Chronic Ankle Instability (CAI)

Dynamic high-resolution ultrasound imaging has multiple advantages over MRI:

• MRI cannot detect subtle instabilities and ligament injuries that can only be visualized with ultrasound
• Dynamic ultrasound lets us observe deficits in ankle function, strength, balance and proprioception that cannot be identified via MRI or clinical exam
• Ultrasound enables us to compare the injured and non-injured limb in the same session
• Ultrasound helps us distinguish functional vs structural ankle instability

Structural instability typically features damage to ligaments, most often due to a lateral ankle sprain. By contrast, functional instability is often caused by deficits in proprioception (sense of joint position), neuromuscular control (ability of muscles to react quickly), and balance, often stemming from previous ankle sprains.

Differentiating between structural and functional instability is a critical step in developing the most effective treatment protocol – a distinction that most doctors and therapists are unequipped to make, often resulting in unnecessary surgeries that fail to restore ankle stability and function.

Prior to beginning physical therapy, we pretreat your tissues to restore their functional properties, and retrain neuromuscular pathways that have been disrupted by your injury. Even old injuries can be successfully rehabilitated, and persistent compensation patterns can be eliminated. We take into account muscles, connective tissues, fascia, nerves and blood vessels whose functional properties have been altered due to injury.

At NYDNRehab, we never rely on one-size-fits-all treatment protocols that fail to deliver results. Our CAI therapy is not isolated to your ankle – in most cases of CAI, functional biomechanics are altered along the entire lower kinetic chain, requiring corrective measures to restore optimal mobility and performance. Our personalized holistic approach to patient care means you get customized treatment based on your unique patient profile.

Tips for Preventing Ankle Instability

• Include ankle strengthening in your exercise routine. Toe raises with bent and straight knees target key ankle stabilizer muscles, such as the peroneals and tibialis posterior.
• Eccentric loading, where the muscle lengthening phase is emphasized, stretches the Achilles tendon and the plantar fascia, helping to improve ankle range of motion.
• Balancing on an unstable surface like a wobble board can help to improve proprioception while engaging the ankle stabilizers.
• Regular stretching of the calf and Achilles tendon, and the anterior tibialis (shin) especially after intense physical activity, can help to promote recovery and maintain ankle range of motion.
• Seated ankle circles in both directions, along with plantar- and dorsi-flexion, help to promote ankle mobility.
• Liberate your feet from shoes – frequently going barefoot increases proprioception and allows your feet and ankles to move in natural patterns.
• Avoid standing and walking in high heels, which forces your feet and ankles into unnatural positions and shortens your Achilles tendon, reducing ankle range of motion.
• Wear supportive athletic footwear for high-intensity sports and activities that involve running, jumping and cutting.
• Use extreme caution when walking, running or exercising on uneven surfaces, like trails or cobblestones.
• Maintain a healthy body weight to avoid excess stress on the ankle’s supporting structures.