Ankle sprains are one of the most common injuries that occur in the body. Athletes playing sports make up part of the millions of people each year who sprain their ankle, as well as people simply walking on uneven ground, stepping into a hole, slipping on ice, or awkwardly stepping off of a curb. Ankle sprains can run the range from simple to severe, with some sprains feeling fine after a few days to others with pain lasting well over a month. Ankle sprains are one of the most under treated types of foot and ankle injuries, and these seemingly simple injuries can often have long term effects on the health, function, and stability of the ankle as a whole.
An ankle can be injured when it rolls either inward or outward. The ankle is bound together on either side by strong straps of tissue called ligaments. The ligaments on the inner side of the ankle are particularly strong, and rarely get injured. The ligaments on the outer side of the ankle are considerably weaker, and therefore it is easier for the foot to roll inward under the ankle during an injury, which then cause the outer ligaments to either stretch or tear. There are three total ligaments on the outer side of the ankle, and the severity of the sprained is defined by how many ligaments were injured, and whether there was simply a stretching of the tissue or an outright tear. Whether stretched or torn, an ankle sprain can pave the way for future sprains to more easily occur because of the looseness of the tissue that follows such injuries. While tears are certainly more unstably, stretch injuries can also lead to ‘loose ankles’ that have a higher chance of re-injury, and even an elevated chance of that injury causing a fracture in the ankle. Unfortunately, even simple sprains can also have additional injures dealt to the foot by the force of the sprain injury, which may go unrecognized or mixed in with the pain of the sprain itself. These can include muscle strains in the leg or foot, sprains of smaller joints in the foot, microscopic fractures in bone, nerve stretching injuries, and tendon strains. It is not uncommon for these additional injuries to be missed even in an emergency room, where sprain care is basic and concentrated on making sure a fracture is not present. These additional injuries may be subtle at first or simply painful with the sprain, but over time can gradually lead to secondary areas of pain, further foot or ankle instability, arthritis, weakness, or loss of some sensation (if a nerve was damaged).
Because of the long term implications of ankle sprains and their associated secondary injuries, it is recommended sprains be evaluated by a physician, with a strong preference towards a foot and ankle specialist well trained to recognize all the subtle elements that make up these injuries. Early appropriate treatment can be vital to ensuring the ankle passes through the injury period intact and healthy. Examples of early intervention includes stable ankle bracing, early therapy and mobility exercises, as well as a guided return back to activity. this level of treatment can make a world of difference between an ankle that stays healthy and strong, and one that becomes chronically weak. As the after-effects of a sprain may take years to fully appear, the notion of being ‘tough’ and ignoring the sprain in the hope it will simply heal on its own is unwise, especially when professional care for these injuries is so easily available.
Scott R. Kilberg DPM 