Physical Therapy To Address Chronic Ankle Sprains And Associated Ankle Instability

Proprioception, Balance and Coordination Training to Address the Unstable Ankle

Anatomy of the Ankle:

​The main ankle joints are the talocrural joint, the subtalar joint, and the high ankle. The talocrural joint is where the lower leg bones, the tibia and fibula, meet the top of the foot, the talus. The talocrural joint allows for pointing and flexing the ankle. The subtalar joint is below the talocrural joint and it is made of the talus and the heel bone, the calcaneus, allowing for tilting of the ankle from side to side.

The high ankle is where the tibia and fibula meet right above the talocrural joint. These different articulations allow for our ankles to move through multiple planes of motion and adjust to varied surfaces. There are ligaments that attach from bone to bone within the foot/ankle that help provide stability to the joints. The lateral or outside edge of the ankle is stabilized by the anterior and posterior talofibular ligaments and the calcaneofibular ligament, while the

Chronic Ankle Sprains Leading to Instability:

The most common ankle sprain involves “rolling the ankle” with the foot in a plantar flexed and inverted position. With this mechanism of injury, the anrtero-lateral ligaments are likely to be sprained or in worst cases, ruptured. Research has shown that following an ankle sprain, there is some inhibition or “quieting” of the signal that helps fire muscles both locally at the ankle/foot and up the chain at the hip girdle. This creates a relative weakness on the injured side and increases the likelihood for re-injury. Those who continue to “roll” their ankles are now increasing the mobility at the

Keeping this in mind, an untreated ankle sprain can cause more problems later on if the neuromuscular system is not rehabilitated properly before returning to activity.

Treatment for Chronic Ankle Instability: 

• Static and dynamic balance activities in weight-bearing positions on varying surfaces (flat ground, foam pads, balance discs, rocker or wobble boards) to re-train the neuromuscular system

• Agility and coordination training using ladder, dot, and/or square drills

• Lower body strength and stability training, focusing on hip strength in addition to lower leg strength (ankle strengthening in 4 directions with a resistance band or pulley, squats, lunges, lateral band walks, monster walks)