Ankle sprains are common injuries that usually recover without problem. Rest, ice, compression and elevation for a few days, followed by a gradual return to activity, will usually be sufficient. If pain is severe and walking is very difficult, early assessment by a medical practitioner may be warranted to rule out serious injuries like fractures or tendon ruptures.
First time injuries may take as long as two months before function returns to normal. Recovery can often be hastened by a supervised training programme working with a physiotherapist or trainer.
Occasionally however, problems remain. The commonest complaints are of persistent pain, and instability. These may range from difficulties with sports, to pain or instability even when walking.
A careful history and thorough physical examination is the most important part of assesment. This often includes an inspection of shoes and footwear, which give a clue to possible problems and abnormalities in gait. For athletes, an understanding of training and competiton schedules is important when formulating a treatment plan.
Often, x-rays will be done as a basic level of assessment. Occasionally, more detailed examinations such as ultrasound or MRI scans will be helpful.
In situations where diagnosis is difficult, diagnostic injections can be helpful.
- Most commonly, persistent instability is due to the tear or stretching out of the lateral ligaments of the ankle.
- Dislocation or subluxation of the peroneal tendons
- Muscle weakness or nerve injury
- Pain from a structure in the ankle that inhibits the muscles that support the ankle
- Deformities of the foot or ankle.
- Osteochondral fractures or bruises of the talus
- Early ankle arthritis or loose bodies
- Tears of peroneal tendons
- Sinus Tarsi
Many of the causes of ankle pain can be treated by an arthroscopic or ‘keyhole’ surgery technique.
The MRI scan in Image 2 demostrates an osteochondral lesion (damage to the bone and cartilage) in the talus bone. This can be a source of a chronic dull ache deep within the bone that is often aggravated by activity.
Treatment may include removal of the unhealthy cartilage and ‘microfracture’ to stimulate new cartilage growth. Larger osteochondral lesions can be repaired with bone-cartilage or artificial transplants and even cartilage cell culture and repair.
Most cases of instability can be traced back to a tear or ‘stretching out’ of the lateral ankle ligaments. These ligaments can be repaired using a small incision.
The ligaments are stitched back together in the proper position. Immediately after surgery the foot has to be placed in a cast for about 4 weeks.
After that, another two or three months of therapy will ensure the maximal benefit of the surgery and allow return to sports.
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