Acute and Recurrent/ Chronic Ankle Sprains

Ankle sprains are one of the most common injuries that occur. When we talk about ankle sprains, typically we are talking about an inversion ankle sprain where the foot twists inward underneath the ankle. When this happens, damage occurs to the lateral ankle ligaments and there can also be medial ankle ligament and intra-articular cartilage damage that occurs.

In the acute setting of a severe ankle sprain, radiographs are used to evaluate for any fractures around the ankle or in the cartilage of the joint. If the ankle joint mortise is maintained well, these are treated with immobilization in a Cam walker boot for 3 weeks. Ice and ibuprofen is helpful in this stage to try to keep the swelling and inflammation to a minimum. After 3 weeks, we typically transition people into an ankle brace and start physical therapy and rehabilitation exercises.

The most important thing with a standard ankle sprain is to work on doing the exercises to try to strengthen the ligaments and tendons around the ankle joint as much as possible. Most of these exercises consist of stabilization and balance training to help increase proprioception that we know is lost after an ankle sprain.

When patient's suffer from a high ankle sprain, this means they have also damage the syndesmotic ligament which is the ligament that holds the tibia and fibula together. This can cause long-term problems in the ankle joint and lead to arthritis in the ankle if it is not addressed. On higher-level athletes we typically recommend surgically stabilizing this to try to allow them to return to activity as soon as possible.

The other issue with ankle sprains is that the cartilage in the ankle joint is often damaged. This is better visualized with an MRI if patients have an ankle sprain that does not seem to improve and get better with conservative measures. We address articular cartilage damage in the ankle joint minimally invasively through arthroscopy. Treatments for this can include a synovectomy where we remove the inflamed tissue, microfracture of small cartilage defects, or stem cell replacement cartilage on larger cartilage defects.

If patients suffer from recurrent ankle sprains, this happens because the lateral ankle ligaments are no longer as tight as they are supposed to be. When the lateral ankle ligaments are attenuated, or chronically stretched out, the ankle will roll and sprain much more easily. We can treat this surgically with several different procedures, but the most common is called a Broström lateral ankle stabilization. In this procedure we used several anchors with suture material to repair the chronically torn ligaments and tighten the ankle joint so that ankle sprains are much less likely again.

When patients have had chronic ankle sprains for years and have not had this surgically addressed, they are at much higher risk to develop ankle arthritis. When arthritis in the ankle becomes severe, the treatments for this are typically cortisone injections, ankle replacement surgery, or ankle fusion. Ankle replacement surgeries have advanced in the last 10-15 years and are used now to help provide a much better functional outcome for most patients if they develop end-stage arthritis of the ankle.

If you suffer from an acute ankle sprain or chronic ankle sprains, your expert Colorado Springs foot and ankle surgeon team is here to help you. The whole team at Foot and Ankle Institute of Colorado is expertly trained to treat you with the most up to date treatments available to try to get you back to activities as soon as possible. Call us at 719-488-4664 today!

Author
Dr. Matthew Hinderland Board Certified Podiatrist and Foot and Ankle Surgeon

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