It can be difficult to tell when your ankle is sprained and when it’s broken. A broken ankle—a fracture—is an injury to bone, whereas a sprain is injury to a ligament, one of the tough fibers that connect bones to each other. It may not matter at the time—all you know is that your ankle hurts and you can’t walk well or at all—but a sprained versus a broken ankle has big implications, both for your treatment as well as your future ankle health.
Chronic Ankle Instability
Sprained ankles beget more sprained ankles. Once the lateral ligament complex—the most often damaged group of ligaments in an ankle sprain, which stabilizes the ankle joint and prevents excessive side-to-side movement—becomes damaged and loosened, it has a harder time holding the foot and ankle steady. This leads to a condition known as chronic ankle instability, where your ankle becomes sprained much more easily.
About 20 percent of people who sprain their ankle go on to develop chronic ankle instability. At Summit Medical Group, we can help you avoid becoming a part of that 20 percent, or getting out of that demographic if you already have chronic ankle instability.
How Ankle Sprains Happen
Ankle sprains almost always happen from “rolling” the ankle. The sole of the foot is normally flat on the ground; when you roll the ankle, the sole is turned toward the other leg, with the inside edge of the foot pointing up. This movement is called supination.
The three ligaments of the lateral ligament complex are meant to resist that type of supination. The problem is that they become weaker every time they are damaged. A previous ankle sprain is one of the biggest risk factors for subsequent ankle sprains.
Diagnosing Ankle Pain
An ankle fracture and an ankle sprain have very similar symptoms: pain, swelling and difficulty or inability putting weight on the injured joint. I’ll start by obtaining a medical history and physical exam. The physical exam is to confirm the pain and try to measure the degree of the injury. In a medical history, I’m looking for more information about any recent injuries. If the patient describes rolling his or her ankle, I’ll suspect an ankle sprain.
Internally, the two injuries are very different, and this is where imaging studies come in handy. I’ll start with an X-ray. X-rays are excellent for visualizing bone, so they are the best way to determine—or rule out—a fracture.
If the X-ray shows no fracture or is inconclusive, I’ll usually order an MRI as the next step. MRIs, or magnetic resonance imaging, use a powerful magnetic field and computer processing to depict a person’s internal structures. MRIs are better than X-rays at showing soft tissue such as ligaments or tendons.
Nonsurgical Treatment for Chronic Ankle Instability
People with chronic ankle instability have a variety of both surgical and nonsurgical treatments. Conservative management is usually attempted first; most people don’t jump straight into surgery.
When a patient comes to me after the second, third or fourth sprain, the first thing I’m going to prescribe is strengthening that ankle joint through physical therapy or a supervised exercise program. That mostly means building up the muscles surrounding the ankle, but strengthening the muscles will also strengthen the tendons and ligaments—called connective tissue—to some degree as well.
Some of my favorite strengthening exercises for the lower legs include:
- Heel raises
- One-legged exercises
See this document for a variety of ankle stretches and strengthening exercises.
Other conservative treatments include:
- Resting the afflicted ankle
- Applying ice a few times a day
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
Lateral Ligament Complex Surgery
If the ankle does not respond to more conservative methods, it’s time to consider surgery. In some cases, we’ll be able to repair the damaged ligaments with sutures. In other cases, though, we will have to reconstruct the ligament using one of two methods.
The first reconstruction method is known as a Brostrom reconstruction. This method uses other connective tissue from the patient’s own body to build a scaffold over the damaged ankle ligaments. Eventually, the body will use this scaffold to build new tissue. A very popular and effective form of this surgery, called a modified Brostrom or Brostrom-Gould technique, uses a ligament from the hand to further reinforce the ankle.
The other method is called an allograft, and it works like a Brostrom procedure except the tissue used is from a cadaver.
Ankle repair and reconstruction are usually outpatient procedures done arthroscopically, with small incisions, small tools and a flexible camera called an arthroscope attached to a video monitor. This reduces trauma to the surrounding area and shortens recovery time. After the surgery you’ll have a boot on to protect and immobilize the ankle but you will be able to walk immediately.
If you have experienced more than one ankle sprain, you may have chronic ankle instability. Schedule an appointment with me or another foot and ankle specialist to discuss your treatment options.