Chronic Lateral Ankle Instability - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 13 гру 2016
- Dr. Ebraheims animated educational video describing the condition of chronic lateral ankle instability
Ankle sprain is a common injury that occurs with sports activities and the lateral ligaments are the most commonly injured ligaments in the ankle.
Three ligaments on the ankle joint on the lateral side:
1- Anterior talofibular ligament: is the weakest ligament of all three of them, the integrity of this ligament is tested by preforming the anterior drawer test.
2- The posterior talofibular ligament: is the strongest of the three ligaments.
3- Calcaneofibular ligament: injury to this ligament usually occurs after injury to the anterior talofibular ligament, the integrity of this ligament is tested by preforming the talar tilt test.
If the patient cannot bear weight after what is suspected ankle sprain, then you need to get an x-ray to check if the patient has a fracture.
Acute ankle sprains are usually treated by:
• Immobilization
• Ice
• Physical therapy
• Surgery (rare)
Sometimes these ligaments do not heal and become incompetent.
Incompetence of these ligaments may create chronic lateral ankle instability.
You may want to examine the hindfoot for varus malalignment.
Occult varus may lead to treatment failure.
Check for peroneal muscles and tendon weakness which is a frequent cause of lateral ankle instability.
If you find that there is hindfoot varus, you may need to do the coleman block test to differentiate between fixed and flexible hindfoot varus.
The treatment will be different.
Treatment:
The majority of ankle sprains will heal with time and are treated with:
• Rest
• Physical therapy
- Peroneal muscle strengthening with proprioception and range of motion of the ankle.
In some cases the patient may not get better and may have:
• Mechanical instability or functional instability
• Patient may not improve with conservative treatment
- Patient may require surgery
What type of surgery may be necessary?
• Anatomic repair (Brostrom procedure).
Direst repair of the attenuated ligament.
OR
• Anatomis repair (Modified Brostrom procedure).
• Direct ligament repair with augmentation using the inferior extensor retinaculum.
• A graft can be used if the Brostrom technique fails.
For chronic lateral ankle instability, we also need to look for other conditions such as peroneal tendon pathology, fractures, joint lesions, or arthritis.
There are a lot of differential diagnosis for this area that can create ankle instability.
These are some of the other causes that can create the same symptoms of pain and instability of the lateral ankle.
When pain is located posterior to the fibula, you can blame this on peroneal tendon pathology.
The peroneal tendons are subjected to excessive repetitive forces causing pain, swelling, and instability of the lateral ankle.
Treated by injection or possibly surgery (synovectomy).
The superior peroneal retinaculum is usually holding two peroneal tendons behind the fibula.
The inferior peroneal retinaculum is not as important as the superior peroneal retinaculum.
Superior peroneal retinaculum tear:
- Tear may lead to subluxation of the peroneal tendons.
- Do physical therapy or reconstruction of the superior peroneal retinaculum.
Peroneal tendon subluxation occurs with dorsiflexion and inversion; however it is tested with dorsiflexion and eversion against resistance.
Peroneus longus or brevis tendon rupture or tear:
- Tear of the peroneus longus tendon may occur at the peroneal tubercle with the Os Peroneum migrationg proximally.
- Tears of the peroneus brevis may occur with peroneal tendon subluxation.
- In these cases you will do repair or tenodesis of the torn tendon.
Lesions inside the joint:
- Osteochondral lesion of the talus (OCD): they are 2 types:
• Posteromedial
• Anterolateral
Treatment:
• NSAIDS
• Physical therapy
• Surgical treatment: ankle arthroscopy.
- If the OCD lesion is less than 1 cm then you will do excision, curettage, or drilling of the lesion.
- Anterolateral Impingement: painful limitation of full range of ankle motion due to asseous (bony) or soft tissue pathology.
- Treatment:
• physical Therapy
• injection
• arthroscopic debridement of the impingment
- ankle synovitis: you do synovectomy.
- Ankle arthritis: ankle arthritis of the ankle joint usually results from prior injury or inflammation to the ankle joint.
