Ankle Instability and Ankle Sprain Treatment

Ankle Sprain Treatment

Every day 25,000 people sprain their ankle and more than 1 million people a year visit the emergency room due to an ankle injury. Although half of all ankle sprains are caused by athletic activity ankle injuries can happen to anyone at any age not just athletes or weekend warriors. There are different kinds of ankle injuries including sprain, ankle strain, and ankle fracture.

Conceptual model of ankle sprain

What Is the Difference Between a Sprain, Strain, and Fracture?

There are several different kinds of tissue in the ankle including bone, ligament, and tendon. The injury is defined by which type is damaged. Three different bones meet at the ankle (tibia and fibula from the leg and talus from the foot) when one of these bones is broken it is considered a fracture. Ligaments are what hold the three bones together at the ankle joint. A sprain is when these ligaments are torn from being stretched past average range of motion. The type of sprain can range from a minuscule tear to a full rupture. A tendon is what connects the muscle to the bone. When either the tendon or the muscle is pulled or stretched too much it causes an ankle strain. If the tendon is overused or has a sudden trauma it can result in an acute tear and or inflammation. This is referred to as tendinitis.

What Are the Causes?

There are many different causes for an ankle injury. All result in an ankle joint being moved or twisted too far out of its normal position. Although many injuries are a result of athletic activity that is not the only cause of an ankle sprain or strain. An injury can be caused from something as simple as walking on uneven sidewalk or wearing faulty footwear such as high heels, clogs, or sandals. Other common causes are:

  • Falling or tripping
  • Landing improperly after a jump
  • Walking or running on rough, loose surface
  • Sudden collision
  • Turning or twisting of the ankle
  • Rolling the ankle
  • Biomechanical predispositions combined with muscle weakness

What Are the Symptoms and Signs of an Injury?

Conceptula model of ankle fracture

With a sprain and a fracture the symptoms are very similar; often fractures are mistaken as sprains. This is why it is important to see a doctor as soon as you show signs of either. Some of the signs are pain (usually sudden and severe), swelling, bruising, and the inability to weight bear on the injured spot. If it is a fracture the injured area will be sore to touch and the ankle will look deformed. If it is a sprain the area will be stiff. The amount of pain can also range depending on the severity of the sprain. Tendinitis and acute tears will also results in swelling and pain in the ankle, the area will also feel warm. These will also cause weakness and instability of the foot and ankle. If any of these signs or symptoms is experienced contact a medical professional immediately.

What to Do while Waiting to See a Doctor?

If you cannot see a physical therapist or doctor immediately there are things you can do to reduce the pain and chances of injuring the ankle further. First step is to rest and keep weight off the ankle. Then apply ice within the first 48 hours of the injury. This will keep the swelling down. Do not apply for more than 15 to 20 minutes at a time and wait at least 40 to 45 minutes in between icing. The ankle should also be compressed by wrapping it with a bandage or brace. This will keep the ankle from moving and becoming injured further. Finally keep the affected ankle elevated in order to reduce swelling. Again it is really important to treat this injury as soon as possible because ignoring an ankle injury can cause long term problems not just about the ankle but anywhere in the locomotor system.

How Is an Ankle Injury Diagnosed?

The first step in diagnosing an injury is a physical examination. The doctor will check the nerves and arteries around the injured area to assure that they have not been damaged. The entire leg including the knee will be examined as well to ensure no damage was done to the rest of the leg. Also checked during the exam is the Achilles tendon. Following the physical exam the doctor will either order an X-ray or MRI depending on what type of injury the doctor suspects. Diagnostic ultrasound is another alternative to MRI when it comes to sprain injuries.

Diagnostic imaging at NYDNRehab

At NYDNRehab we use high resolution ultrasonography to diagnose foot and ankle disorders. Hi resolution ultrasonography is superior to MRI for imaging of: muscles, tendons ,ligaments, bursa , retinaculum and small effusion. The important advantage of ultrasonography over MRI and Xray is in its ability for dynamic imaging which is critical for foot and ankle disorders. Other advantages of ultrasonography are: no radiation exposure and being readily available at the facility of the examining clinician rather then a referral to a diagnostic facility.

 

Why Rehabilitation after Ankle Injury Is so Important?

Most people think that ankle sprain is a trivial injury and it would just heal on its own.

However, current research dictates otherwise. Ankle strain / strain should be renamed into ankle sprain syndrome. Here is why. Ankle injury is the most dangerous injury unless it is properly and fully rehabbed. Ankle ligaments, capsule and tendons contain large amount of proprioceptors. Proprioceptors are nerve ending receptors which allow the brain to recognize the position of the limb in space during gait cycle and other movements. With trauma this important sensation is lost and brain is confused as to how to activate the right muscles. The gait cycle is disturbed, the balance is disturbed and so is stability up the chain into the spine. This most trivial injury is very often the initial cause of many pain syndromes in human muskuloskeletal system. 50% to70% of patients with this diagnosis have residual symptoms after 18 month. Out of those 20 % will go to develop CAI (chronic ankle instability) and another twenty will have subclinical ankle instability(AKA functional instability), which will affect the rest of kinetic chain resulting in movement compensations somewhere up the chain as far as the shoulder.

A computerized image of structure of human's leg and foot

What Is the Treatment Plan Following a Diagnosis?

Ankle Injury Treatment

The type of ankle injury treatment and recovery time depends on the type of injury and the severity. For an ankle fracture there are surgical and non-surgical options of treatment. If the ankle is stable the doctor will put a cast on in order to immobilize the ankle and allow it to heal properly. However if the ankle is not stable it needs to surgically be treated. The recovery for a fracture is at least six weeks because that’s how long it takes for a bone to heal. Once the doctor says it is okay to move the ankle physical therapy is needed.

A computerized image showing how foot pain originates

Ankle Sprain Treatment

If the diagnosis is a sprain the treatment depends on how severe the injury is. There are three different levels of severity mild, moderate, and severe. For a mild sprain the first step in treatment is rest, icing, compression, and elevation. Following that the doctor will recommend starting to put weight on the ankle and also to begin with mobility exercises. This will allow the ankle to strengthen and stretch. Moderate ankle sprain treatment requires serious rehabilitation from 8-10 weeks. Ankle strength, proprioception, range of movement as well as balance and equal weight distribution must be achieved, otherwise there is a moderate chance of developing recurrent ankle sprains and ankle instability. Most patients who have not diligently rehabbed moderate degree sprain will go on to develop so called subclinical instability (functional instability. In case of severe sprain there is a complete or partial tear of the ligaments around the ankle. This means that the ankle must be completely immobilized until the ligament heals. Following that at very serious long term rehab should be carried out.

A woman during CAREN rehab procedure

Ankle Strain Treatment At DNR

With all treatments the physical therapy needed has to address proprioception, gait training, balance, strengthening, stability, mobility and weight bearing.

Being that we are a full gait and motion analysis lab at DNR we see many implication of sprained ankle to locomotor system. This is especially important in athletes and people who run. With our advance technology we can track how to relate the past injury and its effect to musckuloskeletal system. We have developed specific protocols for treatment of ankle instability and chronic subclinical ankle sprains. Ankle sprain treatment should be functional and is very important for sensory-motor function of the rest of the moving apparatus.

Please see our latest technology for rehabilitation of ankle instability


New evidence based and award winning test for ankle stability. Courtesy Maarteen Prins PT PHD

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