Ankle sprains are the most common injury seen in the emergency room. Sprains can happen without warning from an unnoticed curb or a slight hole in a grassy area of the yard. A history of previous ankle sprains tends to result in worse subsequent sprains if not properly treated at the time of injury.
Three ankle ligaments on the outside of the ankle are susceptible to sprains. The ligament in the front is the most often stretched or torn in a sprain. The middle ligament is sprained only during more serious injuries. The third ligament rarely tears. Treatment is first aimed at aggressive immobilization to allow ligament healing followed by aggressive mobilization using physical therapy for strengthening and improvement of function.
Improper ankle sprain healing
Several weeks or months after an initial injury the protective tendons on the outside of the ankle can become painfully affected by scar tissue and can be rather resistant to standard treatments. A therapy that works well is using a combination injection consisting of a steroid to atrophy the scar tissue that is the real culprit, lidocaine for comfort and a dye that shows up on X-ray. The steroid atrophies scar tissue already in place and discourages the continued formation of scar tissue. Usually a single shot will work when this tendon injury is caught early.
The other ankle ligament that can have delayed pain and scar tissue is deep within the outside of the ankle, and when injured causes sinus tarsi syndrome. This short squat ligament can heal poorly resulting in painful scar tissue as well and can easily be overlooked in the course of treatment until it starts causing delayed pain resistant to the standard treatments. Various chip fractures can also occur at the time of injury.
Repetitive ankle spraining
The final problem associated with ankle sprains is that of reinjury or even progression to chronic ankle spraining. For six months following a sprain you are at an increased risk of reinjury because the protective nerve endings on the outside of the ankle take the longest to heal. When there is significant injury to these nerve endings, physical therapy needs to be tailored to reeducate the protective function of the nerve.
Ankle fractures can be fixed on-site with the anesthesiologist present. Fractures where there is less than 2mm of space between the broken bone ends tend to heal OK without surgery. If the gap between the bone fragments is larger, putting the bones back in anatomically correct position greatly decreases the incidence of later ankle arthritis and cartilage degradation.
Posted by Mark A. Kuzel, DPM, FACFAS on March 16, 2010