Ankle Sprain and Instability
Ankle Sprains are a common injury that occurs from over stretching or tearing of the ligaments that support the ankle. The ankle is composed of bones forming a joint and ligaments are the elastic structures which are responsible for holding these bones in their proper place. Ligaments and other soft tissues function to prevent abnormal movement such as twisting, turning, and rolling of the foot beyond the normal range.
Ankle sprains occur due to sudden inward or inverted movement of the foot during sports activities, or while walking and running on uneven surfaces. An ankle sprain can occur from falling, or sudden force on the ankle which twists the joint beyond its normal range, resulting in damage to the ligament. Ankle sprains can occur at any age and although commonly seen as a sports injury, ankle sprains can occur to non-athletes as well.
Ankle sprains result in pain, swelling, bruising, and stiffness of the ankle region. Mobility, range of motion and weight bearing are adversely affected. The severity of the ankle sprain depends on the condition of the torn ligament.
Grades of ankle sprain
Based on the severity of the ligament’s condition, ankle sprains are categorized as grade 1,2, or 3.
- Grade 1: a mild sprain with some damage to the ligament fibers.
- Grade 2: a moderate sprain with partial tearing of the ligament.
- Grade 3: a severe sprain with complete tearing of the ligament.
The diagnosis of ankle sprain starts with the physical examination, which is painful as the ankle is bent in various directions to assess which ligament is injured. Then X-rays are taken to confirm whether any fracture is present, as the symptoms of a sprain are similar. The doctor grades the ankle sprain by looking at the amount of swelling and bruising of the ankle. In complex cases, an MRI scan is ordered for analyzing the injured ligament.
Treatment and healing time of an ankle sprain will depend on the grade of the sprain. All sprains will be treated with the R.I.C.E. method: Rest, Ice, Compression, and Elevation.
Your physician may also order the following treatment measures if the sprain is a grade 2 or 3.
Immobilization: A splint, short leg cast, or boot may be used to immobilize the ankle and allow healing to take place with a grade 2 or 3 sprain.
Medications: Medications such as aspirin and NSAID’s, non-steroidal anti-inflammatory drugs, can be prescribed for your comfort and to minimize swelling.
Physical Therapy: Strengthening and range of motion exercises may be prescribed by a therapist to regain normal function of the ankle and prevent chronic ankle problems. Your therapist may utilize ultrasound and electrical stimulation to decrease pain and swelling and instruct you on taping the ankle for support while it heals.
Surgery for ankle sprains is rarely needed but may be necessary if the sprain is a grade 3 with complete tearing of the ligament and the patient does not improve with conservative treatment measures and months of adequate healing time.
Your surgeon will perform Ankle Arthroscopy surgery to evaluate and repair the torn ligament.
Arthroscopy is a surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.
The benefits of arthroscopy compared to the alternative, open ankle surgery, include:
- Smaller incisions
- Minimal soft tissue trauma
- Less pain
- Faster healing time
- Lower infection rate
- Less scarring
- Earlier mobilization
- Usually performed as outpatient day surgery
Your surgeon will look for any loose fragments of bone or ligament inside the joint with the help of an arthroscope through a small incision.
The torn ligament is repaired by stitching it back together with sutures or by using the surrounding ligaments or tendons to repair the damaged ligament.
Ankle sprain is a common and painful condition in which ligaments supporting the ankle joint are torn or damaged. Sprains are most often treated conservatively by resting the injured joint, applying ice to the injury, using a compression bandage, and elevation of the foot. In severe cases, surgery may be necessary.
Ankle instability is a chronic condition characterized by a recurrent slipping of the outer side of the ankle. It usually results from repeated ankle sprains. It is generally noticed during movement of the ankle joint but can also occur during standing as well.
Repetitive injury of the ankle ligaments on the same side is the most common cause of ankle instability. Inadequate healing of the sprained ligament or incomplete rehabilitation of the affected ligament can result in instability of the ankle. Recurrent injury of the ligaments further weakens them and aggravates the instability which predisposes to the development of additional ankle problems.
Pain is the most common symptom and is associated with swelling and tenderness of the ankle. There may be a persistent discomfort and instability in the affected ankle joint. The ankle is unstable and may turn repeatedly while walking on uneven surfaces or during a sporting activity.
A complete medical history, including a history of any previous ankle injuries, and a physical examination is essential for an accurate diagnosis of the condition. An X-ray may be ordered to confirm the diagnosis. Other imaging tests may also be used to evaluate the injury.
The management of ankle instability depends on the findings of physical examination and the activity level of the patient.
Conservative treatment includes physical therapy for improving the strength, balance and range of motion of the joint, bracing to support the affected ankle and prevent further sprain, and non-steroidal anti- inflammatory (NASAIDs) to reduce the pain and inflammation.
Surgery is recommended in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments. Commonly used surgical procedures involve repair or reconstruction of the damaged ligament.