Ankle Sprains: The importance of proper evaluation and rehabilitation

As the new school  year gets up and running, so too does fall sports.  With that comes the associated injuries.  One of the most common of these are various degrees of ankle sprains. 

These sprains account for 20% of all sports injuries in the United States, and often result from “rolling” or inverting the ankle.  Many ankle sprains go either untreated or mistreated, which can lead to long term instability and arthritis.  It is important to have an ankle sprain evaluated by a foot and ankle specialist, as a full evaluation and treatment plan is essential for better outcomes.  

First, it is important to have an understanding of the ankle stabilizing ligaments.  The joint is stabilized by four main ligaments, the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), the deltoid ligament, and the high ankle ligament complex, also called the syndesmosis.  When the ankle is injured or “rolls,” the lateral ankle ligament complex is stretched and in some cases ligaments will rupture.  Depending on the severity of sprain, one or multiple of these ligaments can be involved, with the ATFL being by far the most common. 

Symptoms of an ankle sprain include pain, significant swelling, bruising, difficulty bearing weight on the limb, and stiffness of the ankle.  There are four main reasons you should be evaluated promptly by a foot and ankle surgeon after an ankle sprain.  

• An untreated ankle sprain or multiple sprains can lead to chronic ankle instability, a condition characterized by chronic pain of the ankle and the feeling of the ankle being unstable or “giving way.”
• Fractures of the ankle often occur via similar injury mechanisms of sprains.  Is is important to have a radiographic evaluation to rule out any underlying fractures
• An ankle sprain can also be accompanied by foot injuries that, if gone untreated can lead to chronic pain or arthritis
• Functional rehabilitation of a sprained ankle should begin right away under the care of a physician.  Delayed care for an ankle sprain can lead to a delayed healing timeline or cause the sprain to not heal properly.  

Treatment for most ankle sprains include an initial period of immobilization to allow swelling, bruising, and pain to subside.  During this period of immobilization, icing, rest, compression, and elevation are typically recommended to help expedite this process.  After a period of immobilization, bracing and progression to physical therapy may be recommended, with an emphasis on proprioceptive retraining.  After an ankle sprain, the body’s ability to detect the ankle rolling and correct for this is dampened, making patients more prone to chronic ankle sprains.  Therapy to work on strengthening the surrounding musculature and the foot's ability to correct for inversion motion can help prevent further sprains and prevent the sequela of long term ankle instability.  

In severe sprains, the syndesmosis can be injured.  Often termed a “high ankle sprain,” these sprains are more severe because they affect the stabilizing ligament between the tibia and fibula.  In cases of high ankle sprains, sometimes prolonged immobilization is required, or in severe cases, surgical stabilization of the syndesmosis is required.  These sprains are imperative to catch, as allowing these to go untreated can lead to quite rapid progression of ankle arthritis.

If you have suffered numerous ankle sprains in the past and experience feelings of instability or weakness of the ankle, it is also important to be evaluated by a foot and ankle surgeon, as stabilization of these ligaments can significantly decrease pain and improve stability.  

If you suffer any form of an ankle sprain or experience chronic ankle instability, call us at Castle Rock Foot & Ankle Care, we make an effort to see trauma and sprains in a timely manner to get you back on track towards return to full function as quickly as possible!

Author

Dr. Evan Smith Dr. Evan Smith is a Board-Qualified foot and ankle surgeon, providing personalized, high-quality care to the Castle Rock community as a physician with Castle Rock Foot & Ankle Care. Dr. Smith received a Bachelor of Science degree in Biology from Illinois Wesleyan University. He then went on to earn a Doctor of Podiatric Medicine degree at Des Moines University College of Podiatric Medicine and Surgery in Des Moines, Iowa, where he received The American Board of Podiatric Medicine Graduate Merit Award. Following medical school, he completed a three-year foot and ankle surgical residency program at Legacy Health in Portland, Oregon, gaining comprehensive training in all aspects of foot and ankle surgery. Dr. Smith takes pride in connecting with his patients and providing personalized care to get patients back to the activities they love.