- It can be diagnosed by an exam or by an x-ray.
- We start with conservative treatment, brace, injection, if nothing works do arthrodesis or total ankle surgery if conservative treatment fails.
- If there is loose bodies inside the ankle, remove it.
- There may be some fractures that cause instability of the ankle, like lateral process fracture of the talus, anterior process fracture of the calcaneus.
- Jones fracture or Pseudo- Jones fracture.
- The treatment is specific for the type of fracture.
- This needs to be diagnosed and treated accordingly.
- Osteal coalition: may cause frequent ankle instability.
Both my ankles have been injured over 5 times. I’ve torn ligaments 2 times on both side and sprained 4 times in a matter of 6 years. Now, it happens yearly. My left ankle got sprained again last week and god I haven’t gotten physio for my ankles ever. Thank u for this video.
Can you please let me know whether ankle stiffness and pain recover on its own and how much time would it take??
Reason? How's ur condition now?
Tell bro...
The UA-cam algorithm is working well in guiding me towards good ankle videos such as this.
THANK YOU for this video it was informative, and answered a few questions about my own weaken arthritis ankles.🤗
Its so fun when you are just walking and your ankle suddenly gives out, fun times.
Happens to me when i walk cos i have loose ligaments
just i feel the sprain feeling for 2-3 steps then back to normal..
i put ankle support which helps me so it will never happen..but every time i didn’t put it..it will go back to sprain thing
Ahh man, truly fascinating. The best part is, when people around you throw a funny look :v
Your videos are superb. It really gives you an overview in a nutshell!
very helpful video dr. Thank you very much, i feel enlightened.
Thanks.Dr nabil ebraheim
So generally speaking the ankle is a piece of crap. Everything in there can break and tear and cause a lot of pain.
It's basically what you get from overclocking a hand/wrist. I'm surprised they last as long as they do tbh.
I am grateful to watch this video.
You have clearly mentioned all reason and solution for those.
I am a patient so that I can relate what you said.
Very helpful and educative information. Thank you so much.
thanks for this ...
Thank you it did explain a lot and helped me out.
Great video.
Extremely informative.
Thanks for sharing
Great! Please more about foot and ankle
thank you learned a lots
Thank you very much Dr....
Mulțumiri pentru minunatele informații!
Very helpful. Now if only I was blessed enough to meet a Doctor like you with such knowledge. I saw 3 orthopaedic surgeons that gave me 3 completely different opinions. One said surgery asap, one said physical therapy and another said that I need surgery but he can’t operate because my ankle is too tender so I have to learn to just live with it.
I can’t walk more than 30 mins straight without pain and ankle swelling. It is very much limiting my life! :(
I have done physical therapy but guess I will keep trying different physical therapists.
Hi, i have exactly similar issue .
What are you doing for your pain ??
@@JANVI_743 Hi, I take a natural anti-inflammatory, apply voltaren gel (topical anti -inflammatory) brace it with a lace up brace and rest it.
By the end of day it is shot so I am off it by 7pm. Then it feels a bit better in the mornings due to 12 hr rest but by noon, pain again with some swelling.
Physio is frustrating, some tell me not to brace it because I am weakening it while others say to brace it to protect it and allow me to do more.
How about you?
It is to the point now that if I am walking around my house my sock starts sliding over on that foot because I guess I am unconsciously walking more on the side of my foot or over supinating…
Sigh…
@@soul76can hi , i am dealing with my issue in similar manner like you,
Physiotherapy, anti inflammatory tablets, massage, work time(with constant uncomfortable pain) is restricted from morning to evening 6pm after this i need proper rest 🥲
Regular balancing and other exercises are heplful but there is no permanent cure just living with this
how did this happen to you why didn’t you get the orthopedic attention right away how old are you
How is it now?
Thanks very helpful
good useful lecture
You was hell full doctor. Thank you
Thank you so much.
Thank You Doc
Thank you Docter
You are helpful kind sir.. you are.
