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Can Ankle Sprains Lead To Chronic Injury?

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Chronic ankle pain, stiffness and other problems can result from old sprains that were not promptly treated.

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By MICHAEL SHEREFF, M.D.

Tribune correspondent

Published: January 14, 2009

A soccer player pivots sharply and hurts her ankle while moving in for a goal. A basketball player plants his foot awkwardly when coming down from a jump shot. While athletes are more prone to ankle injuries, sometimes all it takes to sprain your ankle is a slight roll or twist of the foot while walking on an uneven surface.

Ankle sprains - an extremely common joint injury - are not always minor injuries. In fact, chronic ankle pain, stiffness, weakness and other problems can result from old sprains that were not promptly treated, healed improperly or not fully rehabilitated.

Three bones meet at the ankle joint and are connected to each other by tough elastic bands of fibrous tissue called ligaments. These ligaments stabilize the joint by allowing normal motion while preventing excessive movement. Unfortunately, with severe twisting, the ligaments can stretch or tear causing a sprained ankle.

Most ankle sprains occur laterally - when the ankle rolls outward and the foot turns inward, injuring ligaments on the outer side of the ankle. Sprains are classified based on the severity of the injury. Grade 1 (mild) means the ligament stretched beyond its normal range of motion. Grade 2 (moderate) indicates a partial ligament tear, while grade 3 is a complete tear.

Symptoms of ankle sprain include pain, often accompanied by tenderness to the touch, swelling and bruising. Sometimes, you may have difficulty moving the ankle or putting weight on it. In general, the greater the pain and other symptoms, the more severe the sprain and the longer it will take to heal.

The physician may perform a test to determine whether you've ruptured the ligaments in your ankle. X-rays may be used to rule out a fracture, dislocation or other bony injury. The sooner treatment begins, the greater the chance of preventing chronic pain and other longstanding problems.

Initial treatment includes rest, ice, compression and elevation (RICE). Depending on the severity of the sprain, rest may range from limiting walking and other weight-bearing activities to using crutches with no weight bearing. Applying ice packs several times a day decreases the inflammation often associated with acute injury. Compression with an elastic bandage, brace, walking boot, cast or other ankle support prevents further swelling and immobilizes the ankle. Elevating the foot also helps minimize swelling.

After acute symptoms subside, physical therapy can help strengthen muscles supporting the ankle and restore range of motion. When you can bear weight without pain or limping, proprioceptive exercises are started to improve balance and stability when walking on uneven or slanted surfaces. A lace-up ankle brace to help prevent further injury is often recommended for rigorous walking and athletic activities.

Although most people recover without complications, a small percentage develops chronic ankle joint instability if the ligaments heal in a lax or elongated manner. This condition, marked by a "giving way" of the ankle, may lead to recurrent sprains. If conservative measures don't provide relief, surgery is occasionally needed to reconstruct the ligaments of the ankle.

Ankle sprains treated quickly and adequately usually heal without persistent problems. So if you suffer a twisting injury of the ankle, it's best to seek medical attention as soon as possible.

Dr. Shereff is professor and director of the Division of Foot and Ankle Surgery, Department of Orthopaedics and Sports Medicine, at USF Health.

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