It is often thought that a single will never become stable again after the spraying. However, this does not necessarily have to be the case. After spraining the ankle, it can even recover better and become more stable than before the sprain. If, after the first acute phase, there are still movement limitations or exercise options that are too wide, it is therefore advisable to consult the physiotherapist for examination or treatment.
-When stability does not return, there is always a reason for it.
when a muscle in the vicinity of the joint is too tight or too short.
at an incorrect moment of muscle tension (timing), allowing too much movement in the joint.
if the coordination of your movements is not optimal. This can be a neurological problem (reduced guiding speed of the nerve), but also stress and fatigue can result in reduced coordination.
another joint in the chain of movements does not move well. The sprain is then a logical consequence of compensation for the limitation.
A thorough investigation indicates where there are disruptions in your movement chain. The physical therapist will make limited joint movements smooth again and teach you how to stabilize enlarged movements. After an ankle sprain, the therapist will not only examine your ankle, but also pay attention to your foot joints, knee, hip, pelvis and back. For example, it is very common that the fibula has become less agile after spraining. It is important for a quick recovery to restore the normal pattern of movement as quickly as possible. This way you also prevent the joint from spraying again.
Ankle distortions are the most common injuries during sports activities. Most sprains completely recover without surgical treatment. In 20 to 30% of the cases, permanent instability complaints can occur.In case of a distortion of the ankle, the ligaments are damaged to a greater or lesser extent. Usually this is the anterior talofibular ligament. With the heavier sprains, the healing process can take 3 to 6 months. If persistent instability complaints or repeated distortions occur afterwards, we speak of chronic ankle instability.Classically, a distinction is made between mechanical and functional instability. With mechanical instability, the ligaments are too weak to prevent sprains. Functional instability arises from a reduced neuromuscular function after sprains. Both types of instability often occur together. The presence or absence of instability complaints is strongly influenced by the activities of the patient. Patients who exercise certain burdensome work or sport activities risk having more trouble.
-If you have teased your ankle more than once, it is advisable to consult a physiotherapist!
How can you prevent a sprained ankle in the future? You can take some precautions. Wear well-fitting shoes in the first place. You can train your lower leg muscles. And there is the possibility to wear tape or (even better) a brace when resuming mainly risky sports, such as indoor and contact sports. Limit their use, for example, to competitions. It is not advisable to always use a brace (or tape) during training and exercise because your ankle will get used to it and will not provide sufficient support.
The physical therapist has direct access, which means that no referral from the general practitioner is required to make an appointment. Paul Klaver Groepspraktijk for physiotherapy has extensive opening hours and no waiting list, so you can quickly work on your recovery.
The instability may result from a lack of good neurological reflexes or as a result of an excessive laxity of the ligaments around the ankle.
People with a neutral axis of the hindfoot, the standing out of the ankle (‘varus’), hollow feet or general laxity have an important risk of developing ankle instability. Muscle weakness and neurological abnormalities can also lead to instability.
Certain groups of patients, for example athletes or workers, perform risk activities that increase the likelihood of single distortions. This group of ‘high demand’ patients will be more likely to ask for medical advice in connection with ankle instability.
Important measures to prevent and treat chronic ankle instability are wearing footwear with a firm heel piece, good physiotherapy (strengthening the muscles on the outside of the ankle, training neurological reflexes and improving mobility) and possibly adapted orthotics.
If these treatments are insufficient and the symptoms persist, it may be necessary to undergo a surgical procedure. There are a large number of procedures to strengthen the stability of the ankle. The type of surgery depends on a number of patient-specific (profession, sport, …), any previous procedures, medical history, clinical and radiological factors.
A first surgical option consists of directly attaching and strengthening the torn or laxable outer ligaments. This usually uses a bone anchor to attract the ligaments and to attach them to the bone.
A second important operation is the complete reconstruction of the ligaments with a tendon, which we obtain at the level of the knee (gracilis tendon). This is attached to the outside of the ankle via drill tunnels and anchors, so that the stability of the ankle is regained while maintaining good mobility.
The treatment is usually non-surgical. A correction of the risk factors (shoes, insoles, activities) is necessary where possible. An ankle brace can be useful in risk activities. Physiotherapy can certainly help to improve neuromuscular control and muscle strength.
If no improvement occurs, a surgical approach is indicated. Here we can consider strengthening the weaker ligaments. Often this is insufficient and the ankle ligaments have to be reconstructed. This is best done in an anatomical way with a tendon effect. The use of peroneal tendons is rather discouraged as this is an important stabilizer of the ankle joint. We therefore prefer to use a gracilis tendon (which has long been used for cruciate reconstruction).
The results of such an anatomical reconstruction using the gracilis tendon are very good to excellent. We are currently working with various centers to develop an arthroscopic technique for this procedure. In addition, a viewing operation also makes sense to establish intra-articular lesions and to remove disruptive scar tissue.
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After the procedure, the patients receive a gypsum sling for 2 weeks on which they are not allowed to support. 2 weeks after the operation, patients receive a control appointment for control. The sutures are removed here. From this moment the patient may start supporting, albeit with the help of a protective brace or walking boat. There will also be started with mobilization exercises under the supervisiFinally,the Best Chronic Ankle Laxity and Ankle Instability Treatments.on of a physiotherapist. After 6 weeks, rehabilitation can be continued with strength exercises and proprioception exercises. Provided a proper course of rehabilitation, sport can be resumed after an average of 3-4 months.