Yes, you are helpful. Superior Peroneal Retinaculum Tear find only here. Thank you dr. Nabil Ebraheim. :)
Thaks . Dr. Rehem
Thanks doc i succesfully diagnosed my superior peroneal retinaculum tear
Thank You very much for such an informative video, it was extremely helpful!
Thank you for explaining this... it has answered a few of my questions.
I have a lateral malleolus fracture and a bad sprain. I have been in constant pain for 2 weeks, I am looking forward to the end of this.
Hey I'm back...
Thanks Dr
I've been turning my ankles for YEARS now. Nothing has helped except for one thing. I started wearing the most minimal shoes possible. The thinner the sole, the stronger my ankles get and the lower they are to the floor, thus the less I turn them. I'd gone for probably a year and a half or possibly two without turning an ankle. Got a new job and had to start wearing work boots at work and voila, I'm turning my ankles again. So annoying, but at least I know how to somewhat remedy it.
I’ve also had this problem for years. Do you think those shoes with the toes cut out would help at all or have you tried those?
I’m going to try thinner soles as you are recommending. Thanks you
You were. Thank you
Mine is already 8yrs. It happens when I was playing football in my college days. Hopefully this 2021, will be ok for surgery
I completely detached those 3 ligaments on outside of my ankle. Had tendon replacement surgery was so bad Dr almost had to use cadaver tendons. Thank goodness the Dr managed to use my own.
How are you now
How did you manage to do that (cause that much damage to all 3 ligaments)? How are you now?
Dear... Exactly im facing the same problem... Which yu have mentioned in 1st 30secs.. i can move my leg easily.. bt while climbing steps.. nd walking quite normal.. it shakes to-fro as shown in video.. please let me know... Hw i can get it cured..
I hope I just have a low ankle sprain 🙏
... thanks for this video.
Nice
how to perform the tests mentioned at 1.40 ?
اعاني من نفس المشكل يا دكتور ابراهيم عدم استقرار مزمن في الكاحل الايمن مما اثر سلبا على مشيتي ما الحل جزاك الله خيرا
keep up the good work sir
great video. Can you recommend any doctors in the UK?
KINGS has a lot of orthopaedic surgeons
This is very informative. I am currently having having an issue with my ankle. Is there an ankle specialist I can go to? For I know that the family doctor that I go to is not somebody who can diagnose this kind of injury.
some good chiropractors can help. We're doing a therapy of making a tea of Christopher's Complete Tissue herbal formula, saturate a cloth (washcloth or the like) in the tea, wring out, then place around the ankle. cover this in saran wrap to prevent dripping and wear this overnight every night for six months
Thanks exactly I need. Was happen 3 months ago still feel pain.
thanks
How do you feel now , i had my ankle sprain 6 months ago it still pains , and there's a slight deformation in the ankle i dont know what to do ,the MRI showed that all ligaments are intact but I still have sharp pain
I've had what I believe is an anterolateral impingement in my right ankle for 24 years. Every so often, it will suddenly feel like an icepick stabbing into my ankle, just anterior and slightly proximal to the lateral malleolus- it can come on with no specific activity although sometimes dorsiflexing like when running can do it, also if my shoe is tied too tightly it can trigger it. Otherwise, I have zero pain or other symptoms for months. But when it happens, I cannot weight bear or dorsiflex without pain, there may be some feeling of instability, and sometimes I actually can't walk because the pain is so severe. My GP dismissed it as OA but I don't agree- it was instant onset, not insidious, and I can sometimes fix it by doing a posterior fibular mobilization on myself. It was also purple around the area during a bad flare-up one time. And as I say, I can go for months with no pain- running, hiking, dancing , etc, and have never had an injury there that I can recall. My theory is an impingement of possibly the shared tendon sheath of Fib Tertius and EDL, maybe under the extensor retinaculum. X-ray and ultrasound have been negative. I finally saw a podiatrist a week ago who is getting me a bone scan, and if that shows nothing (as I think it will), then an MRI. He also gave me 20% Diclofenac, which does absolutely nothing. My feeling is that it needs an arthroscopy to see what's actually in there but of course I have to convince someone to do it. Really sucks to have such a long-term problem, especially when I am still fairly young and love to be really active.
we’re was this
@@davidortega1324 I'm sorry, I do not understand what you are asking about?
