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Ankle Instability as a Global Concept.

Jordi Vega1, Nasef Mohamed N Abdelatif2, Matteo Guelfi3

  • 1Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain; MIFAS by GRECMIP, Merignac, France; Foot and Ankle Unit, iMove, Barcelona, Olympia, Madrid, Spain.

Foot and Ankle Clinics
|October 18, 2025
PubMed
Summary

Ankle sprains can cause chronic ankle instability and secondary issues, even without obvious symptoms. Early clinical examination and management of instability are key before treating other changes.

Keywords:
Ankle instabilityAnkle painAnkle sprainAnterior talofibular ligamentChondral lesionImpingement syndromeOsteophyte

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Biomechanics

Background:

  • Ankle sprains frequently impact the anterior talofibular ligament, triggering biomechanical changes known as the "domino effect."
  • Chronic ankle instability can result in intra-articular and extra-articular alterations, potentially causing symptoms even without overt instability.
  • Clinical examination is vital as standard imaging may not detect all ligament injuries.

Purpose of the Study:

  • To emphasize the importance of accurate clinical examination in diagnosing ankle sprains and associated instability.
  • To highlight the sequence of biomechanical changes following ankle sprains.
  • To guide the management of chronic ankle instability and secondary alterations.

Main Methods:

  • Clinical assessment of ankle sprains and instability.
  • Review of biomechanical consequences of ligament injuries.
  • Analysis of diagnostic imaging limitations for ankle ligament injuries.

Main Results:

  • The superior fascicle of the anterior talofibular ligament is commonly injured in ankle sprains.
  • A cascade of biomechanical changes, the "domino effect," can occur.
  • Secondary alterations may become symptomatic, irrespective of overt instability.
  • Clinical examination is superior to standard imaging for detecting ligament injuries.

Conclusions:

  • Accurate clinical evaluation is paramount for diagnosing ankle injuries and instability.
  • Management of the primary ankle instability should precede treatment of secondary changes.
  • Most secondary muscle-tendon issues and some impingements resolve with ankle stabilization, often avoiding surgery.