Don’t Get Sidelined By Ankle Sprains

Ankle sprains are common injuries, usually occurring when the ankle is twisted or inverted. Sprains most often refer to injury in the soft tissue of the ankle, usually the ligaments. A sprained ankle can afflict both children and adults, and can occur during sports and physical activity, or when stepping on an uneven surface or down at an angle.

Ankle ligaments hold the ankle bones and joint in position and protect the joint from abnormal movements. Three ligaments make up the lateral ligament complex on the outer side of the ankle: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The most common ankle sprains involve the ATFL, which helps prevent the ankle from sliding forward, and the CFL, which keeps the ankle from rolling inward. Minor sprains stretch one or all of these ligaments, whereas major sprains involve these ligaments being partially or completely torn. Symptoms include swelling, pain and bruising.

Severe sprains involve damage to supportive ligaments in the ankle. Sometimes referred to as high ankle injuries because they affect the ligaments just above the ankle joint, the recovery from severe sprains can take twice as long as that of a typical sprain.

Your doctor may order x-rays to make sure you don’t have a broken bone in the ankle or foot, as broken bones can have similar symptoms of pain as swelling. An MRI might be required once the period of swelling and bruising subsides, if the doctor suspects a very severe injury to the ligaments, joint surface, or a small bone chip or other problem.

Treatment begins by first controlling the swelling, pain, and weight bearing on the injured ankle. Elevation, as well as gentle compression and ice will help alleviate swelling. Mild pain relievers may help with pain, and crutches might be required to prevent bearing weight on the ankle.

Early weight bearing, often with the support of an ankle brace, has been shown to be beneficial in preventing stiffness, helping control some of the instability and preventing the ankle from giving way and causing further damage. Motion may also help being able to sense the position, location, orientation and movement of the ankle.

Other non-surgical treatment options include physical therapy to help strengthen the muscles around the ankle to help make it more stable. Therapy may also be necessary to ‘retrain’ the nerves around the ankle that may have been torn along with the ligaments. If non-surgical measures are not successful, surgery may be suggested to reconstruct the torn ligaments. Surgical options include:

  • Arthroscopy – A surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage, or part of the ligament caught in the joint.
  • Reconstruction – Surgery for a severe sprain involves making an incision in the side of the ankle to allow the surgeon to clearly see the torn ligaments and perform the surgical repair. In some cases, a neighboring tendon is used to reinforce the repair.

Post-surgery, the lower leg is usually placed in a case or brace for about six weeks to allow the reconstruction to heal. Following the removal of the cast, physical therapy will be required to regain full use of the ankle.

Whether treated surgically or non-surgically patients will benefit from rehabilitation to help decrease pain and swelling, and prevent chronic ankle problems. Ultrasound and electrical stimulation may also be necessary to help with pain and swelling.

Rehabilitation exercises may involve active range of motion or controlled movements of the ankle joint without resistance. Lower extremity exercises and endurance activities are added as tolerated. Once pain is eliminated, other exercises may be added. The overall goal is to increase strength and range of motion as balance improves over time.

Only your surgeon can help you decide what treatment is best for your ankle sprain or other condition. Orthopaedic surgeons, Dr. Lex Kenerly and Dr. Matt Valosen have expertise in a wide variety of orthopaedic and sports medicine services, treating conditions such as ankle sprains, ACL tears, rotator cuff tears, knee cartilage tears, tennis elbow, trigger finger, hip and knee replacements, fracture treatment and more.

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