Ankle Instability in young Athletes

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Due to the growing exposure in the field of sports now more than ever, children and adolescent are participating in various sports at earlier ages. There is an increase in the levels of intensity with increasing competition and a need to outperform amongst their peers.

In adolescent athletes due to the rapid growth spurt, the bones grow quicker than the muscle tendon units that could result in the following;

  • Poor muscular Flexibility
  • Alteration in strengths
  • coordination and balance issues

These factors stress the structures involved beyond its limits of its ability to repair. Resulting in repeated overuse injuries. Moreover, due to incoordination and disbalance can lead to frequent falls. Malalignment, inadequate conditioning, and improper techniques leads to acute trauma and overuse injuries. These are two common mechanisms of foot and ankle disorders in the young athletes.

The patient presents with repeated episodes of giving-away on uneven terrain, or a feeling of looseness, the patient feels the need to be conscious during specific activities with a fear of re-injury thereby exuding lack of confidence while playing their sport. A general drop in performance is noticed making ankle instabilities as a biggest setback in their sporting career. Pain is also a complaint but not necessarily a primary concern.

 

So how does one land up with an ankle injury?

Improper jump landings on the outside of the ankle or foot are typically the mechanism of injury. In this position the entire weight of the body is impacted over the lateral aspect of the foot in a plantarflexion and inversion. Commonly injuring the anterior tibiofibular ligament.

An injury like this can lead to both functional and mechanical instability of ankle.

Mechanical Instability: When ligament heal in an elongated position which can lead to plastic deformation, further reducing the ability to provide support to the ankle. Here there is a structural change.

Functional instability: It is when there is an issue with the balance training that is the proprioception of the ankle is affected. Here there is a feeling of instability.

 

What can be done for preventing and treating ankle instabilities?

Immediate conservative management is always the preferred method of treatment.

Simple rest, ice, compression, and elevation may prove to be the best treatment in the acute and initial stage to reduce swelling, pain and protect the tissue.

Post that consulting with a physiotherapist with sound knowledge of sports biomechanics will help to make the correct diagnosis and initiating appropriate treatment.

For severe cases that resist physiotherapy, surgery may be eventually indicated. Surgical outcomes are generally good, leading to decreased pain and increased function.

In any case a close relationship is formed between the patient, the surgeon, the therapist, the coach, and the parent/guardian to gauge the progress of therapy and deem if surgery does become necessary.  While not every patient will need surgery, it is beneficial for all involved to understand the treatment plan.

In conclusion:

The young athlete can be a challenging patient. An understanding of developing/growing foot and ankle, combined with the knowledge of certain sports-specific mechanisms of injury, can be instrumental in making the correct diagnosis and instituting appropriate treatment.

Early diagnosis and intervention can prevent negative sequelae or persistent pain. The focus of rehabilitation should be a return to previous activity levels. Physical therapy is found to be helpful with emphasis on range-of-motion exercise and isometric and isotonic strength-training exercises should be included as part of recovery, a succession of proprioceptive training should be incorporated, followed by sports-specific activities to prepare the athlete to return to competition.

Inclusion of the parent, the coach, the therapist and the surgeon will better help the athlete to retain his sporting career and excel in his sport.