Ankle Sprains Leading to Instability: Conservative versus surgical options
Many of us have experienced the pain and suffering that accompanies an ankle sprain. It often strikes without warning – whether completing a menial task or during high points of activity. Either way, it’s always a cause for concern, because even though sprains can be healed with proper rest and recovery (depending on the severity of the sprain), ankle sprains are actually much more vulnerable to further injury than you might think. And if your ankle sprain does not heal correctly, it can lead to instability, arthritis and injury recurrence.
Understanding Ankle Physiology
The ankle joint is a hinged synovial joint with primarily an up-and-down movement. It can move from side to side and around in a circle because of the adjacent joints in the foot. Altogether, the ankle joint is formed by the articulation of the Talus, Tibia, and Fibula bones. This differs from a “ball and socket” joint, found in the hips for example, which does have wider range of motions. It is because of this “hinge” style joint that the ankle is susceptible to sprain when the ankle hyperextends too far to the left or right.
What is an Ankle Sprain?
Your ankle is held together by tough bands of tissue called ligaments. When the ankle extends beyond its normal range of motion, almost exclusively left or right, the ligaments can tear. There is a wide range of severity for an ankle sprain depending on how many ligaments are affected and how much they have torn. In severe cases, a total tear or rupture will require several weeks or months of recovery.
The most common type of ankle sprain is a lateral ankle sprain, which affects the ligaments of the outer ankle: the Anterior Talofibular Ligament, the Calcaneofibular Ligament, and the Posterior Talofibular Ligament. Less common are Medial ankle sprains, which affect the ligaments of the inner ankle, and Syndesmotic sprains, which affect the Tibiofibular ligaments that connect the Tibia and the Fibula. The latter version is the rarest (also referred to as a “high ankle sprain”), but the most likely to cause chronic ankle instability and subsequent sprains.
An ankle sprain can range in severity, from stretching to minimal tearing, partial tearing and all the way to a full tear or rupture (Grades 1 through 3). Recovery from these types of ankle sprains can range greatly from 1 week to several months. With proper rest and rehabilitation, an ankle sprain can heal completely. However, if a full restoration is not achieved, it can cause ankle weakness, instability, and recurring injury.
How to know if you have an Ankle Sprain
Effectively healing an ankle sprain begins the moment you experience the injury. You will notice that the ankle has hinged or rolled awkwardly, followed by pain and swelling. You may even hear a “pop” at the same time. Below are some of the indicators that you have a sprained ankle:
- Difficulty walking
- Hindered range of motion
- Difficulty bearing weight
- Popping sensation
It may be difficult to know if you have sprained your ankle, and fractured or broken it. The best thing you can do for the health of your ankle is to see a podiatrist and get an x-ray of the ankle. This will determine for certain whether it is an ankle sprain or an ankle fracture (or a mix of the two), and the severity of the injury. Other imaging modalities such as an MRI may be ordered depending the type of rotational injury/instability and duration of the condition. A specific recovery plan of action can then be determined to meet the exact needs of your injury and prevent further injury or recurrence. This is the most assured way to get the information you need for a complete recovery.
What are conservative treatments for an Ankle Sprain?
Ankle Sprains can be healed through conservative treatments at home, including:
- Applying ice or a cold back in 20-minute increments to reduce swelling
- Over the counter pain medication
- Rest & limiting activities
- Elevation to reduce swelling
- Home rehabilitation exercises
- Using crutches or an air cast to walk
- Compression socks
However, early cessation or returning to activities before the ankle is fully healed may lead to instability, weakness, and susceptibility to further injury. That’s why it’s best to receive an evaluation from your podiatrist to determine the type and severity of your ankle sprain. From there, you can follow a recovery regimen that will lead to a full restoration of the ankle joint.
Conservatively an ankle brace, walking boot or cast may be provided to reduce/restrict the ROM of the ankle joint in order to allow for appropriate healing and prevent laxity of the ligaments therefore reduces the incidence of reoccurrence.
What are surgical treatments for an Ankle Sprain?
Surgical treatments for an ankle sprain may be necessary depending on the grade of injury or if you suffer from chronic ankle pain, chronic ankle joint instability and arthritis in the ankle joint. Each of these symptoms is an indication that your ankle sprain did not heal correctly or completely, and surgery is necessary to fix the affected ligament(s). If after 4-6 weeks your ankle sprain has not healed, it’s a good indication that you may need further treatment, and perhaps surgery.
When an ankle sprain leads to chronic pain or injury, surgery may be the only option to permanently and fully restore stability to the ankle. There are two primary surgeries to choose from: arthroscopic and reconstructive.
Arthroscopic surgery utilizes a tiny camera to help guide the surgeon around the ankle, removing debris or scar tissue to restore the area to health. This can also help prevent inflammation and arthritis formation.
Reconstructive surgery is used to repair the ligament(s) with stiches or sutures. In severe cases, the ligament can be restored by grafting tissue from other ligaments or tendons. The surgeon makes an incision at the site of the injury to repair the affected ligaments.
How to prevent an Ankle Sprain
The best ways to prevent an ankle sprain, or to prevent the recurrence of one, is to practice these steps:
- Warm up before any activity
- Be mindful when you are walking or running
- Exercise on even surfaces
- Wear stability braces, tape or compression socks when exercising
- Wear proper fitting shoes and insoles
- Reduce or stop wearing high heeled shoes
- Increase muscle strength and stability with targeted ankle and lower extremity exercises
- If you did injure your ankle, let the area heal completely before returning to normal activity