Ankle Instability Treatment In New York

On Wednesday, July 30, 2014, Kansas City Chief Sandy Commings was pulled from the practice field after twisting his ankle during a tackle. He was the second person on the team to suffer an ankle injury that week: right tackle Donald Stephenson had injured his left ankle only two days previously.

High Ankle Sprain

Ankle instability, or weak ankles, is among the most common injuries suffered by athletes, but it’s also exceptionally common in the general population: studies suggest that around 36,000 Americans injure their ankles each day. At New York Dynamic Rehabilitation clinic (NYDNRehab) we offer gait analysis and ankle instability treatments like Computer-Assisted Rehabilitation Environment (C.A.R.E.N) to analyze and rehabilitate injured ankles.

Though ankle strains and ankle sprains are often confused, there are significant differences. An ankle strain is an injury involving the stretching or tearing of a muscle or tendon, occurring when a stretched muscle suddenly contracts. This often happens during running or jumping. Symptoms of ankle strain include pain, spasms, weakness, and limited range of motion. Chronic strains resulting from stress or overuse may result in tendinitis, a condition of tendon inflammation.

An ankle sprain is an injury to a ligament resulting from a fall or a traumatic blow that throws the ankle out of alignment. In most cases the sprain occurs when the ligament supporting the joint becomes over-stretched. This can happen, as in the case of Sandy Commings, when an individual twists his or her knee while the foot remains firmly planted on the ground.

A common ankle sprain is an injury to a ligament on the outside of the ankle, the anterior talofibular ligament, that helps stabilize the ankle. A high ankle sprain, on the other hand, is injury to a set of ligaments located above the ankle, the syndesmosis. The syndesmosis functions as a shock absorber and prevents the bones of the legs from splaying. High ankle sprain typically occurs because of sudden twisting. Pain radiates from the ankle upwards through the leg. In most cases high ankle sprain treatment is similar to common ankle sprain treatment, consisting of rest, recovery, and icing. The major difference between the two injuries is that high ankle sprain treatment typically lasts longer than regular ankle sprain treatment because the syndesmosis is subjected to higher pressures. The period of recovery for high ankle sprain may be twice as long as ordinary treatment for ankle sprain.

At NYDNRehab we use several advanced methods for ankle instability treatment. Technological gait analysis allows us to analyze all the different vectors of a person’s motion in the search for irregularities. A patient walks along a treadmill in our lab. Markers are attached to the body at certain key locations. These markers send information to a computer workstation equipped with motioncapture software that analyzes the gait. Using these findings we’re able to prescribe exactly the kind of treatment needed to rehabilitate injury. We also C.A.R.E.N, an immersive virtual-reality environment with a computerized platform and 180-degree hemispherical screen that creates imaginary environments and allows the patient to perform exercises that would not be possible in a realistic clinical setting. With over fifteen years’ experience in sports and orthopedic injuries, NYDNRehab provides some of the best treatment for ankle sprain in New York City.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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