Dr. Allan Horowitz, published newspaper article, Richmond Hill Liberal, Copyright November 22, 1989

Dear Dr. Horowitz:

            I have an ankle that I wish I could replace. I sprained it when I was 15, and since then (20 years) I have sprained it another 10 times at least. The last time was last night while playing indoor tennis. I moved to retrieve a backhand shot when my ankle just buckled under me and I fell and almost broke my neck. Is there anything that can be done fore this dumb ankle or am I doomed to a life of ankle trouble?

I.S. Richmond Hill

Dear I.S.:

            What you describe is an ankle whose ligaments are not tight enough to hold the bones together when you place a bit of stress on your ankle.

If you have been reading this column over the past six years, you should know by now that the ligaments are what hold our bones together. The reason our bones move is because the muscles pull them. But the reason they move in a particular direction, and only that direction, is because surrounding each joint is a series of ligaments which stabilize and support that joint.

If these ligaments become loose or weak, through injury, joint disease or repeated overuse, then the joint will no longer be stable. Pain will result whenever the joint is forced into a position that it shouldn’t really be in, such as what you experience whenever you roll over on your ankle.

In your case the ligaments on the outside part of your ankle were probably stretched when you injured yourself 20 years ago. You probably did not allow these ligaments to heal properly (as my older patients would say: “Who knew about such things back then”). The ligaments were likely still a bit stretched, weak and vulnerable to injury when you injured it again.

Repeated injuries over the years just served the purpose of stretching the ligament out of its normally tight, secure configuration and, therefore, allowed the ankle joint to move to excess. Every time you put the ankle into a position where that ligament normally would hold the joint tight, it didn’t, and the excess movement caused further damage to the surrounding tissues.

At this stage, you can do one of three things. The most dramatic and perhaps the best ultimate solution would be to consult an orthopedic surgeon to see if you are a candidate for surgery. The surgery would involve “tightening up” the ligament to stabilize the ankle, which would ultimately protect your ankle from these repeated sprains. Your doctor or chiropractor could refer you to an orthopedic surgeon who would assess you. Stress x-rays (where your ankle is being stretched while the x-ray is being taken) should first be taken in order to see how much excess movement is actually taking place in the joint. If “the knife” doesn’t appeal to your tastes, you might consider option number two. This involves wearing an ankle brace (preferably of the tight, lace-up variety), whenever you are participating in any activity which might hurt your ankle. This brace might be enough to protect the ligament from further injury, however there is also the possibility that you could re-sprain your ankle just walking down the street or getting out of bed in the morning. You would not have your brace on at these times.

If you do injure your ankle you should have prompt treatment directed at relieving the ankle inflammation and stabilizing the ankle ligaments. Most chiropractors have the necessary equipment to do this for you.

The third option would be to strengthen the muscles around the ankle. This increased muscle strength would serve the purpose of supporting the ankle and, therefore, would take a bit of stress off the weakened ligaments. There is a technique which I have discussed many times in my column which involves muscles strengthening by way of electrical stimulation. This might work with an ankle like yours and it might not. Personally, I have had more success with children and teenagers than with adults, but it does work sometimes with adults as well. If this technique is tried, you should still wear the brace on your ankle whenever you are active.

If you have really sprained your ankle that many times, you should consider consulting a surgeon. If you are dead set against this, then consider one of the other options.