Ankle sprains are commonly treated in the high school or college athletic training room as well as in our office. Sprains occur when the ankle twists in an abnormal position or gives out after stepping on an uneven surface, landing from a jump awkwardly, tripping on the stairs, etc. One may often hear a pop or snap surrounding the ankle. Ankle sprains are often characterized by swelling and discoloration which occurs when ligaments are stretched and/or torn beyond their limits.
All ankle sprains should be considered serious until proven otherwise and should be given immediate attention and care. It is important to perform a detailed examination by a health professional such as an athletic trainer, physical therapist, sports doctor or foot and ankle specialist. Often times, patients with ankle sprains report to our office several weeks after having sustained an injury. Unfortunately, the ligaments failed to heal or have healed stretched out predisposing one to another sprain the next time the foot hits an uneven surface.
If you someone you know have sustained an ankle sprain or have ankle pain, it is important to prevent the ankle problem from getting worse. We take x-rays in our office to determine the presence of a possible fracture or avulsed portion of the bone or ligament. We treat ankle sprains with immediate immobilization via certain soft cast and/or taping techniques. This positions the ankle so the ligaments can be reapposed and proper healing can occur within about three weeks. Alternatively, a brace and/or a cast boot may be utilized to immobilize the ankle. We believe in "active rest", which means that we protect the ankle from further harm, yet allow for early range of motion to help reduce swelling. This has been shown to speed up healing and return one faster to activity without jeopardizing the ankle ligaments.
Sometimes, lingering swelling is a deterrent to healing of the ankle and fluid from the ankle joint may need to be painlessly withdrawn in our office. Once this swelling is eliminated, proper ankle motion and strengthening exercises may begin.
If pain continues over a longstanding period of time, there may be a hidden problem, which needs to be addressed. It has been reported that 5% to 7% of all ankle sprains require advanced specialty care. Our foot and ankle specialists take the time to perform stress x-rays of the ankle in our office. This reveals how loose the ligaments are by manual stressing the ankle and recording this on x-rays. The results obtained by this testing help determine which procedure to perform and how tight to make the ligaments during the reparative process. Ankle ligaments are primarily repaired and augmented with either ones’ own soft tissue grafts or with newer advanced ligament supplementation devices. MRI testing prior to surgery helps uncover additional hidden sources of pain. Tendon tears may accompany ligament injuries. They are often repaired and reinforced with absorbable allografts to help make them strong, so full recovery is gained. If ankle joint pain is present, then ankle arthroscopy is performed at the same session as the ligament or tendon repair.
Many of our patients have failed conservative care and travel from other states seeking our specialty care. We have published articles as well as performed hundreds of ankle ligament repair surgeries with astonishing results. Our athletic patients are back in competitive sports usually within three months after surgery. Should you require care of any ankle injury or for an ankle stabilization procedure, please do not hesitate to make an appointment at our office for a thorough and extensive examination.
Written by Richard T. Braver, DPM, FACFAS
