Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

In the updated 2024 medical publication Stat Pearls (1), the problems of lateral ankle instability and the progression to ankle osteoarthritis is observed this way:

“Lateral ankle instability is a complex condition that can, at times, prove difficult to evaluate and treat for general practitioners. The difficulty in evaluation and treatment is due in part to the ankle complex being composed of three joints: talocrural, subtalar, and tibiofibular syndesmosis. All three joints function in conjunction to allow complex motions of the ankle joint. The main contributors to the stability of the ankle joint are the articular surfaces, the ligamentous complex, and the musculature – which allows for the dynamic stabilization of the joints.”

The ligamentous complex – the ligament function

• The anterior talofibular ligament’s (ATFL), primary function is to resist inversion in plantar flexion (your foot bends too far forward or downward will twist to the inside) and to prevent the talus from moving forward or away from the mortise contributing to problems of “widening of the ankle mortise.”
• The primary functions of the calcaneofibular ligament (CFL)  are to resist inversion in neutral and dorsiflexed positions (prevents your foot from bending too far back) and also restrains subtalar inversion (your ankle from rolling over to the outside), which limits talar tilt (the outward roll of the ankle)within the mortise.
• The posterior talofibular ligament is seen as a secondary ligament to support the function of the anterior talofibular ligament and the calcaneofibular ligament.

It is easy to see why then when you walk, your foot turns inwards causing pain, there is pain when walking up and down steps, when driving, if it is your right ankle, you have dull throbbing pain when stepping on gas or brakes. Your weakened ligaments are allowing for your talus to bang against the mortise causing loss of cartilage, pain, and the development of bone spurs.

The various risk factors for the development of bone spurs in the ankle.

A May 2020 paper published in the Orthopaedic Journal of Sports Medicine (2) outlined the various risk factors for the development of bone spurs in the ankle. Among them were injuries to the Anterior talofibular ligament [ATFL] and the calcaneofibular ligament. Injuries to these ligaments were significantly associated with the presence of lateral osteochondral lesions (bone-on-bone situation developing on that side of the ankle). Further patients with BOTH Anterior talofibular ligament [ATFL] injury and calcaneofibular ligament [CFL] injuries were significantly more likely to develop bone spurs than were patients with single-ligament injuries.

A message to take home is that bone spurs develop because of ligament injury. A comprehensive full-ankle approach to treating ligaments may be a valid way to prevent the development of bone spurs. Surgical repair of one ligament, while successful for many, will not be successful for all. At our clinic, we help patients like this with dextrose or platelet injections into the ankle to strengthen and support the ankle ligament complex.

Treating ligaments

Since ligaments do not heal well on their own, ankle instability quickly becomes a chronic, painful condition. It allows for destructive joint motions every time the ankle joint is used, wearing down the cartilage and causing further structural damage.

Our providers understand the need for ankle stability to prevent the long-term damage resulting from ankle instability. We work to restore the ligament integrity and strengthen the joint function. Helping to prevent continued cartilage degeneration through destructive joint motions and allows the ankle a chance to heal.

Other articles

Chronic Ankle Instability Surgery
In the patients we see, they have at some point considered surgical intervention for their chronic ankle instability because they are basically done with treatments that are not effective. The reason they have not jumped right into surgery is because of its risks and the possibility that it will not help. But clearly, surgery does address ligament and tendon problems. These problems can also be addressed in a non-surgical manner.

Our published research

Avascular Necrosis Case Report of Direct Bone Marrow Injections and Prolotherapy Treatment

References

1 Gibboney MD, Dreyer MA. Lateral Ankle Instability. 2023 May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30855803. [Google Scholar]
2 Wang DY, Jiao C, Ao YF, Yu JK, Guo QW, Xie X, Chen LX, Zhao F, Pi YB, Li N, Hu YL. Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients. Orthopaedic Journal of Sports Medicine. 2020 May 26;8(5):2325967120922821. [Google Scholar]