Ankle Sprain

Ankle sprains are one of the most common injuries. Their effects can range from mild discomfort and swelling of the area to severe instability and pain in the ankle. The ligaments on the outer side of the ankle are usually involved, although the other ligaments can also be injured.

The ligaments on the outer side of the ankle form a complex called the outer lateral ligament and support the ankle by restricting inward movement. The cluster consists of three sub-links. The smallest of the three ligaments, that is located front and outside, is also the weakest and is injured most often, when the leg turns inwards. There are also 3 different degrees of ligament injury. Grade 1 is a stretch and injury of a few ligament fibers, grade 2 involves a partial rupture and finally ,grade 3 is a complete rupture of the ligament involved.

Fortunately, most ankle ligament injuries can be treated conservatively. The use of the principles of the so-called RICE, which are the initials for Rest Ice Compression Elevation (Rest, Ice, Compression, Elevation) ensures that the injury is well treated from the initial stage. Most ligament injuries heal with this initial treatment. A percentage of patients will still have discomforts such as pain and instability, despite this initial treatment. In these cases, the assistance of a physiotherapist is often needed to help with strengthening and balance/proprioception exercises.

Proprioception is the ability of the joints to perceive their position in space. It is an important protective mechanism that prevents the joints from performing movements beyond their normal range, which can lead to injury (such as sprain, dislocation, or dislocation). The sense of proprioception is transmitted to us through the special delicate nerves located within the ligaments. When a ligament ruptures, the proprioceptive nerves that run through the ligament are also damaged, leading to reduced proprioception. This in turn, can predispose to future sprains, as our perception of the position of our joint in space decreases. Practicing proprioception is therefore crucial to reduce the risk of recurrent ankle sprains.

Pain and instability from injuries to the external ankle ligaments can also be treated by modifying footwear (i.e. wearing supportive shoes or boots), as well as, by using supportive elastic ankle straps or taping. In these cases, the goal is to provide external support to the injured ligament complex. Activity modification and analgesia may also provide relief in these cases.

The surgery is intended for patients who still have symptoms despite conservative treatments. These patients often experience pain and a feeling of instability when performing certain activities. Before surgery, an MRI or ultrasound is often performed to confirm the pathology. The surgery is called ligamentoplasty, and it involves locating the injured ligament and suturing the torn or loose fibers together. Sometimes bone anchors are used to fix the ligament. Finally, in certain cases, a synthetic ligament may also need to be used for reinforcement, which will be discussed with your surgeon.

After surgery, the ankle is usually placed in a plaster splint for a few weeks. Usually, this is replaced by a special boot, with an air chamber, before the final transition to sneakers. Physical therapy will again play an important role postoperatively, to help regain strength and movement in the joint. The return to physical activity and sports is usually decided jointly by your surgeon and physiotherapist, depending on the course of your recovery.