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Ankle and Subtalar Instability
Corrie M. Yablon, MD; Julia R. Crim, MD; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Imaging

    • Pathology

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), interosseous talocalcaneal ligament (ITCL)
        • Definitions

          • Functional instability: subjective feeling of ankle instability or ankle "giving way"
          • Mechanical instability: ankle movement beyond physiologic limit of ROM
          • Instability can be demonstrated on physical exam or stress radiography
          • Instability may be present with inversion, eversion, or rotation of ankle
          • Subtalar joint largely refers to posterior subtalar joint (PSTJ) in this chapter: subtalar instability may affect both anterior and posterior subtalar joints, but imaging manifestations are visible at PSTJ

        IMAGING

        • General Features

          • Radiographic Findings

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      • Relevant Anatomy

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Hur ES et al: Lateral Ligament instability: review of pathology and diagnosis. Curr Rev Musculoskelet Med. 13(4):494-500, 2020
                                  2. Zeng G et al: Open Broström-Gould repair vs arthroscopic anatomical repair of the anterior talofibular ligament for chronic lateral ankle instability. Foot Ankle Int. 41(1):44-9, 2020
                                  3. Yoon DY et al: Differences between subtalar instability and lateral ankle instability focusing on subtalar ligaments based on three dimensional isotropic magnetic resonance imaging. J Comput Assist Tomogr. 42(4):566-73, 2018
                                  4. Aynardi M et al: Subtalar instability. Foot Ankle Clin. 20(2):243-52, 2015
                                  5. Burrus MT et al: Predictors of peroneal pathology in Broström-Gould ankle ligament reconstruction for lateral ankle instability. Foot Ankle Int. 36(3):268-76, 2015
                                  6. Barg A et al: Subtalar instability: diagnosis and treatment. Foot Ankle Int. 33(2):151-60, 2012
                                  7. Weindel S et al: Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg. 130(3):313-9, 2010
                                  8. Ferran NA et al: Ankle instability. Sports Med Arthrosc. 17(2):139-45, 2009
                                  9. Alparslan L et al: Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Semin Musculoskelet Radiol. 12(4):346-58, 2008
                                  10. Kirby AB et al: Magnetic resonance imaging findings of chronic lateral ankle instability. Curr Probl Diagn Radiol. 34(5):196-203, 2005
                                  11. Hintermann B et al: Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med. 32(1):183-90, 2004
                                  12. Michelson J et al: The effect of ankle injury on subtalar motion. Foot Ankle Int. 25(9):639-46, 2004
                                  13. Hintermann B et al: Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 30(3):402-9, 2002
                                  14. Keefe DT et al: Subtalar instability. Etiology, diagnosis, and management. Foot Ankle Clin. 7(3):577-609, 2002
                                  15. Larsen E et al: Association of ankle instability and foot deformity. Acta Orthop Scand. 61(2):136-9, 1990
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Pathology

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), interosseous talocalcaneal ligament (ITCL)
                                        • Definitions

                                          • Functional instability: subjective feeling of ankle instability or ankle "giving way"
                                          • Mechanical instability: ankle movement beyond physiologic limit of ROM
                                          • Instability can be demonstrated on physical exam or stress radiography
                                          • Instability may be present with inversion, eversion, or rotation of ankle
                                          • Subtalar joint largely refers to posterior subtalar joint (PSTJ) in this chapter: subtalar instability may affect both anterior and posterior subtalar joints, but imaging manifestations are visible at PSTJ

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      • Relevant Anatomy

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Hur ES et al: Lateral Ligament instability: review of pathology and diagnosis. Curr Rev Musculoskelet Med. 13(4):494-500, 2020
                                                                  2. Zeng G et al: Open Broström-Gould repair vs arthroscopic anatomical repair of the anterior talofibular ligament for chronic lateral ankle instability. Foot Ankle Int. 41(1):44-9, 2020
                                                                  3. Yoon DY et al: Differences between subtalar instability and lateral ankle instability focusing on subtalar ligaments based on three dimensional isotropic magnetic resonance imaging. J Comput Assist Tomogr. 42(4):566-73, 2018
                                                                  4. Aynardi M et al: Subtalar instability. Foot Ankle Clin. 20(2):243-52, 2015
                                                                  5. Burrus MT et al: Predictors of peroneal pathology in Broström-Gould ankle ligament reconstruction for lateral ankle instability. Foot Ankle Int. 36(3):268-76, 2015
                                                                  6. Barg A et al: Subtalar instability: diagnosis and treatment. Foot Ankle Int. 33(2):151-60, 2012
                                                                  7. Weindel S et al: Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg. 130(3):313-9, 2010
                                                                  8. Ferran NA et al: Ankle instability. Sports Med Arthrosc. 17(2):139-45, 2009
                                                                  9. Alparslan L et al: Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Semin Musculoskelet Radiol. 12(4):346-58, 2008
                                                                  10. Kirby AB et al: Magnetic resonance imaging findings of chronic lateral ankle instability. Curr Probl Diagn Radiol. 34(5):196-203, 2005
                                                                  11. Hintermann B et al: Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med. 32(1):183-90, 2004
                                                                  12. Michelson J et al: The effect of ankle injury on subtalar motion. Foot Ankle Int. 25(9):639-46, 2004
                                                                  13. Hintermann B et al: Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 30(3):402-9, 2002
                                                                  14. Keefe DT et al: Subtalar instability. Etiology, diagnosis, and management. Foot Ankle Clin. 7(3):577-609, 2002
                                                                  15. Larsen E et al: Association of ankle instability and foot deformity. Acta Orthop Scand. 61(2):136-9, 1990