FAQ 37-2: Global Foot and Ankle Instability: A Multi-Directional Problem
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Editorial
Foot and ankle instability is a multi-directional or “global” clinical problem, that frequently extends beyond isolated lateral ligament insufficiency. This edition of Foot and Ankle Quarterly presents a pattern-based framework for evaluating and treating instability of the lateral ankle, medial ankle, syndesmosis, subtalar joint, midfoot, peroneal tendons and global hindfoot alignment.
Chronic instability should be differentiated into mechanical and functional/neurogenic components, recognizing that ligamentous injury on its own does not independently establish clinically meaningful instability. Comprehensive assessment incorporates patient history, dynamic examination, neurologic sensory examination, weight-bearing radiographs, stress testing when indicated, MRI for soft-tissue and intra-articular pathology, and weight-bearing CT when three-dimensional loaded alignment or subtle instability is suspected. Treatment begins with structural rehabilitation addressing strength, proprioception, balance and neuromuscular control. When surgery is indicated, procedure selection should be guided by the complete instability pattern, tissue quality, patient demands and associated pathology, rather than an isolated MRI finding. The modern goal is not simply to tighten the anterior talofibular ligament, but to restore a stable, functional, three-dimensional foot and ankle while correcting the mechanical and functional/neurological contributors to recurrent instability.
As Guest Editor for this issue, I have brought in experts from across the trauma/sports injury space to provide valuable insights on this pathology, and I would like to also acknowledge and thank my residents, Dr. Empryss Tolliver (PGY-3) and Dr. Ahmad Alforookh (PGY-2) for their research and assistance in preparing our Feature Article.
Narendra Rajnikant Patel, DPM, FACFAS
Description
37-2 In This Issue
- FEATURE ARTICLE: Global Foot and Ankle Instability: More than an ATFL Repair
Narendra Rajnikant Patel, DPM, FACFAS, Empryss Tolliver, DPM, MA and Ahmad Alforookh, DPM - CONDENSATIONS and COMMENTARIES
- Lateral Subtalar Joint Capsuloligamentous Instability: A Review and Proposed Repair Technique
Commentary by Ersta Ferryanto, DPM - Chronic Medial Ankle Instability Medial Drive-Through Sign and Surgical Repair Technique
Commentary by Marque Allen, DPM and WooYoung Chun, DPM - Open Brostrom for Lateral Ligament Stabilization
Commentary by Ersta Ferryanto, DPM - Prospective Observational Study of Midtarsal Joint Sprain: Epidemiological and Ultrasonographic Analysis
Commentary by Narendra Rajnikant Patel, DPM, FACFAS - Functional Instability of the Ankle and the Role of Neuromuscular Control: A Comprehensive Review
Commentary by Lauren L. Schnack, DPM, MS, AACFAS, FACPM - Diagnosis and Treatment of Syndesmotic Unstable Injuries: Where We Are Now and Where We Are Headed
Commentary by Mark J. Mendeszoon, DPM, FACFAS, FACPM - Syndesmosis and Deltoid Ligament Injuries in the Athlete
Commentary by Jeff Dikis, DPM - The Biomechanical Role of the Deltoid Ligament on Ankle Stability: Injury, Repair, and Augmentation
Commentary by Jeff Dikis, DPM - Combined Arthroscopic All-Inside Repair of Lateral and Medial Ankle Ligaments is an Effective Treatment for Rotational Ankle Instability
Commentary by Brian Burgess, DPM, FACFAS and Hozaifa M. Anjum, DPM, AACFAS - The “All-Inside” Arthroscopic Broström Procedure with Additional Suture Anchor Augmentation: A Prospective Study of 45 Consecutive Patients
Commentary by Brian Burgess, DPM, FACFAS and Hozaifa M. Anjum, DPM, AACFAS
- Lateral Subtalar Joint Capsuloligamentous Instability: A Review and Proposed Repair Technique
- AUDIO LECTURE 1: Evaluating Syndesmotic and Deltoid Ankle Injuries
Jeff Dikis, DPM - AUDIO LECTURE 2: Neurogenic Ankle Instability: A New Perspective on Functional Ankle Sprains
Narendra Rajnikant Patel, DPM, FACFAS - CME Questionnaire
