Exploring ankle instability: part 2

Written by: Mr Hisham Shalaby
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 second article of a two-part series, renowned consultant orthopaedic surgeon Mr Hisham Shalaby discusses how to strengthen the ankle, and when to consider seeking medical treatment for the condition.  



How can I strengthen my ankles and improve stability to prevent injuries?


Maintaining good muscle strength and staying active are crucial factors in preventing injuries to any joint. Additionally, managing weight is essential for joint health. Another specific consideration is the prevention of excessively tight calf muscles.


The tightness of the calf muscles places undue pressure on the ankle joint and increases the likelihood of injuries. Fortunately, various exercises can be employed to strengthen the muscles surrounding the ankle joint. Physiotherapy is instrumental in guiding patients through exercises, often incorporating therabands, to enhance tendon strength around the ankle. Balance exercises and proprioceptive training are also recommended, as they contribute to overall joint stability.


These exercises collectively play a significant role in improving and maintaining joint stability, reducing the risk of injuries.


Are there specific exercises or physical therapy routines recommended for ankle stability?


In Scotland, in collaboration with our physiotherapy colleagues, we have developed a national protocol for the rehabilitation of lateral, ligament injuries. These are the most common ligament injuries of the ankle.


This protocol involves core muscle strengthening, gait training, calf stretching exercises, range of movement exercises, and targeted strengthening routines for both the inner tendons, specifically the tibialis posterior, and the outer tendons, namely the peroneal tendons. The progression extends to include proprioceptive exercises, focusing on balance enhancement. There are also different protocols for the rehabilitation following surgery to repair ankle ligaments.


Additionally, distinct protocols have been established for rehabilitation post-surgery, particularly for cases involving the repair of ankle ligaments.


When should I consider seeking medical evaluation or treatment for chronic ankle instability?


If, following an ankle injury, conservative measures such as rest and physiotherapy prove ineffective, and the ankle remains weak or prone to giving way, or notably, pain on the outer aspect of the joint and a lack of trust in the ankle's stability, leading to feelings of insecurity or the perception that the ankle may give way, these are the main indicators that you should seek medical attention.


If you have sustained an injury to the ankle, and after conservative treatment with rest and physiotherapy, the ankle remains weak or is prone to giving way, leading to feelings of insecurity or the perception that the ankle may give way you should seek medical attention.


Some people may resort to strapping their ankle during physical activities or sports due to a perceived lack of trust in the joint. If any of these symptoms are present, it is advisable to consult a foot and ankle specialist with expertise in sports injuries, as these signs may signify ankle instability.


Unfortunately, an unstable ankle poses the risk of further injury and cumulative damage, potentially leading to secondary arthritis in the joint. Surgical intervention to repair ankle ligaments emerges as a highly rewarding orthopaedic procedure, promptly restoring joint stability and averting cumulative damage and secondary arthritis.


In cases where a young, fit, and healthy patient experiences ongoing pain or an inability to trust their ankle, surgery is strongly recommended.





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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