Ankle Sprain Prevention & Treatment FAQ

‘Ouch!’

A thought we’ve all likely had at some point in our lives as we witness yet another individual fall (often literally) victim to the notorious injury we’ve come to know and love as a ‘sprained ankle’. Whether it’s a professional football player, weekend warrior, or everyday Jane/Joe stepping awkwardly off a curb, ankle sprains can prove to be a challenging pathology for patients to cope with.

Despite them being relatively commonplace, many patients lack a comprehensive understanding of the mechanics of an ankle sprain and the implications on prognosis and recovery. Expanding this understanding can help individuals set expectations and identify actionable items to expedite a return to their desired activities. Let’s take a moment to answer your most frequently asked questions about ankle sprains from the experts at Rothman Orthopaedics,and in doing so, set you or someone you love up for success in case of future injury.

What is an ankle sprain?

In order to actually understand what an ankle sprain is, it is helpful to first understand the fundamental anatomy of an ankle sprain. There are four ligaments in the ankle, and these fibrous-bands of tissue connect bone to bone, subsequently providing stability to the joint. If and when these ligaments are stressed beyond their capacity, they can stretch or tear, ultimately yielding a sprained ankle. The diagram below illustrates the most common mechanism of injury and progressive stages of ligament compromise

Now that you know what an ankle sprain is, how do you know when you have sustained this type of injury? There must be some sort of precipitating event i.e., fall, twist, etc. followed by an acute onset of symptoms. Some of the most common symptoms include, but are not limited to: pain (sharp/throbbing), swelling, and instability.

How Are Ankle Sprains Treated?

Most ankle sprains can be effectively treated through conservative measures, meaning of course, no surgical intervention. A simple mnemonic to remember some of the staples to treatment at home is: RICE

- Rest

- Ice

- Compression

- Elevate

Obviously, there will need to be an adjustment period in terms of activity level after sustaining an ankle injury, and often times resting it from high impact activities for a week or so may be necessary. The efficacy of icing can’t be overstated. Intuitively it makes sense to place the ice directly on the injured ankle and while this may work, it’s not necessarily the most effective. Using the pack of ice behind the knee addresses the problem more upstream, which means everything else downstream benefits. This will reduce inflammation in the foot and ankle, thereby leading to a reduction in pain. Compression with an ACE bandage assists with forcing swelling back towards the heart, which simultaneously mitigates pain and facilitates healing. Lastly, elevating the ankle above the level of the heart makes it more challenging for the leg to swell.

When to see your doctor?

If no progress is being made after employing conservative measures, including the aforementioned RICE therapy in tandem with anti-inflammatory medication, a trip to your Rothman physician may be warranted. Here in the clinic, a proper evaluation can be performed, leading to an accurate diagnosis and consequently optimal chances of healing. A comprehensive physical examination and imaging studies (X-rays/MRI) are utilized in order to lend the physician insight into the underlying pathology.

When to consider surgery?

In severe cases, more aggressive conservative therapy or even surgical intervention may be necessary for a sprained ankle in order to bring healing to the injured ligament or ligaments. To stratify this further, there are high ankle sprains and low ankle sprains, or above the level of the ankle and below the level of the ankle, respectively. There are two different sets of ligaments, each either associated with a high sprain or a low sprain. Colloquially, we can refer to these as the syndesmotic ligament and lateral ligamentous complex, the former compromised in high ankle sprains and the latter with low sprains.

The most common perpetrator in the setting of an acute ankle injury is the syndesmotic ligament which serves to tether the tibia and fibula together. This is a formidable tissue that is challenging to injure, however, once insulted can be quite difficult to recover from. Initially, this may be treated conservatively with immobilization in a cast or walking boot for about six weeks, followed by physical therapy for rehabilitation. However, if this does not yield resolution, surgically repairing the ligament directly may be required in order to restore quality of life and return to desired activities. During the typical procedure, a screw is placed between the fibula and the tibia to hold the bones in their proper positions while the ligament heals. Like in the case of a conservative approach high ankle sprains, a period of immobilization and rehabilitation is extremely important after surgery to ensure the best possible outcome.

On the other hand, the lateral ligamentous complex is more traditionally associated with multiple, repeated low ankle sprains. This can lead to chronic instability and pain which may in turn lead to additional injuries incurred. In other words, a vicious self-amplifying cycle of sorts if not properly addressed. This type of pathology can be addressed through a surgical approach involving reconstruction of the torn ligaments and fortifying further with the placement of something called an internal brace. As with all surgeries, there is a post-operative period requiring immobilization and intensive physical therapy to retrain and regain ground previously lost.

How can ankle sprains be prevented?

There are a number of steps that you can take which will help to minimize your risk of a sprained ankle. These include:

•Warming up prior to exercising

•Exercising additional care when walking on uneven surfaces

•Wearing shoes that fit properly and are appropriate for current activity

•Avoiding sports for which you are not properly conditioned

•Practicing stability training and balance exercises

•Maintaining strength and flexibility

The value provided by physical therapy cannot possibly be overstated, both with respect to prevention and rehabilitation of ankle sprains.

Where can I get the best treatment?

If you or someone you love does experience a sprained ankle, it is important to find an experienced foot & ankle physician with the appropriate resources at their disposal. At Rothman Orthopaedics, you will find a team of such specialists working together to provide patients with the best possible diagnosis, treatment, and rehabilitation.

Dr. Christopher L. Reeves is a nationally recognized, board certified Podiatric Foot & Ankle Surgeon who has been serving Central Florida since 2004.He provides comprehensive care for all ages and conditions affecting the foot and ankle and has specialized training and interest in complex reconstruction, lower extremity trauma, and total ankle replacement.