Ankle sprains are the most common musculoskeletal injury seen in the Emergency Room. Sprains are injuries to the ligaments of the ankle causing them to partially or completely tear as a result of sudden stretching. They can occur on either the inner and outer portions of the ankle joint. The typical injury occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface. The pain is initially severe and can be associated with a “popping” sensation. Immediate swelling and bruising over the area of injury often occurs as the injured blood vessels leak fluid into the local tissue. Examination of the area may be quite tender to touch and painful with weight bearing. Ligament injuries may be graded from I to III, ranging from partial to complete tears. Partial tears retain some ankle stability, whereas complete tears result in decreased stability.
Acute ankle sprains are initially treated with RICE (Rest, Ice, Compression, Elevation). Anti-inflammatory medications can be given to reduce local inflammation. Frequently, an x-ray is required to rule out the possibility of a fracture. Many sprains are under treated, which may result in chronic instability of the ankle. Certain severe sprains require a period of immobilization in an orthopaedic boot or cast so that the ligaments will heal in the correct, tight position. An ankle sprain that remains painful may indicate other injuries to bone, cartilage, or tendon. Occasionally, additional imaging such as an MRI may be required to investigate these associated problems. A “high ankle sprain” may be diagnosed as well which takes significantly longer to heal.
At Texas Sports Medicine, we deal commonly with athletes and their injuries. Our goal is to return the athlete to the playing field as quickly as possible while never compromising safety and overall well being.
Chronic Ankle Instability
Ankle sprains not treated correctly or an ankle that has sustained multiple injuries may result in chronic instability. This may produce an ankle that feels “weak”, “unstable”, or “buckles” frequently. An orthopaedic surgeon can perform a physical exam to determine the amount of joint “laxity”. Initial treatment includes bracing to protect the joint, but most important is correct rehabilitation of the ankle. This often requires the aid of a physical therapist to improve strength and balance. Severe sprains also result in loss of nerve fibers within the ligaments that help us tell where the foot is in space. The therapist can also help to restore this proprioception, or “position sense” of the ankle. If the ankle remains unstable after these measures, surgery may be required to “re-tighten” the ligaments.