QUESTION
About a year ago, I noticed that my right ankle feels like it might give out when I walk down stairs. I didn’t injure it. Does this just mean I’m getting older?
ANSWER
Actually, your age may—or may not—be the primary cause. Based on your description, you could have chronic ankle instability (CAI), a common condition that can develop after sustaining an ankle sprain. In fact, about 40% of people who suffer an ankle sprain develop CAI. Years after the injury, some of the symptoms of the original sprain never go away, and the person reports feeling like his/her ankle will give out or easily roll over. In many cases, however, so much time has passed that people do not attribute their unstable ankle to an injury that originally occurred years or even decades ago. Other ankle symptoms may include cyclic swelling and pain. CAI can affect a person of any age.
Here’s where it gets tricky. Ankle instability also can occur in people who haven’t been injured—and this is where age does play a significant role. From a technical standpoint, the term “CAI” is often reserved for individuals who sustained an earlier ankle sprain. However, it is possible to develop unstable ankles without a primary injury. Here’s why: As we grow older, there’s a natural decline in our body’s muscle and tendon function, as well as our neuromuscular control (the interworking between our nerves and muscles to provide joint stability during movement). When these age-related changes take hold, prolonged use of the joint, which occurs while we are walking or standing, for example, can cause our ankles to feel unstable. Because our muscles weaken and neural responses tend to slow down as we age, our neuromuscular control becomes less efficient, which can contribute to our joints becoming more susceptible to instability, injury and “wear-and-tear” osteoarthritis.
The good news is that simple exercises can help you maintain and even improve your joint health by combatting the natural decline in muscular and neural function. A few minutes a day of strength and balance exercises can go a long way to keeping ankle joints healthy. The exercises below are intended to be done barefoot, but if you prefer to wear shoes they will still be beneficial. They should be done on both sides of the body and can be performed daily, doing the strength and balance exercises on alternating days.
What to do: To strengthen the muscles that support your ankles, start by performing heel-toe raises. To do this, stand on one foot and roll backward from heel to toes, then reverse and roll from your toes to heel. Be sure to stand next to something sturdy if your not sure of your balance…or perform the exercise while standing on two feet. Repeat three sets of 10 to 15 repetitions three to four times a week. Next, walk on all areas of both feet. First, walk a few feet just on your heels…then the insides of your feet…the outsides of your feet…and finally on your toes. Once you feel your muscles burning and getting tired, try to take three to five more steps and then change the position of your feet to work a new muscle group.
Balance exercises, such as standing on one leg, also have been shown to improve neuromuscular control. To make this exercise a bit more challenging, close your eyes or place a pillow underneath your foot…or do both. If any of these exercises start to become painful, stop immediately and try again another time. Important: The exercises described above are safe and often recommended during the rehabilitation process after joint surgery. However, it’s essential to have something nearby to brace yourself to prevent falling. if you have a balance disorder, discuss these exercises with a physician before doing them unsupervised.
If you still feel wobbly, a lace-up ankle brace (such as the ASO Ankle brace) will provide support and help keep your ankle from turning. This ankle brace can be worn during activities that make your ankle feel unstable. And if your ankle is painful or swollen, a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin) or naproxen (Aleve), can provide relief. Note: If you do not want to take an oral NSAID, icing the ankle for 15 minutes can also help relieve the pain.
If these measures don’t adequately improve your symptoms or the instability in your ankle worsens, consult a foot and ankle surgeon, who can X-ray your ankle and make recommendations, which could include physical therapy or even surgery to repair ligaments. To find a foot and ankle surgeon near you, consult the American Orthopaedic Foot & Ankle Society (click on “Find a Surgeon”).
