Ankle Sprains

In this blog post Cypress foot and ankle specialist Dr. Christopher Correa discusses the ins and outs of ankle sprains including conservative and surgical treatments. Ankle sprains are a common injury that occurs when the ankle ligaments are stretched or torn. These injuries usually occur during any physical activity that involves sudden twisting or rolling of the ankle, particularly during weight-bearing activities such as running or jumping. Injury can also occur when stepping off of a curb or unexpected changes in the terrain when walking such as in grass or a gravel parking lot (or kids toys left around the house!) Prevention of ankle sprains involves wearing appropriate footwear, warming up properly before exercise or physical activity, and using caution when walking or exercising on uneven or unstable surfaces. To understand the different types of ankle sprains first a quick lesson in anatomy.

Ankle Ligament Anatomy

Ankle joint range of motion is maintained by a network of ligaments on both sides of the ankle which are divided into three groups.

1. The lateral ligaments, which are located on the outside of the ankle and consist of three separate ligaments: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These ligaments are most commonly injured in ankle sprains. AKA “lateral” ankle sprains.

2. The medial ligaments, which are located on the inside of the ankle and include the deltoid ligament. The deltoid ligament is a broad, duel layered ligament that actually comprised of 4 smaller ligaments blended together and are generally talked about as a single ligament. The smaller component ligaments are the posterior tiobiotalar, tibicalcaneal, tibionavicular, anterior tibiotalar. Injuries to these ligaments are less common than lateral ankle injuries. AKA “Medial” ankle sprains.

3. The syndesmotic ligaments, which are located above the ankle joint and connect the tibia and fibula bones. These ligaments are particularly important for stability during rotational movements and are commonly injured in high ankle sprains. The group of ligaments that make up the syndesmosis are the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, Interosseous ligament, interior transverse tiboiofibular ligament. Injury to this group of ligaments is known as a “high ankle sprain” and tends to have a more varied and protracted recovery vs a “low” ankle sprain.

Causes of Ankle Sprains

Ankle sprains can be caused by a variety of factors, including sudden twisting or rolling of the ankle, landing awkwardly from a jump or fall, or simply losing your balance and putting weight on the ankle in an awkward position. The most common mechanism of an ankle sprain is inversion, which occurs when the foot turns inward, causing the ankle to roll outward. This puts stress on the ligaments on the outside of the ankle, causing them to stretch or tear. Inversion ankle sprains are more common than eversion sprains, which occur when the foot turns outward, causing the ankle to roll inward and putting stress on the ligaments on the inside of the ankle. Ankle sprains can also occur from other mechanisms, such as a direct blow to the ankle or excessive twisting or bending of the ankle but these causes are far less common. The severity of an ankle sprain is usually graded in one of three levels”.

Grades of Ankle Sprains

Ankle sprains are classified into three grades based on the severity of the injury:

1. Grade 1: Mild sprain that involves stretching or minor tearing of the ligament. Symptoms may include pain, swelling, and stiffness in the ankle, but mobility is generally not significantly affected.

2. Grade 2: Moderate sprain that involves partial tearing of the ligament. Symptoms may include significant pain, swelling, bruising, and difficulty walking or bearing weight on the affected ankle.

3. Grade 3: Severe sprain that involves complete tearing or rupture of the ligament. Symptoms may include severe pain, swelling, bruising, instability, and inability to bear weight on the affected ankle.

Treatments of Ankle Sprains

Initial treatment for all ankle sprains typically involves protect, rest, ice, compression, and elevation (PRICE) to reduce pain and swelling. In more severe cases, immobilization of the ankle may be necessary to allow the ligaments to heal properly. Physical therapy may also be recommended to help regain strength, flexibility, and range of motion in the ankle. Surgery is typically not necessary for most ankle sprains, as they can usually be effectively treated with the above-mentioned methods. However, in some cases, surgery may be necessary if the ligaments are severely torn, the ankle is unstable, or conservative measures have been unsuccessful in resolving the symptoms. Surgery for ankle sprains may involve repairing or reconstructing the torn ligament using sutures, anchors, or other devices. In some cases, the surgeon may also perform a procedure to stabilize the ankle joint, such as a joint fusions or other boney procedures to restore stability. These measures may be necessary in people who have a pre-existing deformity prior to the ankle sprain such as a high arched foot.

It is important to note that surgery for ankle sprains is generally considered a last resort and is only recommended when other treatments have failed or when the injury is severe enough to require surgical intervention. Failure to stabilize an unstable ankle can cause further damage to the tendons and remaining ligaments in the ankle and lead to a more extensive surgery down the road if symptoms are ignored. The decision to undergo surgery will depend on a variety of factors, including the severity of the injury, the patient's age and overall health, and the patient's goals and expectations for recovery. Your surgeon can help determine whether surgery is the best option for your specific situation. If you suffered a recent ankle sprain or suffer from continued instability following an old ankle sprain, make an appointment with the experts at Select Foot and Ankle Specialists and take the first step toward recovery today.