Ankle Sprain and Instability

Ankle Sprains are an extremely common injury. Ankles support our entire body weight and are thus vulnerable to instability.  It can happen to anyone: if you are walking on an uneven surface, or if you are not wearing the right shoes, you can suddenly lose your balance and twist your ankle. 

If the ankle twists dramatically enough, the ligaments that hold the bones together can be torn or stretched. This is what is commonly known as a sprain. Any major sprains or repeated minor sprains can lead to permanent ankle instability.

Ankle Anatomy

The ankle is a joint formed by the meeting of our leg and foot. There are two bones in the leg: the large bone is the tibia, and the small bone is the fibula.  These bones sit on the Talus bone in the foot. The Talus bone is supported by the Calcaneus bone, also known as the heel. Our heels bear 85% to 100% of our total body weight.

Ligaments, which are strong ropes of tissue, bind our leg and foot bones together.  One particular ligament located on the outer side of the ankle, called the Lateral Collateral Ligament (LCL), is more susceptible to ankle sprains than others. It contributes to our balance and stability at any time we are using our ankles.  The LCL also prevents the ankle joint from abnormal movements, such as extreme ranges of motion, twisting, and rolling.

The LCL is composed of three separate ligaments.  The Anterior Talofibular Ligament is the weakest and most commonly torn, followed by the Calcaneofibular Ligament.  The Posterior Talofibular Ligament is the strongest and is rarely injured.

 Ankle Sprain and Ankle Instability Causes

Our ankles are susceptible to instability, especially when walking on uneven surfaces, stepping down at an angle, playing sports, or when wearing certain shoes like high heels. Even the most talented athletes are likely to lose their balance in such a situation. Our ankle supports our entire body weight, but no one ligament in the ankle is strong enough to do so. Therefore, when the foot is bent at an abnormal angle, the weight of our body places an abnormal amount of force on ligaments that were only designed to support some of that weight, causing them to stretch in response.  When a ligament is forced to stretch beyond its limit, it may overstretch, tear, or disconnect from the bone completely.

Ankle Sprain and Instability Symptoms

You may lose your balance and fall if your foot is placed at a strange or abnormal angle on the ground.  Some individuals may hear a “pop” noise at the time of the initial injury. It will probably be painful to walk or put any weight at all on the injured ankle.  Pain is generally the first symptom of a Sprained Ankle.  Swelling, stiffness, or bruising can either occur right away or may take a few hours to develop. 

Ankle Sprain and Instability Diagnosis

A doctor can diagnose a Sprained Ankle by examining the injured ankle and by discussing possible causes of the injury with you. During this examination, your doctor will rotate your ankle into various positions to determine which ligament was injured.  An X-Ray of the ankle and foot may be necessary. In severe cases, a MRI scan may be needed to view the ankle in more detail. 

Ankle Sprains are categorized by the amount of damage to the ligaments, and the subsequent impairment it causes.  A Grade One sprain means the ligament has sustained slight stretching and some minor injury to the fibers. There will be minimal impairment.  A Grade Two sprain is characterized by partial tearing of the ligament. The ankle will be looser than normal. A Grade Three Spain, the most severe, occurs with a complete tear of the ligament.  The ankle will be completely unstable. 

Ankle Sprain and Instability Treatment

The vast majority of Ankle Sprains heal with non-surgical treatment methods. However, it is important that you seek evaluation and treatment for any ankle injury, as they can worsen if not treated properly. In addition to this, fractures, a more serious injury, can sometimes be mistaken for sprains.

The treatment of an Ankle Sprain depends largely on its Grade.  Grade One sprains are typically treated with the RICE method – Rest, Ice, Compression, and Elevation. You should rest your ankle by not placing weight on it.  You may need to use crutches to aid walking. Applying ice packs to your ankle can help manage pain and swelling.  Ice should be applied immediately after the sprain occurs. Your doctor can provide you with a continued icing schedule. Your doctor could recommend over-the-counter or prescription pain medication in some cases.  Compressing the injured ankle with bandages or elastic wraps can be helpful in immobilizing and supporting the ankle. The ankle should be elevated above the heart for at least 48 hours to control swelling.

