We often hear about someone’s knee being unstable in that it buckles or that they dot have confidence in it on an uneven surface.

A similar condition exists in the ankle but this is often under recognised and as a result often not diagnosed. It is less frequent than knee instability but for those who are affected it can be quite disabling.

Ankle instability is a sensation of or true going over of the ankle on uneven surfaces. It maybe uneven ground, it maybe the sensory pavement, it maybe ladies wearing heels where just not being flat on the floor makes their ankle feel loose.

The commonest cause is damage to the ankle ligaments. The ligaments are the natural check reins of the ankle. They are not always actively being used but when our ankle goes into certain positions such as an inward twist they tighten up and stop the ankle moving too much or “going over” or “getting sprained”. It’s not normal for people to keep spraining their ankles.

The ligament themselves, especially the anterior talofibular ligament or ATFL is a very thin ligament only a couple of millimetres thick. It rarely tears completely but just becomes incompetent and loose. Sometimes as it becomes thickened due to scarring the tissue pinches in the ankle, giving the sensation of something catching – a bit like a pebble in you shoe. The ankle never feels natural.

Physiotherapy certainly helps in over half the cases by strengthening the muscles that also help stabilise the ankle joint. Using a brace during sport or other vulnerable activities can also help.

Cue Nick from Health and Fitness Solutions. I have known Nick on a professional level for some years and he has helped rehabilitate many of my patients. Nick is a keen sportsman but his ankle kept limiting his performance or abilty to do simpler tasks such as even running a short distance.

Obviously as a leading physio I knew he was compliant with the exercises and had tried all the less invasive options.

Despite this Nicks ankle kept going over and swelling due to lots of bone spurs, tissue build up and very lax ligaments. Given he had tried all other measures we decided that the only definitive solution was surgery.

It was an honour to treat Nick but then as a colleague and friend I cant say it wasn’t stressful for me! Physios have a habit of analysing each motion and tender spot in the ankle in great detail so the work will be critiqued! I performed an extensive ankle arthroscopy and tightened/ reconstructed his ankle ligaments.

I learnt a lot from Nick. He is self-employed; if he doesn’t work he doesn’t get paid. We fast tracked his rehab and I was a little apprehensive about Nick returning to work as early as a week after op. But we didn’t encounter any issues or problems. Indeed it’s fair to say that now in complaint patients I also encourage a more rapid rehab as in Nick’s case.

So how is he doing? Well he still speaks to me and refers other ankle patients to me that’s a good start! On a serious note I did feel a certain pride when Nick ran the Paris Marathon in an admirable 3hr 43min. Not bad for a first timer just nine months post surgery. This in someone whose ankle was “so smashed that I hadn’t run in years.”