Ankle and foot: Chronic instability

Ankle sprain is a common sports-related injury that predominantly occurs in skeletally mature patients with a lower incidence in children and adolescents. Recurrence of acute twisting episodes may lead to chronic ankle instability, which is distinguished into mechanical and functional. Mechanical ankle instability (MAI) is characterized by an abnormal ankle mobility, assessed clinically using manual stress application via the anterior drawer and the talar tilt tests. Functional ankle instability (FAI) was firstly described as a subjective feeling of the ankle giving way during either physical activity or during common activities of daily living. More than 80 different surgical procedures have been described in literature for managing chronic ankle instability. Anatomic reconstruction should be the primary choice for the surgical treatment of chronic ankle instability in young patient and more widely in athletes. Some studies are available addressing non-anatomic reconstruction in youngers and reporting satisfactory results, even if the need of bony tunnels in a growing epiphysis, alteration in ankle biomechanics and the high frequency of restricted subtalar motion are major drawbacks of non-anatomic reconstruction.