Exploring ankle instability: part 1

Written by: Mr Hisham Shalaby
Published: | Updated: 17/05/2024
Edited by: Aoife Maguire

Participating in sport can put a huge strain on our bodies, particularly on the ankles, leading to ankle instability. In the first article of a two-part series, renowned consultant orthopaedic surgeon Mr Hisham Shalaby discusses ankle stability, and what factors can contribute to its instability.

 

 

What is ankle stability, and why is it important for overall joint health?

 

The ankle joint is a very stable and congruent joint, that exhibits exceptional stability and congruence, primarily due to bony architecture, encompassing the shape of the bones and the way that the talus fits within the ankle mortis. This structural integrity establishes a foundation for remarkable joint stability.

 

Additionally, the ligaments play a pivotal role in maintaining stability. The ankle is surrounded by ligaments on the medial, or inside, and lateral, or the outside, aspects of, the joint. They are robust ligaments that contribute significantly to keeping the joint stable.

 

Positioned on both the medial (inside) and lateral (outside) aspects of the joint, these robust ligaments significantly contribute to upholding the joint's stability.

 

A third crucial factor involves dynamic stabilisers, which are the tendons surrounding the ankle joint. As these tendons connect muscles to bones, their strength directly enhances the overall stability of the joint. In essence, a combination of bony architecture, ligaments, and dynamic stabilisers work to ensure the ankle joint remains steadfast and secure.

 

In terms of why stability is important, stability holds significant importance for any joint, particularly for the ankle joint. Stability results in conformity of the joint surface, facilitating seamless movement and, consequently, reducing the likelihood of wear and tear in the joint.

 

When the joint is stable, the chances of sustaining another injury decrease. The most important aspect of joint stability is preventing cumulative damage to the joint. This raises the question: what are the main factors that can lead to ankle instability? Ankle instability typically occurs after an initial injury to the joint that has been managed. The most common injuries are sprains, when a person goes over their ankle or rolls their ankle. After a sprain, individuals usually experience pain, swelling, and bruising.

 

Depending on the severity of the ankle sprain, proper treatment is essential. For example, a significant injury resulting in soreness, swelling, and bruising requires appropriate treatment. Ideally, the patient should go to A&E or a minor injuries unit for assessment with x-rays to rule out fractures.

 

Subsequently, patients should undergo a period of rest or immobilisation in a boot. This allows the joint to rest, reduces swelling and pain, and prevents tightness of the calf muscles. Moreover, it facilitates the healing of ligament injuries. Following this, patients should engage in a rehabilitation program with a physiotherapist.

 

This is how ankle injuries should be initially managed. Poor management, such as inadequate immobilisation and lack of rehabilitation after a significant injury, can lead to joint instability and the joint giving way, accompanied by persistent pain. Pain usually occurs when tendons around the ankle overwork to compensate for the instability.

 

What are the main factors that can lead to ankle instability?

 

Ankle instability invariably occurs after an initial injury to the joint that has been managed. The most common injuries involve sprains, where individuals either go over their ankle or roll it, resulting in pain, swelling, and bruising. Proper treatment is crucial, especially for significant ankle sprains characterised by soreness, swelling, and bruising. Ideally, patients should seek assessment in A&E or a minor injuries unit with x-rays to rule out fractures.

 

Following assessment, patients should undergo a period of rest or immobilisation in a boot. This facilitates joint rest, reduces swelling and pain, and prevents tightness in the calf muscles. It also supports the healing of ligament injuries. Subsequently, patients should engage in a rehabilitation programme with a physiotherapist.

 

This comprehensive approach is essential for the initial management of ankle injuries. Poor management, such as insufficient immobilisation and a lack of physiotherapy rehabilitation after a significant injury, can lead to joint instability and persistent pain. The joint becomes prone to giving way when tendons compensate for instability, emphasising the importance of proper care for long-term ankle health.

 

 

 

 

If you are suffering from ankle instability and would like to book a consultation with Mr Shalaby, do not hesitate to do so by visiting his Top Doctors profile today

By Mr Hisham Shalaby
Orthopaedic surgery

Mr Hisham Shalaby is a respected consultant orthopaedic surgeon based in Edinburgh, who specialises in foot, ankle and limb reconstruction surgery. His expertise in this area covers arthroscopy and sports injuries alongside foot pain, ankle instability and deformity correction. He privately practises at Spire Murrayfield Hospital, Spire Shawfield Park Hospital and Nuffield Health's The Edinburgh Clinic. Furthermore, he is a consultant foot and ankle and limb reconstruction surgeon for NHS Lothian.

Mr Shalaby has an impressive education and has had esteemed training. He has an MBBS from Ain Shams University in Cairo, Egypt, and went on to develop his specialist skills at a major orthopaedic unit in the city as well as ones in Edinburgh and Liverpool. He also has an MD based on his thesis "Correction of Complex Foot & Ankle Deformities", completed an advanced deformity correction fellowship in Liverpool and a trauma fellowship in Nottingham. In addition, Mr Shalaby was awarded for his work done on the Amsterdam Ankle Arthroscopy course.

Mr Shalaby prides himself in mastering the full spectrum of foot and ankle pathologies, including the latest techniques including the Scarf/Akin osteotomies for bunion correction, ankle arthroscopy and endoscopic planter fascia release alongside ankle replacement, gradual correction of ankle and foot deformity, ankle joint distraction for early arthritis. He also has a special interest in correction of flat foot and pathological high arch.

Mr Shalaby is also an expert in all limb reconstruction tools including the Ilizarov frame, the Taylor Spatial frame and the Sheffield Hybrid fixator, alongside the Orthofix LRS monolateral fixators and Intramedullary lengthening nails.

He is a respected name in clinical academia; he has had various research papers published in peer-reviewed journals while he is also a reviewer for various international journals. Mr Shalaby is on the faculty of several foot and ankle and limb reconstruction courses around the world, conducted on an annual basis.

Mr Shalaby is also a member of various professional organisations including the Royal College of Surgeons of Edinburgh (FRCS Ed Tr & Orth), British Orthopaedic Association (BOA) and British Orthopaedic Foot & Ankle Society (BOFAS), as well as British Limb Reconstruction Society (BLRS), The World Orthopaedic Organisation (SICOT) and Association for Study & Application of Methods of Ilizarov (ASAMI International).

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