Ankle sprains are a very common injury. There are over 25,000 ankle sprains occurring daily in the U.S. Both athletes and non-athletes experience these injuries during their daily activities. What is important is to treat these injuries properly and not to brush them off as just a “simple” sprain.
What is it?
An ankle sprain occurs when the ligaments to the ankle are stressed by abnormal movements such as twisting, turning, or rolling on the foot. Ligaments are elastic structures that respond to normal forces by stretching and returning back to their normal position. Abnormal or excessive forces stretch the ligaments past their normal point of return and with excessive force the ligament actually tears.
Ankle sprains are classified in the following way:
- Grade 1: Slight stretch with some change to the fibers of the ligament.
- Grade 2: Complete tear of some but not all of the collagen fibers of the ligament.
- Grade 3: Complete tear or rupture of the ligament.
Diagnosis: It is very important to determine the extent of the injury when an ankle sprain occurs. The amount of swelling, the location of pain and the clinical signs of instability are important physical findings that guide the orthopedic surgeon in the management of these injuries. X-rays are valuable in ruling out fractures and can help determine the severity of the injury. MRIs are sometimes used when complete ruptures or osteochondral injuries are suspected.
Treatment: Non-surgical treatment is the mainstay of most ankle injuries. R.I.C.E. or rest, ice, compression and elevation are employed in the initial 48 hours. Immobilization in an air splint or boot can help the injured ligament heal in the proper position. Even Grade III injuries, with proper immobilization, can heal without long-term symptoms of instability. Most injuries require four to six weeks to heal fully. Ankle sprains heal through three phases. Phase 1 – resting or protection to allow the ligament to heal (up to two weeks). Phase II – Restart of motion exercise, usually at two weeks. Phase III – gradual return to all physical activities, three to six weeks. Physical therapy, by employing modalities such as ultrasound and proprioceptive exercises to restore ankle function, help the injury to heal more quickly. Medication usually employs treatment of NSAIDS.
Surgical treatment is rarely needed and is reserved for patients that fail to respond to non-surgical treatment or continue to experience persistent symptoms of pain and instability. Surgery options include Arthroscopy, where an orthopedic surgeon looks in the joint to remove loose fragments of bone or cartilage that were the result of the injury. Reconstruction is also an option where the surgeon repairs the ligament using sutures or tendon transposition.
Summary: Chronic ankle instability can often be prevented by proper treatment of acute ankle injuries. The orthopedic surgeon can order the proper diagnostic tests and treatment plans to return the patient back to their pre-injury level. Preventative measures such as proper shoe wear, external athletic braces and exercise to strengthen the ankle are all part of the regime. Our goal is to prevent long term problems while returning the patient back to full speed as soon as possible.