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Is it normal after ankle surgery 5 years ago that I can't stand on my left leg without falling over?

Q: I recently noticed while playing Simon Says with my five-year-old that I can no longer stand on my left leg without losing my balance and falling over. I had surgery on that ankle two years ago due to a severe sprain. I completed physiotherapy afterward, and everything seemed fine at the time. Is this normal, or should I be concerned?

A: What you’re experiencing might be related to something known as functional instability. To determine if this is the case and to figure out the best course of action, more formal testing would be necessary. Functional instability refers to an ankle that seems stable during everyday activities—it doesn’t give out when standing, walking, or facing challenges like walking on hills or uneven surfaces. However, when it comes to balancing on that foot, certain deficiencies may become apparent.

One potential issue could be a loss of normal proprioception. Proprioception is your joint’s ability to sense its position. If the receptors in your ankle joint that signal to your brain about your foot’s position aren’t functioning properly, the signals may be absent, delayed, or too weak. This can result in instability when the joint is stressed or challenged.

You can try standing on your other (uninjured) leg to see if the balance issue is specific to your surgically repaired ankle or if it’s a more general problem. Regardless of the outcome, some targeted rehabilitation work is recommended to prevent future injuries or re-injuries.

Your best bet is to consult your physiotherapist for a re-evaluation and to develop a plan for functional rehabilitation. They can review your previous discharge notes to assess your balance status at that time and compare it to your current condition. This comparison may help clarify what has changed, what’s currently happening, and what steps you can take to address it. It’s fortunate that a simple children’s game brought this issue to your attention now. Simon says: take action and improve your balance!

Reference: John G. Kennedy, MD, MCh, MMSc, FRCS (Orth), et al. Anatomic Lateral Ligament Reconstruction in the Ankle. In The American Journal of Sports Medicine. October 2012. Vol. 40. No. 10. Pp. 2309-2317.