What is an Ankle Sprain?
A sprain is the stretching or tearing of ligaments, which connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs when you suddenly fall or twist the ankle joint or when you land your foot in an awkward position after a jump. Most commonly it occurs when you participate in sports or when you jump or run on a surface that is irregular.
What are the Symptoms of an Ankle Sprain?
Ankle sprains can cause pain, swelling, tenderness, bruising, stiffness and inability to walk or bear weight on the ankle.
How are Ankle Sprains Diagnosed?
The diagnosis of an ankle sprain is usually made by evaluating the history of the injury and physical examination of the ankle. X-ray of your ankle may be needed to confirm if a fracture is present.
What are the Treatment Options for Ankle Sprains?
The most common treatment recommended for ankle sprains is rest, ice, compression and elevation (RICE).
- Rest: You should not move or use the injured part in order to reduce pain and prevent further damage. Crutches may be ordered to limit weight-bearing while walking.
- Ice: An ice-pack should be applied over the injured area up to 3 days after the injury. You can use a cold pack or crushed ice wrapped in a towel. Never place ice directly over the skin. Ice packs help to reduce swelling and to relieve pain.
- Compression: Compression of the injured area helps to reduce swelling and bruising. This is usually accomplished by using an elastic wrap for a few days or weeks after the injury.
- Elevation: Place the injured ankle above your heart level to reduce swelling. Elevation of an injured leg can be done for about 2 to 3 hours a day.
Dr Maor may also use a brace or boot to reduce motion of the ankle. Anti-inflammatory pain medications may be prescribed to help reduce the pain and control inflammation.
What is the Rehabilitation for an Ankle Sprain?
During your recovery, rehabilitation exercises are recommended to strengthen and improve range of motion in your foot. You may need to use a brace or wrap to support and protect your ankle during sports activities. Avoid pivoting and twisting movements for 2 to 3 weeks. To prevent further sprains or recurrence of injury, you may need to wear a semi-rigid ankle brace during exercise, special wraps and high-top lace shoes.
Surgical intervention to reconstruct the injured ligament may be considered in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments.
Ankle Ligament Reconstruction Procedure
The aim of surgery is to stabilise the ankle by repairing or reconstructing the damaged ligaments. Restoring normal ankle joint biomechanics helps to prevent damage to the joint from recurrent sprains, and ultimately minimise the risk of post-traumatic ankle arthritis.
Ankle lateral ligament repair surgery is performed though a small curved incision over the tip of the fibula. The torn ligaments are identified, shortened and repaired to their anatomical position on the fibula. This is usually achieved using bone anchors and strong sutures. Once the ligaments have been repaired solidly, the incision is sutured up and a local anaesthetic block is given to provide pain relief after the procedure.
Patients with other ankle joint problems such as joint surface damage (chondral or osteochondral lesions), synovitis, bone spurs or loose bodies in association with ankle instability may also require an ankle arthroscopy performed at the same time as the ligament repair.
At the end of the operation, a bulky dressing is applied and the leg is placed in a walking boot or plaster.
The surgery is usually performed as a day procedure.
Dressings should remain dry and intact until review by Dr Maor two weeks after surgery. The boot is usually worn for two weeks, and a brace may be required for several weeks thereafter. Physiotherapy rehabilitation is a very important part of the post-operative recovery, and is usually started at two weeks once the wound has healed.
Time to return to work and sport is dependent on the type and severity of any associated ankle joint problems, as well as the type of work or sport. Dr Maor will be able to evaluate this and provide some guidelines prior to surgery.
What are the Risks and Complications of Ankle Ligament Reconstruction?
Apart from general complications associated with the anaesthesia. Specific complications of ankle ligament reconstruction include infection, nerve damage, ankle joint stiffness, and recurrent instability.