■ ■ ■ Description

Subtalar instability is the giving way or looseness of the foot just below the ankle. This usually occurs together with ankle instability, although less commonly it may occur by itself.

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■ ■ ■ Common Signs and Symptoms

• Recurrent foot and ankle pain and giving way

• Difficulty running on uneven surfaces, jumping, or cutting (changing directions while running)

• Pain, tenderness, swelling, and bruising at the site of injury

• Weakness or looseness in the ankle joint

• Occasionally, impaired ability to walk soon after injury

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■ ■ ■ Causes

The most common cause of functional instability is incomplete or no rehabilitation of a previous ankle sprain. It may also be caused by stress imposed from either side of the ankle joint that temporarily forces or pries the ankle bone (talus) out of its normal socket. The ligaments that normally hold the joint in place are stretched and torn.

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■ ■ ■ Risk Increases With

• Loose ankle due to previous severe ankle sprain or congenital (you are born with it) joint looseness

• Resumption of activity too soon after previous ankle sprain

• Activities in which the foot may land sideways while running, walking, and jumping (basketball, volleyball, and soccer) or walking or running on uneven or rough surfaces

• Inadequate ankle support with strapping, taping, bracing, or shoes before participation in contact sports

• Poor physical conditioning (strength and flexibility)

• Poor balance skills

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Ankle and leg flexibility

  • Muscle strength and endurance

• Balance training activities

• Use proper technique and have a coach correct improper technique.

• Taping, protective strapping, bracing, or high-top tennis shoes may be worn. Initially, tape is best; however, it loses most of its support function within 10 to 15 minutes.

• Wear proper protective shoes (high-top shoes with taping or bracing is more effective than either alone).

• Provide the ankle with support during sports and practice activities for 12 months following injury.

• Complete rehabilitation after initial injury.

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■ ■ ■ Expected Outcome

• Most athletes regain full functional stability and are able to return to full activity with a rehabilitation program, although occasionally surgery is necessary to restore mechanical stability (reduce the looseness) to the ankle.

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■ ■ ■ Possible Complications

• Frequent recurrence of symptoms; appropriately addressing the problem with rehabilitation decreases frequency of recurrence and optimizes healing time

• Injury to other structures, such as bone, cartilage, or tendon

• Chronically unstable or arthritic ankle joint with repeated sprains

• Complications of surgery, including infection, bleeding, injury to nerves, continued giving way, ankle stiffness, and ankle weakness

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■ ■ ■ General Treatment Conditions

Initial treatment consists of medication and ice to relieve the pain and compressive elastic bandaging and elevation to help reduce swelling and discomfort. A walking cast, walking boot, or brace may be recommended to provide support to the joint in addition to using crutches for varying times, depending on severity of injury. Chronic instability of the subtalar joint usually can be treated by strengthening the muscles of the foot and ankle and bracing. Referral to a physical therapist or athletic trainer for further evaluation and treatment may be recommended. A heel wedge to put in your shoe or taping or bracing of the ankle along with wearing high-top shoes may also be recommended. If symptoms persist after 3 to 6 months of rehabilitation, surgery may be recommended.

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■ ■ ■ Medication

• There are no specific medications to improve the stability of the ankle or subtalar joint.

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 6 weeks despite treatment

• Any of the following occur after surgery:

• You experience pain, numbness, or coldness in the foot and ankle

• Blue, gray, or dusky color appears in the toenails

• Signs of infection develop, including fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)