sprained ankle

A sprained ankle is an injury caused by a twist of the ankle, either inwards (inversion) or outwards (eversion).

The most common method of injury is usually found in plantar flexion (toes pointed down) and inversion. This is a very common injury and is important to note that 90% of patients recover very well without surgery.

Sprained Ankle Symptoms

Initial sprained ankle symptoms of bruising and swelling can be painful and severe, therefore it is important to present to your doctor for initial investigation. This will usually include an x-ray and an ultrasound. You may require crutches initially, and your doctor may recommend that you either use a compression stocking to control your pain & swelling, or a walking cast.

Dayton Orthopedic Surgery can assess your sprained ankle in-house, for far less money than the Emergency Department! Call to schedule a same-day X Ray.

To reduce swelling & bruising, the mnemonic RICE (Rest, Ice, Compression & Elevation) is important. It can take anywhere up to 2 weeks or more for the symptoms to settle.

X-ray findings for a sprained ankle are usually normal, or may reveal small avulsion. An ultrasound report can also find ruptures of ligaments such as the ATFL and the CFL. Despite this, many ankles go on to recover well.

A sprained ankle is usually diagnosed clinically, or with the initial x-ray and ultrasound. The only reason to perform and MRI would be to exclude other injuries within the ankle that do not appear to resolve after 4-6 weeks.

After the initial pain and swelling settles down, your doctor will advise you to gradually increase your ankle’s range of motion with simple flexion and extension exercises. You can then gradually increase the amount of weight you place on your sprained ankle. If you were prescribed an ankle brace or walking boot, your physical therapist will help you build the immobilized muscles back up to full strength.

Depending on the severity of your injury, it can take up to 6 weeks or more to recover from a sprained ankle, and sometimes up to 3 months before you can return to sport.

The most common reasons your surgeon would recommend surgery would be:

  1. There is other pathology within the ankle as a result of the sprain that requires surgery
  2. Ongoing pain, likely due to chronic inflammation & scar causing impingement within the ankle joint
  3. Chronic instability or frequent giving way of the ankle

Ankle Instability

Ankle instability is a condition causing recurrent ‘giving way’ of the ankle, usually into inversion.

This condition develops after repeated sprained ankles that have not been treated or rehabilitated appropriately. It can also be linked to ligamentous laxity or particular soft tissue conditions causing your ligaments to be stretchier than normal.

This condition can be particularly debilitating as you gradually lose trust and confidence in your ankle. You may feel particularly unstable initially on uneven ground or when playing sports, progressing to instability even when doing normal activities of daily living. Each ankle sprain will progressively weaken your ligaments, resulting in greater loss of confidence and increased instability.

This instability can clinically be proven when your doctor examines your ankle and notices increased tilt of the talus (ball joint of the ankle) and also increased laxity to pulling your ankle anteriorly (anterior drawer). 
This can be further confirmed by an ultrasound that reveals chronic tears or absence of the ligaments that stabilise the ankle.

Your doctor may order an MRI to exclude any other concomitant pathology within the ankle. Repetitive sprains to the ankle can sometimes cause damage to the cartilage within the ankle joint and it is important to identify these if surgery is required, as these can be addressed simultaneously.

Treatment for chronic ankle instability is the same as an acute ankle sprain, Rest Ice Compression Elevation, followed by gentle exercise and/or physical therapy to improve proprioception and balance in the ankle. Wearing a brace can also help to increase stability and proprioception to the ankle.

Occasionally your surgeon will recommend surgery when non-operative measures have failed or there is other additional damage within the ankle requiring attention. Stabilizing the ligaments is usually done through an open approach on the lateral (outside) aspect of your ankle, where your surgeon will identify the torn or lax ligaments, and tighten and repair them up to the fibula, using sutures, or anchors – which are special screw-like devices with sutures within them.

You may be placed into a plaster cast or walking boot while the ligaments repair themselves, and there may be a period of non-weight bearing to allow the wound to heal. After that, you are encouraged to allow gentle range of motion of the ankle. Once the ligaments are healed, ongoing physical therapy is encouraged to continue strengthening the ligaments and to obtain adequate range in the ankle.