Chronic ankle instability?

From the Guidelines

For chronic ankle instability, a comprehensive rehabilitation program should be the primary treatment approach, focusing on strengthening exercises, balance and proprioception training, range of motion exercises, bracing, and gradual return to activity, as this approach has been shown to improve muscle strength, proprioception, and joint stability, reducing the risk of future sprains 1. The rehabilitation program should include:

• Strengthening exercises: Focus on the peroneal muscles, calf muscles, and tibialis anterior, performing 3 sets of 15 repetitions, 3-4 times per week.
• Balance and proprioception training: Use a balance board or single-leg stance exercises for 10-15 minutes daily.
• Range of motion exercises: Ankle circles and alphabet tracing with the foot, 2-3 times daily.
• Bracing: Wear an ankle brace during physical activities to provide support and prevent further injury.
• Gradual return to activity: Start with low-impact exercises and progressively increase intensity as strength and stability improve. If conservative treatment fails after 3-6 months, surgical intervention may be considered, such as lateral ligament reconstruction or ankle arthroscopy, as it has been shown to decrease the prevalence of recurrent ankle sprains and improve outcomes in terms of recovery of ankle activity and instability 1. It is essential to note that a large percentage of individuals who sustain a lateral ankle sprain respond well to non-surgical treatment programs, and surgical therapy should be reserved for patients who have chronic instability and have not responded to a comprehensive exercise-based physiotherapy program 1.

From the Research

Definition and Characteristics of Chronic Ankle Instability

• Chronic ankle instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations 2.
• CAI is often a consequence of lateral ankle sprains or ligamentous injuries, and can be described as a failure of the lateral ankle joint complex after an acute or recurring ankle injury 3.
• Individuals with CAI typically exhibit diminished range of motion, decreased strength, impaired neuromuscular control, and altered functional movement patterns 4.

Rehabilitation and Treatment Options

• Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address the deficits associated with CAI 2.
• A combination of balance and strength training is recommended for optimal recovery, with personalized programs incorporating various methods 2.
• Minimally invasive treatments, such as arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies, have shown improving functionality, recovery, and patient satisfaction 3.
• Core stability training on stable and unstable surfaces has been shown to improve ankle muscular strength, proprioception, and dorsiflexion range of motion in athletes with CAI 5.

Effectiveness of Different Rehabilitation Interventions

• A review of 11 randomized controlled trials found that all rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores, with no single intervention consistently superior 2.
• Single-limb balance training for the non-affected side has been shown to be effective in improving postural control of the affected side in patients with CAI, with significant improvements in the Overall Stability Index (OASI), Antero-Posterior Stability Index (APSI), and Medio-Lateral Stability Index (MLSI) 6.
• Traditional balance training, strength exercises, and whole-body vibration have all provided meaningful functional gains in individuals with CAI 2.