time to return to sports or full work duties?

The goal of ankle reconstruction for instability is to return to a level for work/athletic performance around four months or so. This varies patient to patient, but a general goal is return to play at four months. Bracing is usually utilized for up to a year for protection.