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Dr. Baravarian discusses ankle sprains and why not to ignore them.
Ankle Sprain & Chronic Ankle Instability
Ankle sprains often occur while participating in sports, walking on uneven surfaces, or just awkwardly planting the foot.
A sprain is an acute injury that can happen in the blink of an eye and typically occurs when the foot is twisted or turned out of its normal range of motion.
The most frequent type of sprain is called an inversion sprain, which occurs when the outer ligaments stretch or tear as the foot is rolled outward, with the sole facing inward. Less common is a medial sprain, which is when the foot rolls inward and overstretches the inside ankle ligaments.
What are the symptoms of an ankle sprain?
Ankle sprains are one of the most common injuries for children and adults alike. They are also the most under-treated. Repetitive sprains and untreated sprains can result in re-injury and long-term pain, which is called chronic ankle instability. These are very serious and can cause a lifetime of issues, and sometimes can only be repaired with surgery.
For this reason, it is crucial to have any ankle sprain injury evaluated by a specialist.
Typical symptoms of a sprained ankle include:
- Ankle pain and swelling on the outside of the Ankle and foot.
- Some patients can’t place their foot on the ground without pain.
- The injured area becomes bruised and discolored.
- There can be a feeling of imbalance as well; it may feel as though the Ankle can roll again at any time.
- You may also experience locking or clicking of the Ankle when it is moved.
Diagnosing the severity of a sprained ankle?
After suffering for months from an ankle sprain that didn’t heal, Cynthia is feeling relief from just a few sessions of physical therapy.
Your doctor will likely take X-rays in the office to determine if there are any fractures or bone chips from the ligament tear, which are not uncommon. In some, usually chronic cases, special stress x-rays are taken to determine the amount of dislocation.
Occasionally, an MRI is needed to provide an enhanced image of the ligaments, tendons, and cartilage of the joint to determine the true extent of your injury.
There are three grades of severity for sprained ankles:
Grade 1 Sprain – Mild
The ligaments are only slightly stretched, marked by swelling and soreness in the injured ankle.
Grade 2 Sprain – Moderate
There is a small tear in the ligament that loosens the ankle joint. The ankle appears swollen, and patients experience pain, as well as difficulty putting weight on it.
Grade 3 Sprain – Severe
A severe sprain is a complete tear of the ligament. There is considerable pain and swelling. The ankle will feel very weak, and patients will be unable to put any weight on the foot at all.
As we mentioned earlier, repeated sprains of the same ankle can lead to what we call a “chronic ankle sprain.” Chronic ankle sprains can cause pain for months, or even years, after the initial trauma, flaring up whenever the patient tries to play sports, dance, or exercise.
High ankle sprain
A high ankle sprain occurs when you tear or damage the high ankle ligaments that connect the tibia to the fibula. High ankle sprains occur when the foot is flexed, and the ankle turns inward or outward. Most low ankle sprains happen when the ankle rolls inward, while other low ankle sprains happen when the ankle rolls outward. The low ankle sprains don’t involve the high ankle ligaments. Low ankle sprains are what most of us think of when we hear someone has a sprained ankle.
Treatment for ankle sprains
If you may have an ankle sprain, call your foot and ankle specialist. You may be asked to schedule an appointment for a closer examination, or your doctor may be able to give you a home treatment plan.
While the treatment options will depend on the severity of the injury, many ankle sprains can be successfully treated at home within 4-6 weeks with attentive care and rest.
RICE method
- Rest. Avoid putting weight on the foot as much as possible, especially for the first week. Limit walking, and use crutches or a scooter to get around.
- Ice. Use ice to reduce swelling. Wrap a bag of ice or an ice pack in a paper towel and apply it to the ankle immediately after the injury. Apply ice to the sprain for 15-20 minutes every 3-4 hours for the first couple of days after the injury.
- Compression. Your doctor may splint the ankle or recommend an elastic wrap to limit the joint’s motion and compress the area around the injury. Compression helps your ligaments to heal and prevent further injury.
- Elevate. Prop the leg up at or above the level of your heart
Ankle brace
If there is minimal damage, a simple lace-up ankle brace will be used for weight-bearing. An elastic bandage can also be used to immobilize the joint and provide support to the ankle.
Physical therapy
Physical therapy is often crucial to a successful recovery from an ankle sprain. A physical rehabilitation program can be the difference between a fully healed ankle and chronic ankle instability.
Successful physical therapy is not only for reducing swelling and inflammation, but also with the vital strengthening exercises you learn. Physical therapy plays an essential role in reconnecting the patients’ minds with their physical apparatus.
Medication
For pain relief, you can use nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
Immobilization
Grade 3 sprains usually require complete immobilization in a cast or a boot. This helps ensure the ligaments have enough time to heal before they are used again.
Surgery
In rare and very severe cases, your foot and ankle specialist might recommend surgery. An arthroscopy is performed through a small incision near the joint. The doctor inserts a narrow, flexible camera into the incision and makes the necessary repairs.
It is essential to remember that proper protection of the ligament after a sprain, combined with active physical therapy, will result in a better long-term outcome. Even with adequate protection and bracing, 30% of ankle sprains can have secondary factors leading to pain. These include chronic ankle instability from loose ligaments, tendon tears, cartilage damage, and scar tissue in the ankle joint. These problems can cause ankle instability, pain, and swelling that often require surgical correction.
Preventing ankle sprains
Some ankle sprains simply can’t be prevented. Here are a few tips for keeping your ligaments safe and strong:
- Take caution on slippery or uneven surfaces.
- Stretch before and after athletic activities: prepare your body and muscles for the activity. Changes in your activity level increase your risk of injury.
- Balance: Improving balance will improve your ability to control your body in all types of positions
- Strength training: the stronger the muscles that support the ankle, the less likely you are to suffer a sprain
- Wear well-fitted shoes, appropriate for your activity
- Avoid sudden turns and changes in direction during athletic activities
- Be aware of the surface on which you walk, run, or jump
- Taping and bracing to support the ligaments
When ankle sprains turn into chronic ankle instability
It’s estimated that roughly 30% of individuals will develop some level of chronic ankle instability after the initial lateral ankle sprain occurs due to under-treatment of the injury.
Chronic ankle instability is a condition characterized by a feeling of the ankle “giving way” during normal activities. It is often caused by a previous ankle injury that did not fully heal or was not properly rehabilitated. People with chronic ankle instability may experience pain, swelling, weakness, and difficulty walking or participating in sports. Treatment typically involves physical therapy, strengthening exercises, and, in some cases, bracing or surgery.
Why is Dr. Baravarian the best choice for heel pain in the Los Angeles area?
Dr. Baravarian is at the forefront of foot and ankle care and surgery. He offers a comprehensive range of care, including conservative treatments, a spectrum of diagnostic imaging services, MRI and CT scanning, and dedicated foot and ankle physical therapy.
Dr. Baravarian is a nationally recognized expert in the treatment and correction of overuse injuries and foot deformities that lead to heel pain. He is at the forefront of treatment and research and is committed to offering state-of-the-art surgical and non-surgical foot and ankle treatments. He regularly teaches his techniques to foot surgeons worldwide.
By offering a full range of workup, conservative, surgical, and recovery options, Dr. Bob genuinely takes care of you in a state-of-the-art manner without requiring you to go from one place to another.
To schedule a consultation, please call (855) 557-5400 or make an appointment now.
Dr. Bob Baravarian is conveniently located in Los Angeles, near Cedars-Sinai Medical Center, providing expert foot and ankle care for patients throughout Southern California.