Care for Grade Two sprains also includes applying the RICE method of treatment and in most cases, you will need to use an ankle air cast or a soft splint to stabilize the ankle. As the sprain heals, your doctor will advise you about increasing your activity.  Even once the cast or splint is no longer necessary, your doctor may still recommend wearing a brace.

In addition to the RICE method and necessary pain management, your doctor may recommend a short leg cast or a cast-brace system for any Grade Three sprain. This type of cast is typically worn for two or three weeks and is complemented by rehabilitation.  Rehabilitation is the most helpful aspect of treatment, as it will help decrease pain and swelling and to increase movement, coordination, and strength. Your doctor may recommend customized inserts called orthotics for your shoe or even custom, rigid shoes to help you maintain proper ankle positioning.

The recovery time is obviously shorter for any ankle sprains with non-surgical treatment.  Grade One sprains could heal in about six weeks. Grade Two and Three Sprains may take several months to heal.  Grade Three Sprains usually include a period of physical therapy to promote healing.

Ankle Sprain and Instability Surgery

Ankle Sprains rarely require surgery; however, it is an option where the sprain is so severe that non-surgical treatments and rehabilitation fail. Ankle sprains must be evaluated on an individual basis.  Your physician will be able to discuss surgical options with you and to help determine the most appropriate choice for you.

One type of surgery, termed Ligament Tightening, is performed to tighten any overstretched ligaments.  This usually involves sprains that injure the Anterior Talofibular Ligament (ATFL) and the Calcaneofibular Ligament (CFL).  The surgeon will create an opening over the ligaments and cut the ATFL and the CFL in half. He will then attach these two ligaments to the fibula.  The surgeon will further reinforce the ligaments by also attaching the top edge of the Ankle Retinaculum, a large band of connective tissue located at the front of the ankle.

If the ligaments are severely damaged, or if a Ligament Tightening is not appropriate for another reason, the next option is a Tendon Graft.  For this procedure, the surgeon will take a portion of a nearby tendon to be used for a tendon graft, to reinforce the injured tendon. The tendon from the Peroneus Brevis muscle in the foot is most commonly used.  The tendon graft will be attached to the Fibula and the Talus, near the attachment sites of the original tendon.

In some cases of chronic pain, cartilage or leftover bone fragments may need to be removed using a method called Arthroscopic Surgery.  Arthroscopic surgery will use a small camera to inspect the affected area so that only small incisions need to be made. This can shorten the recovery time. 

Ankle Sprain and Instability Recovery

Depending on the grade of the injury and what surgical or non-surgical methods are applied to repair the ankle, the rate of recovery can vary.

  • Grade 1 sprains should only experience minor limits to the range of motion, and the recovery process is about six weeks.
  • Grade 2 sprains experience moderate impairment and recovery may take up to a few months.
  • Grade 3 sprains involve more severe impairment and may take several months to fully recover. A period of physical therapy will usually be necessary for a full recovery and may help with any residual swelling.

Recovery from surgery varies a great deal and depends mostly on the extent of your injury and the type of surgery that was performed, as well as following your doctor’s instructions.  Your physician can help you understand what you should expect during recovery. Individuals are usually required to wear a cast for up to 2 months after surgery. Your doctor will advise you as to how much weight can be placed on your injured foot.  Rehabilitation following surgery can often be a slow process. Individuals typically participate in physical therapy for two to three months. Physical therapy helps to strengthen the ankle muscles and increase movement. Success rates are high for both types of surgical procedures used to repair severe ankle sprains.  The vast majority of individuals achieve an excellent recovery in about six months.

Ankle Sprain and Instability Prevention

Individuals that experience one ankle sprain become more likely to experience another.  If you have experienced an ankle sprain in the past, it is best to avoid shoes with higher heels as much as possible.  Shoes with low heels and flared heels may feel steadier. In some cases, doctors recommend a heel wedge or prescribe a plastic brace, called an orthosis, to help position the foot inside the shoe.

At SPORT, we will identify the source of your pain and then utilize state-of-the-art therapeutic techniques that focus on restoring your range of motion.

Depending on the specific condition and its severity, these treatment options may include physical therapy, over-the-counter anti-inflammatory medication, slings and supports, cortisone shots, or surgery.

If you have an acute or chronic foot or ankle injury that needs medical attention, call SPORT at (469) 200-2832 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.

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