ANKLE

Sprains & Instability


The ankle is held together by three main ligaments. The two lateral ligaments stop the ankle sliding forward and rolling from side to side. They are attached to the fibula (the small bone next to the shinbone) and the talus (the anklebone).

When the ankle is violently twisted or forced beyond its normal range of movement, the ligaments can easily become stretched or torn. This is known as a sprain.

If your ankle doesn't heal properly after a sprain, or you sprain your ankle repeatedly, you may end up with chronic ankle instability. The resultant constant swelling in the ankle can cause a reflex in the body that 'switches off' the muscles around the joint, which reduces the stability even more.

If the ankle does not respond to non-surgical treatment (orthotics, supportive footwear, physiotherapy), surgery is recommended.

How does it feel?

There is a sensation that your ankle is going to give way, especially on uneven ground. Your ankle will frequently turn during activity, causing pain, inflammation and swelling. You may have almost constant swelling in the ankle.

What Is An Ankle Sprain?

An ankle sprain (also known as a lateral ankle ligament sprain) is the most commonly occurring injury to the ankle. During weight bearing activity (walking, running or jumping) the ankle and foot move inwards, towards the mid-line of the body, more than the stabilising structures allow, thus resulting in injuries to these structures. Most commonly it is the lateral ankle ligaments and the lateral ankle joint capsule which are torn.

Bleeding into the joints itself is common after this injuries and this can lead to chronic inflammation setting up in the soft tissues within the ankle joint known as synovitis.

What Symptoms Might I Have With An Ankle Sprain?

The symptoms following an ankle sprain are pain, swelling and subsequently bruising which may effect both sides of the joint. Additionally, it is not unusual to find it painful to put weight through the joint and the joint may also feel immediately unstable. Pain on attempted weight bearing after a presumed ankle sprain is something which requires immediate medical review.

Treatment of Ankle Sprain

There are four ways available to manage an ankle ligament sprain/rupture. These are either to do nothing and simply wait for the ankle to settle. Secondly, to immobilise the injured ankle in a plaster cast for a period of 4-6 weeks, walking as comfortable. Thirdly, to use functional rehabilitation to treat the sprained ankle (a graded physiotherapy programme, often combined with a removable ankle brace). The final option is to operatively repair the injured ligaments.

The Aircast airsport brace
The Aircast airsport brace

When is an Operation Appropriate After an Ankle Sprain or Ligament Rupture?

Operative intervention is used for two sets of symptoms, which may co-exist. These ongoing symptoms following an ankle sprain are either pain at the level of the ankle or instability from the ankle.

At arthroscopy any areas of loose cartilage or inflamed tissue (synovitis) or scar tissue (arthrofibrosis) can be removed from the joint.

Synovitis
Synovitis before and after removal with an arthroscopic shaver.
If ankle instability is also a problem following ankle sprain then the ligaments may or may not need to be repaired as well.

Image © Primal Pictures