Recent Developments in the Treatment of Ankle and Subtalar Instability

Kazuya Sugimoto1, *, Shinji Isomoto1, Norihiro Samoto1, Koujirou Okahashi2, Masasuke Araki3
1 Department of Orthopaedic Surgery, Nara Prefectural General Medical Center, Nara, Japan
2 Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Nara, Japan
3 Developmental Neurobiology Laboratory, Dept. of Biology, Nara Women's Uuniversity, Nara, Japan

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© 2017 Sugimoto et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Nara Prefectural General Medical Center 1-30-1, Hiramatsu, Nara-shi, Nara 6310846, Japan, Tel: +81-742-46-6011, Fax: +81-742-46-6001; E-mails:;


It was nearly a centenary ago that severe ankle sprain was recognized as an injury of the ankle ligament(s). With the recent technological advances and tools in imaging and surgical procedures, the management of ankle sprains - including subtalar injuries - has drastically improved. The repair or reconstruction of ankle ligaments is getting more anatomical and less invasive than previously. More specifically, ligamentous reconstruction with tendon graft has been the gold standard in the management of severely damaged ligament, however, it does not reproduce the original ultrastructure of the ankle ligaments. The anatomical ligament structure of a ligament comprises a ligament with enthesis at both ends and the structure should also exhibit proprioceptive function. To date, it remains impossible to reconstruct a functionally intact and anatomical ligament. Cooperation of the regenerative medicine and surgical technology in expected to improve reconstructions of the ankle ligament, however, we need more time to develop a technology in reproducing the ideal ligament complex.

Keywords: Ankle, Subtalar joint, Instability, Ligament, Repair, Reconstruction, mechanoreceptor, Arthroscopy.