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Treating Ankle Sprain: What Works—and What Doesn’t

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Every day, there are an estimated 30,000 ankle sprains in the United States. In fact, sprains account for 75 percent of all ankle injuries. While most ankle sprains resolve themselves with no long-lasting effect, approximately 20 percent to 40 percent progress to become chronic (ongoing) problems.

The ankle depends on particular ligaments and muscles to stay stable. The most common ligament-related ankle injuries involve the ligaments on the outside of the ankle. These are called the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL).

It is important to note that ankle sprains are often not just ligament injuries; there can be injuries to other structures surrounding the ankle. Injuries that can occur following an ankle sprain include tendon tears, chip fractures off of a bone or in the ankle joint, and cartilage damage.

If you experience a sprain, it is important to be thoroughly evaluated by a medical professional—such as a podiatrist (DPM)—to ensure that all of the structures around the ankle are in working order. If an ankle sprain is left untreated, it may lead to a chronically unstable ankle joint and, from there, to degenerative and arthritic changes in the ankle, as well as chronic tendon inflammation. It may also feel as if the ankle is constantly trying to give out, which can, from there, cause a re-injury of the ankle.

There are several things you should never do if you have an ankle sprain:

Don’t “walk it off” and continue playing. Severe sprains should be immobilized and should not be played on after injury. Playing on an ankle sprain may lead to further injury of the ankle ligaments.

Don’t ignore it. The highest risk factor for future sprains is a history of a prior sprain. This is especially true in sprains that were not treated. If they’re left untreated, sprains will often cause the ankle to become unstable, which can lead to chronic pain, swelling, instability and, ultimately, arthritis.

Don’t delay treatment. Sprains should be immobilized quickly, with the ankle ligaments in a stable position. This enables the ligaments to heal in the correct position while the injury is fresh and the body is sending inflammatory and growth factors to heal the sprain. Any delay in treatment may result in the ankle ligaments stretching and becoming lax, which can lead to an unstable ankle. Other injuries that occur at the same time—such as tendon tears and cartilage injuries—should be promptly diagnosed as well to get appropriate treatment going as soon as possible.

After a sprain, take these steps to ensure the quickest and most complete recovery possible:

Have the injury evaluated by a medical professional, such as a podiatrist (DPM). After an initial look at the injury, your doctor may order an X-ray to rule out any associated fracture. Occasionally, an MRI is helpful in order to see if the injury includes a tendon tear or damage to cartilage. A prompt and accurate diagnosis of your injury will aid in its healing.

Rehabilitate the ankle. Physical therapy is important after any sprain to help strengthen the ankle. Special exercises—called proprioception exercises—are especially important to help train the muscles to stabilize the ankle. This involves balance exercises, such as standing on the injured ankle alone and using a wobble board.

Immobilize the ankle. It is important to immobilize the ankle properly in order for the ligaments to heal in a tight and stable position. If not, the ligaments may heal in a lax position, leading to chronic ankle instability and further injury.

An ankle sprain may seem like just one of those things that happens now and then, but if it isn’t treated promptly and appropriately, what appears to be a small injury can lead to chronic ankle instability—and it may eventually cause arthritis and other ailments. Don’t hesitate to ask for medical help for ankle sprain, and don’t neglect rehabilitating the injury to ensure a strong, stable and healthy ankle in the future.

Sydney K. Yau, DPM, is a podiatrist with the University Foot and Ankle Institute of Simi Valley and is on the medical staff at Simi Valley Hospital.