Ankle Instability Treatment In New York

Ankle Instability Treatment In New York

Ankle instability is a common condition among athletes, and ankle injuries are the most commonly reported sport-related injuries. Weak and unstable ankles are also common among the general public, with an estimated 2 million sprains occurring in the US each year. Ankle instability is often the primary underlying cause of ankle injuries, and weak ankles should not go ignored.

Ankle Strains vs Sprains

Ankle strains and ankle sprains are often confused, but there are significant differences. An ankle strain is a soft tissue injury to the muscles or tendons. It often occurs when a stretched muscle suddenly contracts, frequently during running or jumping.

Ankle Strains vs Sprains

Symptoms of ankle strain include:

  • pain
  • muscle spasms
  • weakness
  • reduced range of motion.

Chronic strains due to excessive stress or overuse may result in tendinitis, a painful tendon condition caused by inflammation.

An ankle sprain is an injury to the ligaments that support the foot and ankle. It often results from a fall or a traumatic blow that throws the ankle out of a lignment. Foot and ankle alignment is essential for transmitting body weight and ground reaction forces through the foot and ankle region. When the foot turns inward, the ankle ligaments are forced to support the entire body weight. Ligament injuries also occur when the athlete pivots on a loaded foot.

ankle sprain is an injury to the ligaments

There are three basic types of ankle sprains:

  • Inversion ankle sprains affect the lateral ligaments on the outer side of the ankle that protect it from excessive inversion (rolling outward). Inversion sprains are considered the most common type of lower extremity injury. The complex architecture of the feet and ankles and the small size of the lateral ligaments, along with the fact that they are not as strong as the ligaments on the inner ankle, make them more vulnerable to injury. Inversion sprains are much more common than eversion sprains.
  • Eversion ankle sprains, also called medial or deltoid sprains, affect the four separate ligaments that make up the deltoid group: the anterior tibiotalar, tibiocalcaneal, posterior tibiotalar, and tibionavicular ligaments. Eversion sprains are much less common than inversion sprains because the deltoid ligaments are stronger than the lateral ankle ligaments, and because the fibula extends farther than the tibia, blocking the foot from moving to that side during eversion.
  • High ankle sprains involve the syndesmotic ligaments that bind the tibia and fibula together near the ankle. Syndesmotic ligaments include the anterior inferior tibiofibular ligament, the distal posterior tibiofibular ligament, interosseous ligament, and the interosseous membrane. High ankle sprains often occur in sports played on turf with cleated shoes, where the cleats immobilize the foot as the athlete turns with forward momentum. High ankle sprain treatment typically lasts longer than lateral sprain treatment because the syndesmosis is subjected to higher pressures. The period of recovery for high ankle sprains may be twice as long as for lateral sprain treatment.
There are three basic types of ankle sprains

Ignoring a serious ankle sprain may lead to multiple kinematic alterations along your entire kinetic chain, along with loss of balance and proprioception. A bad sprain can eventually result in ankle osteoarthritis.

Get Your Ankle Checked by an Ankle Specialist in NYC

The ankle specialists at NYDNRehab will use high resolution diagnostic ultrasonography and motion analysis to identify which ankle ligaments are injured, and the extent of damage. Motion analysis testing is necessary to assess the degree of your sensory-motor deficit so that appropriate ankle rehab is administered.

Motion Analysis Testing at NYDNRehab

We use the most sophisticated technologies and evidence-based testing modalities to analyze the effects of your ankle injury on movement patterns:

  • DLEST (dynamic lower extremity test on C.A.R.E.N. using perturbation and 3D motion analysis
  • Ankle SEBT (star excursion banner test) with 3D motion analysis on C.A.R.E.N.
  • 3D walking and/or running gait analysis
  • Pressure and ground reaction forces analysis using an instrumented treadmill
  • Assessment of walking and running spatiotemporal parameters
  • 3D hopping and jumping analysis
  • Ankle proprioception evaluation
  • Neuromotor testing with DDRobotech for proprioception, tracking ability, force sense, critical power, reactive power and flexibility
  • Myolux proprioception and foot and ankle muscle eccentric strength testing

Treatment of Ankle Instability at NYDNRehab

At NYDNRehab we use several advanced methods to treat ankle strain, sprain and instability. Technological gait analysis allows us to analyze all different vectors of the patient’s motion to look for irregularities.

Here’s how it works:

Markers are attached at key locations throughout your body, and send information to a computer workstation equipped with motion capture software to analyze your gait as you walk on a treadmill in our lab. The resulting data is used to prescribe the best treatment to rehabilitate your ankle injury.

We also use C.A.R.E.N., an immersive virtual-reality environment with a computerized platform and 180-degree hemispherical screen that creates imaginary environments, allowing the patient to perform exercises that would not be possible in a realistic clinical setting.

With over fifteen years of experience in sports and orthopedic injuries, NYDNRehab provides the best treatment for ankle sprains in New York City. For the best physical therapy, chiropractic care and TeleHealth remote services, contact NYDNRehab today.


About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


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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