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Ankle Instability and Ankle Sprains

By Timothy Chen, DPM, Podiatry
The Chester County Hospital

Published: July 13, 2009

Ankle sprain is a very common injury. Most ankle sprains are minor and have no long-term effects. However, if your ankle is swollen and painful for more than three days, you may have stretched or torn the ankle ligaments.

The ankle works in a systematic way. Generally, the ankle joint is only supposed to move in one plane - in other words, up and down. The ankle joint is held in place securely by a group of bones that house the main ankle bone (Talus). On the inside is the medial malleolus and on the outside is the lateral malleolus.

The inward and outward movements of the back of the foot do not actually occur in the ankle joint but occur in the joint underneath it called the subtalar joint. The muscle that pulls the foot inward (inversion) is slightly stronger than the muscles that pull the foot outward (eversion). When the foot rolls inwards, it creates stress on the outside ankle ligaments. A sprain is actually a tear that occurs in the outer supportive ligaments of the ankle. As these ligaments are stretched, a critical point is reached beyond which ligaments do not return to their normal elastic function and a tear of the ligament occurs. Sprains can range from the relatively minor to those where the ligaments are completely torn.

The acute sprain of the ankle is commonly associated with marked swelling and bruising on the outer side of the ankle. Rest of the ankle with immobilization immediately is critical. The classic treatment for a sprain of the ankle is rest, ice, compression and elevation. This treatment is designed to decrease the inflammation and swelling of the ankle associated with the sprain. In order for the ankle ligaments to heal, the ankle needs to be immobilized with either a cast or a boot. For minor sprains, a brace can be applied to the ankle. Depending on the severity of the injury, walking is usually permitted during this recovery process.

Following this period of initial immobilization, strengthening exercises are essential to regain the balance of the ankle. It is critical that the tendons and muscles on the outside of the ankle (peroneal tendons) are strengthened. This should be done initially in a supervised exercise program. If the ligaments have been severely torn, the ability to fine-tune the ankle and prevent further sprains from occurring depends on the strength of the peroneal muscles. Multiple ankle sprains weaken the peroneal muscles' ability to prevent injury.

As a result, the ability to fine-tune the foot on uneven surfaces becomes limited. The inability for the foot to adapt to uneven terrain increases the likelihood of a frequent severe ankle sprain. This chronic recurrent instability of the ankle is at risk of developing other problems. These include bruising of the cartilage of the talus and bone spurs that develop around the ankle joint. These are all precursors of ultimate arthritis of the ankle.

Once the diagnosis of the extent and severity of the ankle instability is made then a treatment plan can be initiated. A strengthening program is helpful before proceeding with surgery. Fortunately, most ankle sprains are successfully treated conservatively.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009