One of the most common complaints that I see clinically is ankle pain or a feeling of the ankle being unstable. Patients will make comments like "my ankle feels like it just gives out. " Often times when I ask if they have had any ankle injuries they respond that they played sports and have sprained their ankles many times.  Undertreatment of ankle sprains by patients, athletic trainers and frankly physicians has created many patients with long term pathology.  This problem has been worsened by increasing pressure on young athletes to compete at high levels all year round.

The most common ankle sprain is an inversion type of sprain,  so for the purpose of this blog post I will focus on this type of sprain. This occurs when the ankle rolls outward.  The outward motion puts strain on the  ligaments on the outside of the ankle.  We call these collectively the lateral ankle ligaments.  The specific names of the three ligaments in order of rates of injury are anterior talofibular, calcanenoefibular and  posterior talofibular.  

Ankle sprains can cause serious acute and chronic complications.  Acutely ankle sprains cause swelling, bruising, pain and removal from sports and other activities.  There are many chronic complications as well.   Research has shown that ankle sprains frequently lead to various pathologies including chronic instability, cartilage injury and syndesmotic injury.  Again, for sake of brevity this post will focus on instability only.  

Chronic ankle instability comes in two forms.  The first is what we call frank instability and the second is called subjective instability.  Frank instability is actual physical  instability and subjective instability is the perceived instability.  Often ankle injuries cause both frank and subjective instability. Both types affect patients during ambulatory activities and both are treated differently. The occurrence of instability can be lessened with proper care after  the sprain.  Athletes and patients in general tend to ignore an ankle sprains and use the take it easy approach.   A recent study in the journal Foot and Ankle Specialist has found that 23.4 % of division 1 college athletes had ankle instability.  The same study demonstrated a slightly higher rate for high school athletes. Many of these will be patients heading to the operating room in the future to stabilize their ankle ligaments.

Ankle sprains need to be treated as a serious injury to reduce downtime and prevent long term problems.  It is vital to be seen by a foot and ankle specialist who is trained in the subtleties of possible injuries and how to best treat them.  This will likely require some sort of support brace,  sometimes offloading and almost always  physical therapy.  A good therapy program is vital.  Casual therapy with just electric stimulation is not adequate. This injury requires a skilled therapist to work on reducing pain and swelling, preserving function, stability and treating the subjective instability as well. I refer these patients out to trusted therapists as they have the equipment and facilities to best treat this condition. 

As mentioned above, it is important to get evaluated by a foot and ankle specialist after an ankle sprain, but here are some tips  for immediate care.  First, stop activity.  Second, Ice and elevate the ankle.  Third, provide compression with an ace bandage.  Doing these things will keep swelling down and reduce recovery time.  Next time you want to rule out your injury as just a sprain, remember its not just an ankle sprain.



Bryan Molen