Some people may not think ankle sprains are that serious. However, sprains need to be promptly evaluated and treated by highly competent orthopedic specialists like those at OCC- Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado. Sprains untreated or not adequately rehabilitated, or repeat injuries all can cause chronic instability—a condition marked by persistent discomfort and a giving way of the ankle from stretched or torn ligaments. Weakness in the leg may develop and a more severe ankle injury may have occurred along with the sprain. Don’t wait until the injury worsens. Advanced Orthopedics is the place to start.

OVERVIEW

All it takes is a simple step and suddenly an ankle sprain happens. Some 25,000 people a day get ankle sprains. Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16-40% of all sports-related injuries. The injury occurs when one or more of the ligaments in the ankle are stretched or torn., causing pain, swelling, and difficulty walking. The most common ankle sprain occurs on the lateral (outside) of the ankle. Many people try to tough out an ankle sprain often saying, “If I can walk on my ankle, nothing is wrong.”  They don’t seek injury which is the worst decision they could make.

ABOUT THE ANKLE

The ankle is the joint that connects the foot to the lower leg. Healthcare providers sometimes refer to it as the tibiotalar joint or the talocrural joint. It is formed by the tibia (shinbone which is the larger and stronger of the two leg bones), fibula (the smaller bone that runs parallel to the tibia, and the talus (foot). Functionally, the ankle is a hinge joint that allows it to move in two directions: plantar flexion: down and away from the body, and dorsiflexion: up, toward the body. The ankles are made of an intricate network of ligaments, tendons, muscles, and nerves working in harmony to facilitate movement and function. The ankle is a synovial joint. Synovial joints have the most freedom to move. Slippery cartilage covers the ends of bones that make up a synovial joint. A synovial membrane—a fluid-filled sac that lubricates and protects the joint—lines the space between the bones. This extra cushioning helps synovial joints move with as little friction as possible.

WHAT IS ANKLE SPRAIN?

When an ankle twists, turns, or rolls awkwardly, it can stretch or tear the ligaments that support the ankle. Commonly—as much as 90% of the time—an injury to ankle ligaments results from an inversion sprain. This is where the foot turns inward, and the ligaments on the outside of the ankle stretch beyond a normal range of motion. These are the anterior talofibular ligaments, the calcaneofibular ligaments, and the posterior talofibular ligaments—all can be injured at the same time. And each can stretch or tear to differing degrees than the others.

Doctors usually follow a three-step grading system:

• Grade 1: grade 1 ankle sprain is the mildest. It occurs when the ligament has been slightly stretched with no tears. Often it only includes mild pain, swelling, and tenderness. The injured person can still easily bear weight and remain stable on their feet.
• Grade 2: this type of sprain usually results from a partial tear of the ligament. It can make it difficult for a patient to bear weight on their ankle without pain resulting in compromised mild to moderate joint instability, and some loss of range of motion
• Grade 3: full rupture or tear of the ligament. Along with severe pain, tenderness, bruising, and swelling, bearing weight becomes quite difficult and stability is often severely impacted by the lack of ligament strength.

A high ankle sprain vs. low ankle sprain refers to not only the ligaments involved but also the movement of the ankle that caused the injury. A high ankle sprain is an external rotation injury that injures the connection of the fibula and tibia bone in your ankle (syndesmosis). It can occur during athletic activity particularly when the ankle gets caught and the body twists around the ankle. This injury can often also hurt near the knee joint.

CAUSES

There is an endless list of causes of ankle sprains:

• Planting the foot the wrong way when running, stepping up or down, or doing everyday things like getting out of bed.
• Stepping on an uneven surface, like a hole.
• Having balance problems.
• Wearing high heels or shoes that don’t fit well. For example, if you wear shoes made for tennis while playing basketball.
• Having weak or still ankles, due to a previous injury.
• High arches that make it easier to turn on the ankle.
• Those who have weak muscles, especially the peroneal that run along the outside of the ankle and provide muscular support to the ankle may be more predisposed.
• Ankle sprains are common sports injuries, particularly in sports that require jumping, basketball, tennis, football, soccer, and cutting action. Cutting is an example of a natural repositioning movement which allows the athletes to quickly use an appropriate angle to change the path of the body.
• Stepping on someone else such as the ankle rolling when playing basketball, going up for a rebound, and coming down on another player’s foot.
• Once an athlete sprains an ankle, it increases the likelihood of injuring it again. If an athlete attempts to return to activity before the sprain has healed and stability has been restored, the risk for further injury increases.

SYMPTOMS

• Pain, especially when trying to bear weight on the affected foot
• Tenderness when touching the ankle
• Swelling and bruising
• Redness and warmth
• Instability
• Restricted range of motion including walking
• Hearing or feeling a popping sound at the time of the injury

NON-SURGICAL TREATMENTS

The first goal of treatment is to decrease pain and swelling and protect the ligaments from further injury. This usually means adopting the classic RICE regimen — rest, ice, compression, and elevation. NSAIDs such as ibuprofen may help reduce pain and swelling, but in some cases, prescription pain medications are needed to provide adequate relief. Physical therapy and rehabilitation exercises are used to improve flexibility, strength, and muscle balance. These may include range-of-motion exercises to prevent stiffness, weight-bearing exercises, and balance exercises and once pain-free, other exercises such as agility drills may be added gradually.

WHEN IS SURGERY INDICATED?

Surgery is reserved for injuries that fail to respond to more conservative treatment, and for patients who experience persistent ankle instability and pain, and pain after rehabilitation attempts. Surgery may be indicated for some high ankle sprains with instability of the ankle syndesmosis. (Five ligaments that connect  the tibia to the fibula are called the syndesmosis)

Sometimes surgery is recommended if a severe ankle sprain is associated with additional injuries, such as ankle cartilage or tendon rupture.

GETTING A GOOD DIAGNOSIS. GETTING A GOOD DOCTOR.

X-rays aren’t routinely used to evaluate ankle injuries. Ligament problems are the source of most injuries and they don’t show up on regular X-rays. X-rays may be used to check for fractures. Other imaging such as MRIs, ultrasounds, and CT scans may all help with the diagnosis of an ankle sprain. Since there are 3 different grades of ankle sprains, it is key to have a highly competent orthopedic specialist with extensive experience in diagnosing and treating ankle sprains. The skilled and accomplished surgeons at Advanced Orthopedics in Denver, Parker, and Aurora, Colorado are notable for their ability to understand and recognize the nuances between the different grades of ankle sprains and how to recognize and rule out broken bones or other serious injuries. This allows them to create the most individualized treatment plans based on each patient’s needs. With Advanced Orthopedics you’ll soon learn that a well-qualified and compassionate orthopedic surgeon can be a trusted partner in the journey to a healthier, pain-free, and more active life. Schedule an appointment today.