Ankle and Subtalar Joint Instability


Article by Dr. Misako McLeod 

Have you ever felt like you ankle is ready to roll at anytime, or your foot feel unstable and you might roll your ankle? Do you roll your ankle  easily and feel like you have a “loose” ankle?

Many patients suffer from a condition called “Ankle instability,” a condition where the ankle joint ligaments are loose due to previous trauma or sprained ankles. Also, the subtalar joint, the joint that lies underneath the ankle joint, can have ligaments that become lax or stretched out due to previous injury.

Most of the time, the feeling of instability can be remedied with a solid and consistent physical therapy to strength the peroneal muscles, the muscles on the outside of the leg, which serve to stabilize the ankle and subtalar joints. Whereas, small ligament tears can sometimes heal over time and a properly made, custom orthotic with a lateral flange can help to support the foot on the side and prevent future inversion type injuries.

However, some patients, even after a trial of physical therapy and proper custom orthotics, still experience pain, instability, and the feeling as if they are going to roll their ankle anytime. These patients often require surgery to stabilize the ankle ligaments.

There are several type of surgical procedures that address ankle joint instability:

The subtalar joint is a bit more complicated in that, there are less procedures for subtalar joint instability at this time. Surgery focuses on fusing the subtalar joint in order to stabilize the subtalar joint under the ankle and leg, and prevent future inversion-type injuries or sprains of the deep ligament of the subtalar joint.

Regardless of the procedure, all patients should receive physical therapy after surgery to retrain and develop the muscles to regain strength, function, coordination, and to prevent future incidents of injury.

Once walking, the patient should be evaluated for any structural issues and biomechanical problems that may have predisposed the patient to sustaining an injury in the first place. At this point, the patient should have a custom made orthotic with a supportive lateral flange to support the side of the foot and to prevent future inversion type injuries.

For the future, patients should be counseled on future athletic activity limitations. That is, non-impact sports such as swimming, bicycling, and other activities that avoid future high-impact injury risk are optimal.

For a consultation with Dr. McLeod to discuss your ankle issues, please call 1-844-442-FOOT (3668).

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