Ankle sprains are common injuries associated with the lower extremity. It involves a twisting motion of the ankle is such a manner that causes straining and injury to the ligaments that stabilize the ankle. These ligaments are elastic like bands that provide ankle stability and minimize excessive rolling out motion of the ankle.
The initial signs and symptoms of an ankle sprain may include pain, swelling, bruising, difficulty ambulating and tightness/stiffness to the ankle joint. With repeated ankle sprains there will be less pain and less swelling with increased instability with walking on uneven terrain.
After an ankle sprain, attention must be directed to reducing the initial swelling. The swelling if not managed properly will create pain and discomfort to the ankle. The ankle needs protection from further injury. Continual walking on a sprained ankle will create further injury, pain and instability. The injured ankle needs to be immobilized in a cast/boot to provide compression to the ankle which will reduce the swelling and protect the ankle from further injury to the ankle ligaments. As the swelling subsides, the patient is transitioned into an ankle brace with sneakers, which will give the ankle stabilization against torsional forces which may reinjure the ankle. At this point, range of motion exercises are initiated. Depending on the severity of the ankle sprain, physical therapy may be prescribed in order to decrease swelling, increase ankle range of motion, decease stiffness. Therapy may be needed to strengthen the peroneal muscles which are weakened during severe ankle sprains. The proprioceptive fibers of the ankle ligaments which give the ankle position sense may be injured during the sprain, may need to be strengthen and trained to give the ankle further stability. At this point, custom molded orthotics are recommended to further stabilize the ankle in order to avoid future ankle sprains. The ankle may need to be braced appropriately to prevent further injury.
If an ankle sprain goes untreated, it can lead to a chronic ankle instability where there is a constant pain, swelling, weakness and an ankle that tends to “give out” on uneven terrain. If an ankle sprain remains persistent and is showing no signs of healing, a magnetic resonance imaging (MRI) may be needed to determine if further pathology is present from the initial sprain. An ankle sprain that is not healing may indicate the possibility of peroneal tendon tears, bone contusion injury/fractures of the talus, ankle impingement pain secondary to synovitis, and torn ankle ligaments leading to instability and subluxation of the ankle.
Pending the results of the MRI, surgical intervention may be necessary to repair the ruptured ligaments via primary repair or tendon transfer to stabilize the ankle. The ankle may need arthroscopic examination with possible debridement of inflammed joint tissue as a result the initial injury. The ankle may have a bone contusion injury and/or fracture in the talus which may need further immobilization and/or surgical intervention. The peroneal tendons may have been torn during the initial spraining injury and may need surgical repair.
Ankle sprains are common injuries affecting the lower extremity. If the ankle sprain is not adequately treated, it can lead to chronic pain, swelling and instability. Proper immediate attention is necessary in order to avoid problems with the ankle in the future.
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