Ankle Sprains
The ankle joint is a complex joint consisting of three bones known as the tibia, fibula, and talus.
These three bones provide motion in four ways: plantar flexion, used when moving the foot downward away from the body; dorsiflexion, used for backward bending of the foot; inversion, turning the foot inward; and eversion, turning the foot outward. The ankle joint also works at absorbing shock as the heel strikes the ground when walking and running.
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Ankle sprains are routinely discussed based on location of the injury.
The most common sprain is to the outside ankle or the lateral malleolus of the fibula. The lateral ankle has three ligaments known as the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These ligaments are easier to sprain as they operate independently and the bony structure of the ankle provides less support to the outside of the ankle.
High ankle sprains are also seen or discussed often in sports injuries. High ankle sprains are a result of injury to the syndesmosis ligaments which help connect the tibia to the fibula. These syndesmosis ligaments are found above the ankle joint. They help stabilize the ankle especially in inversion and eversion movements. If an outside force happens to the ankle during these inward or outward twisting motions the syndesmosis ligaments can sustain injury.
The last type of injury occurs to the inside ankle and or medial malleolus of the tibia. The medial ankle is held together by a very strong ligament complex known as the deltoid ligaments. The deltoid ligaments are composed of multiple ligaments that together, form the single strong complex. This interconnected complex has high strength and is responsible for stabilizing the medial ankle. Medial ankle sprains are uncommon ankle injuries and are often noted as a result of a complex injury.
Cartilage found in the ankle joint can also be damaged during an injury. Cartilage covers the end of the tibia, fibula, and talus within the ankle joint. Cartilage allows these bones to slide past each other to form the joints. The articular cartilage in the ankle joint is thin compared to other larger joints such as the hip, knee or shoulder. Since the ankle is responsible for bearing full body weight in a smaller surface area, the ankle joint can be more susceptible to damage when compared to the hip, knee, or shoulder.
Recognizing the symptoms of an ankle sprain is essential to initiate proper treatment and prevent further damage. Common symptoms include the following:
- Pain: Often the primary symptom, which may vary in intensity depending on the severity of the sprain.
- Swelling: The affected area may become swollen due to inflammation in the ligaments of the ankle.
- Bruising: Discoloration or bruising around the ankle may occur due to damaged blood vessels.
- Limited Range of Motion: Ankle movements may be restricted due to pain and swelling.
- Instability: Some severe ankle sprains can lead to ankle instability, making walking or other weight bearing activities challenging.
- Tenderness: The ankle and surrounding area may be tender to the touch.
Diagnosis of an Ankle Sprain
When presenting with an ankle pain and related symptoms, Dr. Castelein will conduct a thorough examination to assess the extent of the injury and rule out other possible conditions. The diagnostic process usually involves the following:
- Medical History: Dr. Castelein will begin by gathering information regarding medical history, previous injuries and the circumstances surrounding the current injury.
- Physical Examination: A detailed physical examination of the ankle will be performed. This examination will assess swelling, tenderness, bruising and range of motion.
- Imaging Studies: X-ray imaging done in our office will be performed to rule out any fractures. In some cases, advanced imaging such as an MRI may be ordered to identify soft tissue injuries.
- Stress Test: To determine the severity of the sprain, Dr. Castelein may perform a stress test to evaluate the ankle stability and identify any ligament laxity.
Dr. Castelein evalues each ankle, and based on the degree of injury, may offer conservative or advanced reconstructive treatments for ankle sprains.
Physical exam provides clues to the structural support of the ankle and helps determine if an MRI is needed.
An MRI is the most informative test to order when evaluating ankle sprains. An MRI will show damage to the supporting tendons, ligaments, and cartilage of the ankle. MRIs also show inflammation within the ankle bones and assist in determining the degree of ankle sprain. The MRI will help dictate if surgical repair is required to restore the structural support of the ankle. By restoring the ankle’s ability to function, arthritis and future injury risks are minimized.
When the ankle remains structurally intact after a sprain, conservative measures are initially implemented. The RICE protocol of Resting, Ice, Compression, and Elevation helps to reduce inflammation and pain. Immobilization is an important part of the conservative treatment process as it allows for the ligaments to be in an appropriate position. Based on the degree of inflammation and injury, immobilization may include a splint, walking boot, ankle brace, or a combination of methods.
Many ankle sprains take 4 to 6 weeks of conservative treatments to heal. However, more severe ankle sprains that involve permanent ligament damage and lack structural support may not properly heal with conservative methods.
Ankle Arthroscopy Treatment for Ankle Sprains
Ankle Arthroscopy is a minimally-invasive surgical procedure that involves two small incisions to insert a small camera and instruments into the ankle joint. By using a camera the ankle joint is examined for inflammation and damage. Small instruments are used to repair the cartilage, bone, tendon, and ligaments inside the ankle joint. Arthroscopy also allows for the removal of inflamed scar tissue within the joint capsule. Patients report less scarring and a quicker healing time when comparing arthroscopy to most traditional ankle surgery methods. Dr. Castelein routinely involves ankle arthroscopy with his complete ankle treatments. Arthroscopy procedures can reduce ankle pain, improve overall ankle function and mobility, and can be used to diagnose and treat different disorders of the ankle.
Brostrom Procedure Treatment for Lateral Ankle Sprains
The Brostrom procedure is another surgical treatment method Dr. Castelein offers to restore the structure of the ankle joint. This operation involves the repair of ligaments located to the outside of the ankle joint. A small incision is made on the outside of the ankle to access the ankle joint. Dr. Castelein will then locate and tighten either the anterior talofibular ligament, the calcaneofibular ligament, or both depending on which ligaments are damaged. The Brostrom procedure effectively stabilizes the lateral ankle which improves overall mechanics and function of the ankle. Historically, the Brostrom procedure involves six weeks non-weight bearing with a total recovery time of four to six months. To improve traditional measures, Dr. Castelein also utilizes additional implants to internally support and brace the ankle’s ligaments. These implants create a seat belt like support to allow for the ligaments to fully heal during an expedited recovery time. When the implants are used, Dr. Castelein allows his patients to weight-bear in two weeks time and to return to normal activity in two months. This greatly reduces the time back to activity and provides additional protection from future injury.
High Ankle Sprains
High ankle sprains are a type of ankle injury that occurs when the syndesmosis, a group of ligaments that connects the tibia and fibula bones, is stretched or torn. This type of injury is common in high energy trauma such as car accidents or sports injuries, particularly in activities that involve sudden changes of direction or jumping. Symptoms of a high ankle sprain include pain, swelling, and difficulty walking or bearing weight on the affected ankle.
Flexible implants are a relatively new option for treating high ankle sprains. These systems involve the use of a flexible cord that is placed between the tibia and fibula to stabilize the syndesmosis while allowing for some degree of natural motion. This approach offers several advantages over traditional screw fixation, including reduced risk of implant migration or breakage and improved preservation of joint motion.
High ankle sprains can be a challenging injury to manage, but with appropriate diagnosis and treatment, most patients can achieve a full recovery and return to their normal activities. Dr. Castelein uses a variety of treatment options available to help patients with high ankle sprains achieve optimal outcomes, including the use of flexible implants such as the TightRope system.
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