Ankle Sprains and Instability
By Grant Gonzalez, DPM, Foot & Ankle Center of Illinois
Over one million people visit an emergency room or prompt care for ankle injuries per year, and the majority of these incidents are the result of a sprain. An ankle sprain generally involves an injury to the ligaments that stabilize the ankle, and connect the ankle to the foot. The lateral collateral ligaments on the outside of the ankle are considerably weaker than those on the inside of the ankle, and they are most often damaged during inversion types injuries, which occur when the ankle rolls outward, and the foot rotates inward under the ankle. A “high” ankle sprain is an injury to the ligaments that secure the tibia to the fibula.
All ankle sprains result from a varying degree of damage to the lateral ankle ligaments, and these can be graded in severity on a scale of one to three. Grade one sprains result in only a stretch of the lateral ligament complex, but since there is no actual tear, the ankle joint remains stable. Conversely, in a Grade two injury, one of the ligaments are torn, which results in mild instability of the ankle joint. Subsequently, Grade three injuries involve a rupture of all of the lateral ankle ligaments. This results in moderate to severe instability of the ankle, and can also be associated with damage to the joint cartilage. Treatment in the acute phase varies according to grade, and ranges from simple bracing, or wearing a walking boot to compression cast immobilization for a short period of time — to control pain and swelling.
The majority of ankle sprains, even those that result in immediate instability, heal uneventfully with conservative measures. Immobilization followed by physical therapy and rehabilitation are successful treatment for over 80 percent of cases. There are, however, a certain number of these injuries that result in chronic lateral ankle instability, of which there are two types: mechanical and functional.
During some injuries to the lateral ankle ligament complex, the nerves and receptors that help with balance and proprioception can be damaged, even when the actual ligaments themselves heal uneventfully. This results in a lingering feeling of instability, especially when the sufferer has his or her eyes closed; and this is known as functional ankle instability. Treatment involves bracing, which activates the receptors with pressure to give the patient’s ankle a better feeling of spatial awareness. Physical therapy and balance training can be used to recondition the receptors, and eliminate the feeling of instability; and often results in complete resolution of symptoms.
Conversely, a second type of chronic ankle instability can be truly mechanical. This results when the ligaments do not heal properly, and settle in a lengthened, lax position, which truly results in an unstable ankle. The peroneal tendons that run along the outside of the ankle then have to work harder to externally stabilize the ankle, and this often results in tendonitis from overuse. The talus, the bone that sits on your heel bone and connects the foot to the ankle, is not properly supported, and can rock forward, resulting in impingement at the front of the ankle, which causes pain — and eventually osteoarthritis. Conservative treatment can be attempted to strengthen the tendons supporting the ankle, and prevent further injury; and an ankle brace can be worn to support the ankle in lieu of the lax ligaments. Surgical intervention is often warranted if pain persists, and arthritic changes begin to develop.
Ankle sprains are a very common injury, especially during intense sporting activities that require sharp turning, cuts, and lateral movement, such as basketball, football, soccer, and tennis. Damage to the ankle ligaments is normally treated conservatively, and is largely successful — especially when correct rehabilitation is instituted. Proper monitoring by an experienced foot and ankle surgeon is recommended in order to ensure lateral ankle instability does not develop; and if it does, corresponding treatment can be efficiently set in motion.
Call 217-787-2700 to schedule a consultation with Dr. Gonzalez or Dr. Sigle at the Foot & Ankle Center of Illinois for ankle sprains and ankle instability. The Foot & Ankle Center of Illinois has clinic locations in Springfield, Decatur, and Carlinville, IL. This is the only podiatry clinic in central Illinois that offers innovative MLS Laser treatments for ankle sprains. Visit myfootandanklecenter.com to view a short video on the laser technology that is used by several NBA, NFL, MLB, and intercollegiate sports programs used to treat athletes.
Photo credit: Maridav/iStock
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