Ankle Sprains/Instability

Ankle Sprains

A sprain is stretching or tearing of ligaments, which connect adjacent bones in a joint and provides stability to the joint. An ankle sprain is a common injury and occurs when you twist the ankle joint. It most commonly occurs when you participate in sports or when you jump or run on a surface that is irregular. Ankle sprains can cause pain, swelling, tenderness, bruising, stiffness, numbness in the toes, and inability to walk or bear weight on the ankle.

The diagnosis of an ankle sprain is usually made with a history of injury and physical examination of the ankle. X-ray of your ankle may be needed to confirm if a fracture is present. The most common treatment recommended for ankle sprains is rest, ice, compression and elevation (RICE).

Rest : You should not move or use the injured part to help to reduce pain and prevent further damage. Crutches may be used that help in walking.
Ice : An ice-pack should be applied over the injured area. You can use a cold pack or crushed ice wrapped in a towel. Ice packs helps to reduce swelling and relieve pain. Never place ice directly over the skin.
Compression : Compression of the injured area helps to reduce swelling and bruising. This is usually accomplished by using an elastic wrap for few days to weeks after the injury.
Elevation : Place the injured extremity above heart level to reduce swelling.

The doctor may also use a brace or splint to reduce motion of the ankle. Anti-inflammatory pain medications may be prescribed to help reduce the pain and control inflammation.

You may need to use an ankle brace or wrap to support and protect your ankle during sports activities. Avoid pivoting and twisting movements for 2 to 3 weeks. To prevent further sprains or re-injury you may need to wear a semi-rigid ankle brace during exercise, special wraps, and high-top tennis shoes. A program of ankle exercises will also help to prevent re-injury by making the ankles strong and flexible.

Ankle Instability

Ankle instability is a chronic condition which usually results from recurrent ankle sprains.

Causes: Repetitive injury of the ankle ligaments is the most common cause of ankle instability. Inadequate healing of the sprained ligament or incomplete rehabilitation of the affected ligament can result in instability of the ankle. Recurrent injury of the ligaments further weakens them and aggravates the instability which predisposes the patient to additional ankle problems.

Symptoms: Pain is the most common symptom and is associated with swelling and tenderness of the ankle. There may be a persistent discomfort and instability in the affected ankle joint. The ankle is unstable and may turn repeatedly while walking on uneven surfaces or during a sporting activity.

Diagnosis: A complete medical history, including a history of any previous ankle injuries, and a physical examination is essential for an accurate diagnosis of the condition. An X-ray may be ordered to confirm the diagnosis. Other imaging tests may also be used to evaluate the injury.

Treatment: The management of ankle instability depends on the findings on physical examination and the activity level of the patient.

Conservative treatment: Conservative treatment includes physical therapy for improving the strength, balance and range of motion of the joint, bracing to support the affected ankle and prevent further sprain, and non-steroidal anti- inflammatory (NASAIDs) to reduce pain and inflammation.

Surgical treatment: Surgery is recommended in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments. Commonly used surgical procedures involve repair or reconstruction of the damaged ligament.