Conservative management of chronic ankle instability.

TLDR: Conservative management of chronic ankle instability can be a viable option in selected patients and failure of conservative management can be an indication for surgery if morbidity warrants it.

Abstract: The mechanism of injury of lateral ankle sprains is usually a forced inversion injury with the tibiotalar joint in plantar flexion. Up to 20% of lateral ankle sprains progress to functional instability [1]. Inversion injuries of the ankle account for up to 25% of all musculoskeletal injuries [2]. Despite the high incidence, there is still some contention about the optimal method of management. Proposed management modalities include surgical repair/reconstruction, rigid/semirigid casting, bracing, elastic bandaging, strapping, ultrasound, temperature contrast baths, electric current therapy, hyperbaric oxygen, oral anti-inflammatories, oral proteolytic enzymes, and injectable steroids [3]. These options are usually combined with rest, compression, ice, and elevation. Conservative management involves one or more of the above modalities within a program of either strict immobilization or early controlled movement and rehabilitation [3]. This article discusses some of the conservative management modalities described in the literature. Types of instability Two types of ankle instability are described, namely functional and mechanical. Mechanical instability is abnormal laxity of the ligamentous restraints, and is a sign. Functional instability refers to abnormal function, with recurrent episodes of the ankle giving way, and is a symptom. The two types of instability can exist independently of one another, but often occur together. Indeed, a patient can have minimal mechanical instability