Ankle Sprain

Research tells us that ankle sprains are the most common reason for Emergency Department visits in the U.S., with a total number of ankle sprains approaching two million per year in the States alone. If you have ever experienced an ankle sprain in your life, have you wondered what the term actually means and what is really happening to your body when it happens?

An ankle sprain is essentially the tearing of the ligaments that stabilize the ankle. Immediate pain is accompanied by swelling and bruising, and depending on the severity, you may or may not be able to put weight on the foot. The most common ankle sprain occurs on the outside portion of the ankle after a twisting or rolling injury.

Some of us are more vulnerable to ankle sprains than others because of the activities we are involved in. Those who play a lot of basketball, pickleball, or are involved in jumping and cutting sports, are naturally at a higher risk. In these types of sports, there is a high incidence of jumping and landing on an opponent’s foot or twisting the ankle coming down hard on the foot. Also, the shape of some feet makes it easier to turn or roll on the ankle. Additionally, those who have had a severe sprain in the past – especially if it did not heal properly – may be at higher risk to sprain it again.

So, you think you have an ankle sprain. How will you know for sure?

Usually, a simple retelling of the story and the current symptoms are shared with the provider, followed by an examination of the foot and ankle. If the injury is from twisting or rolling the ankle; and there is tenderness, pain and swelling on the outside of the ankle, this is very likely to be a true sprain. Sometimes, additional testing such as X-rays and/or MRIs can help determine if a more serious injury has occurred. Oftentimes a more serious injury such as a fractured bone, tendon or cartilage injury, has occurred and these tests help ensure this diagnosis is not mistaken for an ankle sprain.

Diagnosis: Ankle sprain – what now?

Thankfully, the torn ligaments contributing to the sprain will likely heal and recover without surgery. Even in more severe cases, immediate surgical repair is almost never needed. The first several days it is important to RICE (Rest, Ice, Compress, Elevate). Icing for 20 minutes every two to three hours is useful to reduce swelling and pain. To further speed healing, applying a compressive wrap and elevating your foot with your toes above the level of the nose, is key. If bearing weight is very painful, a removable walking boot can be used temporarily. Also, it’s important that you begin professional physical therapy early in your recovery. Rehabilitation is a critical step to help improve pain and swelling; and restoring strength and motion back to normal (or even improved) levels. An ankle brace may be used until your provider or therapist believes the ankle is strong enough to return to desired activities without it.

Now what?

The length of recovery depends on the severity of injury. Minor sprains may only take days, whereas more severe injuries may take weeks to months to get back to normal activity. Swelling may persist for a much longer period of time and, although annoying, that is normal. The results are generally quite good if the recommended rehabilitation is properly followed. Thankfully, most people can return to their normal lives, sports and activities following a sprain, when proper rehabilitation is completed. Yet, in some severe sprain cases, there may be persistent ankle instability if the ligaments have not healed appropriately.

When is surgery considered?

In some severe or recurrent ankle sprains, the cartilage within the ankle joint may be damaged which can lead to persistent and progressive problems. If the ligaments do not heal properly the ankle can also continue to be unstable and painful, which occurs in approximately 20% of cases. When this is the case, the ankle should be repaired surgically. Fortunately, surgery for problems related to sprains is highly successful, with approximately 85% resolution of pain and more than 95% of patients feeling stable when returning to regular activities and sport. Ankle sprain surgery generally consists of arthroscopy, a technique where the surgeon makes small incisions to access the ankle joint with a camera and tools to manage problems related to scar tissue and cartilage injury. In addition, many patients need their ligaments tightened, which can be performed with a relatively small incision. Other problems identified by the surgeon pre-operatively can be fixed at the same time.

Post-operatively, we let patients walk on their ankles immediately. Physical therapy is an important aspect for patients to have the best result possible following their surgery and return to their desired activities faster.

As Orthopedic surgeons specializing in the foot and ankle, our patient care goals concentrate on helping patients reach their most optimal results despite their injury. Many times, this does not require surgery. Ultimately, which treatment option to pursue is a discussion and agreement between patient and provider. Our job is to provide each patient with the most clear, honest and pertinent information about their personal injury, allowing us to formulate the best treatment plan together. Our foot and ankle team at ROC are leaders in the industry and have published numerous papers and international presentations related to treatment options and recovery methods associated with surgery for ankle sprains.