Medial Instability of the Ankle

Abstract

Patients with medial instability of the ankle report a feeling of giving way, especially medially, when walking on uneven ground, downhill, or down stairs; pain at the anteromedial aspect of the ankle; and sometimes pain in the lateral ankle, especially during dorsiflexion of the foot. A history of chronic instability manifested by recurrent injuries with pain, tenderness, and occasionally bruising over the medial and lateral ligaments indicates combined medial and lateral instability that is believed to result in rotational instability of the talus in the ankle mortise. Acute injuries to the medial ankle ligaments (deltoid ligament complex) occur much less frequently than do injuries to the lateral ligaments. Typically, the foot was on the ground when an eversion force caused a valgus stress to the ankle, or an internal rotation force caused a pronation stress to the hindfoot. The injury can also occur in association with a lateral ankle fracture. Conservative treatment, including shoe modifications and orthotics with medial arch support, physiotherapy to strengthen the tibialis posterior muscle, and proprioceptive training, is advised as a first measure. If the symptoms of giving way and medial ankle instability persist, surgical treatment should be considered. Options for surgery include medial ligament repair for acute injuries, lateral ligament reconstruction for rotational instability, and calcaneal lengthening osteotomy for preexisting valgus/pronation deformity.

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