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Chronic Ankle Sprain

Ankle sprains are a frequent injury that can affect individuals of all ages and levels of activity. Actually, they are the leading cause of missing or not participating in sports.

A sprain happens when the tough ligaments supporting the ankle are stretched past their capacity, resulting in tears. The severity of the injury depends on how many ligaments are affected, plus the extent of the damage.

Symptoms

The symptoms of an ankle sprain can vary in type as well as intensity depending on the severity of the injury. Common signs are:

  • Pain, whether at rest, during movement or when bearing weight
  • Swelling
  • Tenderness when touched
  • Bruising
  • Ankle instability or a sensation of the ankle “giving out.”

In cases of severe sprains, symptoms may closely resemble those of a fracture, hence making early medical evaluation essential.

Cause

A sprained ankle normally results from a twisting damage of the foot or ankle. In cases of severe ligament tearing, a popping sound or sensation may also be experienced. Sprains can happen suddenly during various activities:

  • Tripping or falling
  • Walking or working out on uneven ground
  • Engaging in sports that involve quick directional changes or jumping, like trail running, basketball, football, tennis, and soccer

Diagnosis

Ankle sprain diagnosis generally involves the following:

Physical exam

During a physical examination, your doctor will ask about the injury and conduct a thorough examination of both the foot and ankle. Because of swelling and inflammation, this exam may be uncomfortable and usually involves:

  • Observation: The doctor will compare the injured ankle to the uninjured one, noting swelling and bruising over the affected ligaments.
  • Palpation: By gently pressing around the ankle, the doctor can identify which ligaments are injured based on tenderness.
  • Range of motion testing: Your ankle may be moved in different directions, though swelling and stiffness may limit mobility.
  • Stability testing: To assess ankle joint stability, the doctor may carefully manipulate the ankle in controlled movements.

The severity of the sprained ankle is often determined by the degree of swelling, bruising, pain, and instability. If you experience trouble bearing weight or develop tenderness in the foot or ankle bones, further tests may be needed to exclude a fracture.

Imaging tests

Ankle sprains are mostly diagnosed through a physical examination and a review of symptoms. However, these imaging tests may be used to rule out broken bones or other injuries:

  • X-rays: These are helpful in assessing bone structure and help distinguish between a severe sprain and a fracture, as both can cause similar symptoms.
  • Stress X-rays: Taken while the ankle is being moved in different directions, these images help determine if ligament damage has caused joint instability.
  • MRI Scan: Though not necessary for diagnosing a sprain, an MRI may be recommended to evaluate surrounding cartilage and tendons, look for high ankle sprains, or investigate symptoms that persist past 6 to 8 weeks despite treatment.

Ankle Sprains Classification

Following the examination, your GP will classify the sprain based on the extent of ligament damage. This grading system helps determine the appropriate treatment plan.

Grade 1 (Mild Sprain)

  • Minor stretching and microscopic tears in the ligament fibres
  • Mild bruising, tenderness, and swelling near the ankle
  • Little to no pain when bearing weight
  • No instability detected during the examination

Grade 2 (Moderate Sprain)

  • Partial ligament tear
  • Moderate bruising, tenderness, and swelling
  • Mild discomfort with weight-bearing
  • Slight instability noted during the examination

Grade 3 (Severe Sprain)

  • Total ligament tear
  • Significant bruising, tenderness, and swelling near the ankle
  • Severe pain when bearing weight
  • Noticeable instability in the ankle during examination

Treatments Options

For mild ankle sprains, the following at-home care remedies can aid recovery.

The RICE method:

It’s advisable to start the RICE method immediately after the injury. It includes:

  • Rest: Avoid walking on the injured ankle, and do not resume sports too soon.
  • Ice: Apply ice to reduce swelling for 20–30 minutes, about 3–4 times each day. Always use a cloth or barrier to avoid direct skin contact.
  • Compression: Use bandages, ace wraps, or compression dressings to stabilise the ankle and help minimise swelling.
  • Elevation: Keep the ankle raised above heart level as much as you can during the initial 48 hours to effectively manage swelling.

Medication:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage discomfort and swelling. These medications are preferred over narcotics, as they not only relieve pain but also improve function by reducing inflammation.

Physical therapy:

  • Physical therapy exercises during the later stages of recovery (phases 2 and 3) focus on restoring strength, flexibility, and proprioception (balance) to prevent future injuries. Your therapist may recommend the following:
  • Early movement: To reduce stiffness, your GP or physical therapist will introduce gentle range-of-motion exercises that involve controlled ankle movements without resistance.
  • Strengthening exercises: As pain and swelling subside, exercises will be incorporated to strengthen the muscles and tendons that stabilise the ankle. If weight-bearing exercises like toe raises are painful, water-based exercises may be suitable. Resistance exercises will be introduced as tolerated.
  • Proprioception (balance) training: Improper balance can increase the risk of recurrent sprains as well as ankle instability. Balance exercises (such as standing on the injured foot with the other foot raised and eyes closed) can help. Balance boards are commonly used to improve stability.
  • Endurance and agility movements: After the pain subsides completely, agility training can be introduced gradually. Exercises such as running in increasingly smaller figure-eight patterns help build ankle strength, improve balance, and enhance overall agility. The goal is to regain full strength and movement range while preventing future injuries.

Surgical treatment:

Surgery for ankle sprains is uncommon and often considered only when nonsurgical treatments fail. It may be recommended for:

  • Persistent ankle instability and discomfort despite conservative treatments and months of rehabilitation
  • High ankle sprains along with instability of the ankle syndesmosis
  • Severe sprains involving additional injuries like cartilage damage or tendon rupture

Types of ankle sprain surgeries are:

  • Arthroscopy: This is a minimally invasive procedure where a small camera (arthroscope) is inserted into the ankle joint. Tiny devices are used to take out loose bone or cartilage fragments and any damaged ligament tissue trapped in the joint.
  • Repair/reconstruction: The torn ligament may be repaired using stitches or sutures. If reconstruction is needed, the damaged ligament is replaced with a tissue graft taken from surrounding ligaments or tendons in the foot and ankle.

Prevention

Maintaining good balance, strong muscles, and flexibility is key to preventing ankle sprains. To reduce your risk, follow these precautions:

  • Warming up properly before exercising or engaging in physical activity.
  • Strengthening your ankle muscles with targeted exercises to improve stability.
  • Being mindful of your surroundings when running, walking, or working on bumpy surfaces.
  • Wearing appropriate footwear that provides adequate support during activity.

Summary

Ankle sprains are common but treatable injuries that, with proper care, can heal effectively. Early diagnosis, appropriate treatment, and rehabilitation play a major role in restoring ankle strength and stability.

If you have persistent pain, swelling, or instability after an ankle injury, it’s important to seek professional evaluation to ensure a full recovery. Schedule an appointment with our specialists today for a comprehensive assessment and personalised treatment plan.