The ankle joint is a hinged joint and allows up and down movements. Either side of the ankle joint are strong ligaments. These give the joint stability. The ligament on the inside (deltoid ligament) is injured in severe ankle fractures. It is rarely injured in sporting activities. The ligament on the outside of the ankle (lateral ligament complex) is made of three bands and is commonly injured with sporting activities. Ankle sprains usually involve twisting the foot inwards and stretching the lateral ligament complex.
An MRI scan may be requested to confirm the diagnosis and assess the severity. It can also diagnose damage to nearby joints and tendons.
For the majority of people the symptoms of an ankle sprain usually settle with self care within 2 to 3 months.
The first line of treatment is to rest and take the weight off your injured leg for a day or two. Ice packs may help to relieve the pain and reduce the swelling. Make an ice pack by wrapping ice cubes or a bag of frozen peas in a towel and apply the ice pack for 10 to 30 minutes. Do not apply ice directly to the skin as it may damage the skin. A compression stocking or strapping may help to reduce swelling and support the ankle. Elevating your leg will also help reduce the swelling. Gentle exercises to your ankle are recommended when comfort allows.
Following a severe sprain or if symptoms persist physiotherapy usually helps to improve your symptoms. Exercises concentrate on strengthening the ankle muscles and also on improving ankle balance.
Insoles supporting your foot or an ankle brace supporting your ankle may help your symptoms.
If the non-surgical treatments do not help then surgery maybe an option. Occasionally the lateral ligament complex may fail to heal properly resulting in weakness and ankle instability. Damage to surrounding joints or tendons may cause persistent pain and swelling. The surgical treatment depends on the severity of the lateral ligament injury and damage to surrounding structures.
There are two types of surgery for the lateral ligament complex injuries. One involves tightening up the ligaments and re attaching them. The other involves using a nearby tendon to replace the ligaments.
This surgery is usually done under general anaesthetic. You may be able to go home that day or may require an overnight stay in the hospital. These decisions depend on your health and social situation. A decision will be made with you.
After the surgery your leg from will be in a cast or splint below the knee to your toes for 2 to 6 weeks depending on the severity of ligament damage. It is important to keep your foot elevated. This reduces the swelling and helps the wound heal. You will be seen at approximately two weeks to have the wound reviewed. When you come out of your cast or splint physiotherapy will be arranged.
If takes six months for the ligaments to heal and usually a year to recover from the surgery. Light exercise (jogging) can start at 3 months. Contact sports (squash, football) can start at 6 months.
With any surgical procedure there is a chance of a complication. Every effort is made to minimise the possibility. The complications include:
Long term pain: For this reason surgery is not done for cosmetic reasons.
Instability: A few patients continue to have instability after surgery.
Infection/Wound Breakdown: Infections may settle with antibiotics but if serious surgery maybe required. Smoking increases your risk.
Swelling: Most swelling resolves but some may have permanent swelling.
Scar pain: A scar can be painful and sensitive. When the wound has healed and is dry, gentle massage with skin moisturise is recommended.
Numbness or Tingling: Usually this resolves but it may be permanent.
Blood clots: The risk of a blood clot in your calf (deep vein thrombosis) or lungs (pulmonary embolus) is rare after this surgery. Please inform the team if you have had one of these previously as this increases your risk.