I have had chronic bilateral ankle instability since birth and it is really starting to bother me now because Im falling over all the time and never feel like Im walking normally. As a high school student, I get laughed at a lot because I will 'trip' and get food all over me, I will 'trip' and slide down a flight of stairs, I will 'trip' and drop all of the papers/books for the class and people find it hillarious. Its kind of painful when I fall after my ankles giving way. I tryed phisio and It just made it exctrutiating to walk and I would wake up crying because my legs were cramped and all curled up like a hedgehog.
Hey buddy, I hope you're okay. I understand what you mean because I get cramps in my feet and legs after walking too much. Lots of times in the middle of the night. No one understands how painful and frustrating that is but us. Keep in touch, maybe we can help each other figure this out and get better soon.
how did this happen to you bro i feel bad for you i hope your ok i had broken ancle not much ago so i’m looking around to better help me too
I have a severe case of this, cant walk without my feet bending backwards and folding onto themselves
My right ankle is totally trashed. I know I have stuff torn and floating in there. I sprained my left foot, near my ankle, so that's bad too.
there is one mistake. you said varus of ankle but in the picture was showing the Valgul. Starting from that point till the end of coleman block test is confusing.
Thank you
Por favor subtitulado en español !!!
Sir I am suffering ankle fracture pain since 11/2year i can't walk properly sir please help me sir
I've had this condition for almost twenty years. if I do any jumping or running without ankle brace it hurts the next couple of days... How much in cash can cure this condition? I don't have insurance
I know this has been a year, but I just had a surgery to correct it. Even with insurance it’s still very expensive. Without insurance I would say 10 grand
Prolotherapy, prolozone, or PRP are much less costly options
@@girlygirlygurl100 Did it work though? My ankles are so weak my calf muscles are wasting away and easily cramp in my sleep. It's getting out of control.
@@dillagence2 mine too
@@dillagence2 yes I'm also faced this problem.....
I sprained my ankle 5 times in two months, I sprain my ankle at least 5 times every year.
Pls where is ur office located
Sir mai upka Ankel vedio shake.Amar Ankel akhi problem.khase sujan milage. Please reply mari problem.
no reference?
I had a brostrom surgery and the surgeon left 3 holes in my talus and 1 in the fibula. After surgery I complained of constant pain and was told i was walking funny. Year later MRI showed the 4 holes left from surgery as well as OCL and was told the anchor had been placed in a sensitive area. A year later and next MRI showed breakdown of all cartilage new doc says only option is to fuse. Did the brostrom surgeon cause this arthritis?
I am suffering from ankle sprain for 4 months .
I need surgery on my ATFL
Hlo doctor am filling de same pain in my fibula it's now two months
it took me a year and a half to find the cause of this necrosis
iwant treatmant
I have , necrosis in the middle of the talus. !
Dr. Sometimes the foot will pronate more with an ATFL injury. You didn’t touch I this
I sprain my ankle on Fallen leafs
Vastexec
My shit just folded on an uneven surface in front of school I fkn hate my life
Thanks . I think my ankle became incompetent and created chronic lateral ankle imstability 😏
Joseph Jay Hercules did. U fix it?
@@lolow4646 my foot is fine now. I can run normally.
Joseph Jay Hercules how did u heal it? How long did it take u? I rolled my ankle around 9 weeks ago and re-injured it 6 weeks ago, and Im not sure what is going on w my ankle. I can balance on my injured foot, jog, but still feels uncomfortable and sometimes hurts..
@@lolow4646 i do masage in my ankle. Put warm water in glass bottle then roll it using ur foot. I also apply ice on my foot for about 10-15 minutes. It still hurts after 2 months but i can run. And i also wear socks at night because it hurts coz it's cold and when i wake up every morning it swells.
Joseph Jay Hercules May I ask u how u injured ur ankle?