Ankle Sprains &
Chronic Ankle Instability
What are ankle sprains and why do they occur?
The ankle has many ligament complexes connecting and stabilizing the bones that make up the ankle. These ligaments can become sprained (i.e. stretched or torn) following acute trauma. Two of the most commonly sprained ligament complexes are the Anterior Talofibular Ligament (ATFL), located on the outside of the ankle, and the Deltoid Ligament, located on the inside of the ankle. Sprains of these ligaments are called “Low Ankle Sprains” and usually result from “twisting” or “rolling” the ankle. Ligaments higher up between the two lower leg bones (tibia and fibula) can also be sprained (Anterior and Posterior Tib-Fib ligaments), often referred to as high ankle sprains. High ankle sprains tend to be the most serious of the ankle sprains and usually take the longest time to recover.
Symptoms:
Patients most commonly report pain, bruising, and swelling of the ankle. While some people experience significant pain and inability to walk, some people may surprisingly experience only minimal pain and range of motion deficits. Patients with complete tears often complain of instability.
Although some ankle sprains may be minor, patients should be vigilant about seeing a doctor right away and determining the extent of injury. Ankle sprains which remain untreated can lead to further ankle sprains, chronic ankle instability, and cartilage defects if not initially treated correctly.
Diagnostic Testing
An x-ray is usually ordered to rule out fracture. An Ultrasound or MRI may be ordered to further evaluate the extent of ligament tearing if suspected.
Treatment Options
The treatment of ankle sprains depends on the extent of the injury as well as the age and activity level of the patient. There are three grades of ankle sprains based upon the extent of damage done to the ligament. Grade 1 sprains are minor and mean that the ligament has been overstretched. Grade 2 sprains are moderate sprains which may include partial tearing of the ligaments. Patients with Grade 2 sprains may or may not experience ankle instability. Grade 3 sprains are the most severe and involve a complete ligament tear. Patients with Grade 3 tears usually experience significant instability.
Grade 1 and 2 sprains are generally treated nonoperatively. Patients are usually instructed to modify their activity and wear an ankle brace to support the ankle. The ankle brace may be an aircast splint (cushioned piece of plastic that supports each side of the ankle) or an ASO brace (soft lace-up brace that wraps around the ankle). Patients are usually able to wear their own shoes with these ankle braces.
Dr. Lee often chooses to place patients with Grade 3 sprains into a walking boot for up to 6 weeks. Patients may be advised to remain non-weight bearing using crutches or a knee scooter for a period of time. Patients will usually be transitioned into an aircast or ASO brace one they have progressed far enough along in the healing process.
A 6-week course of physical therapy is usually prescribed to reduce swelling, improve range of motion, and increase ankle strength. The importance of physical therapy can’t be stressed enough. Patients who forego therapy are at increased risk for additional ankle sprains and chronic ankle instability.
Surgical Treatment
Surgery is usually only recommended for the most severe tears, in patients who have had 2 or more ankle sprains, or in patients who have suffered concomitant cartilage damage. Surgery is minimally invasive and involves performing an arthroscopy first to view and fix any joint damage, followed by making a relatively small incision into the skin overlying the ankle ligament. The ligament is then tightened, repaired, and strengthened using Internal Brace Technology. Dr. Lee is a pioneer and world authority in Internal Brace technology, which is now a technique being employed in professional athletes to weekend warriors. Read more about Internal Brace technology here.
Learn more about scheduling surgery.
Recovery Expectations
Those undergoing Internal Brace surgery can expect to remain immobilized in a short-leg splint (rises to the level of the calf) and non-weight bearing with crutches for the 1-2 weeks following surgery. Patients are then usually transitioned into a walking boot where they are allowed to weight bear as tolerated. Patients are usually transitioned out of a walking boot and into an aircast or ASO brace at 4 weeks. Physical therapy is usually started at this time as well in order to improve range of motion and strength. Patients are usually allowed to return to sports 6-8 weeks with a small brace following surgery. Patients treated with Internal brace technology can expect to return to sports 4-6 weeks sooner than those undergoing standard repair of the ligament without Internal Brace technology.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.