Foot and Ankle Injuries

Prepared by Dr. Thomas I. Sherman

ANKLE SPRAINS
A sprain is an injury to ankle ligaments - the structures responsible for holding the ankle in the appropriate alignment. Depending on the position of the foot and the motion of the body, different ligaments may be injured. The most commonly affected ligaments are those on the outside or lateral aspect of the ankle. The typical mechanism by which these occur is rolling the ankle with the foot pointed down and inward. The severity of the ankle sprain is dictated by multiple factors, the most important of which is the energy imparted by the injury to the ankle.

• GRADE I SPRAIN
  Recovery process = 2-10 days

• 2ND DEGREE SPRAIN
  More severe
  Excessive abnormal motion of the ankle
  Difficulty with impact activities
  Recovery process = 10-30 days

• 3RD DEGREE SPRAIN
  Severe swelling
  Instability of the ankle
  Inability to bear weight
  Recovery process = 1-3 months
  Severe swelling
  Instability of the ankle
  Inability to bear weight
  Recovery process = 1-3 months

Regardless of the severity, the initial treatment should consist of PRICE therapy:

Protection, Rest, Ice Compression, and Elevation.
It is vital to protect the ankle from further injury by avoiding pain inducing activities. With severe sprains, immobilization of the ankle in a boot may be required. Rest is essential to allowing the ankle to heal. Ice will help decrease swelling and reduce pain. This should be done 10-20 minutes every 1.5 to 2 hours for the first 2 to 3 days. Compression and elevation help reduce swelling.

If there is difficulty bearing weight and/or significant swelling and pain, medical attention is required to ensure there is no fracture (break in the bone) by taking X-rays. Medications to decrease inflammation may be prescribed. Finally, referral to a physical therapist may be required to facilitate an expedient recovery. Focus is typically given to restoring balance and strength. Return to play is recommended when normal motion is restored, strength is regained, and impact activities are no longer painful. Consideration may be given to taping or bracing the ankle during the initial return to play period. 

Sometimes the sprained ligament does not heal property, and the ankle continues to remain unstable despite following the typical rehabilitative process. When this is the case, surgery is required. Here, the ligament is surgically repaired or reconstructed. Often, an ankle arthroscopy will be performed at the same time. This is a minimally invasive technique to treat injuries to the joint surfaces. This is performed on an outpatient basis and return to full play is typically in 3 to 4 months.

ANKLE JOINT INJURIES

These are often associated with instability of the ankle such as recurrent sprains. If left untreated, these injuries, known as osteochondral lesions of the talus or osteochondral defects, may lead to persistent pain and even progress into arthritis. These injuries will typically be associated with persistent ankle pain, particularly with impact activities. Swelling with activity, and even popping or grinding when moving the ankle are common.

These injuries are typically diagnosed by MRI. Sometimes surgery is required. This typically consists of removing the injured surface and promoting a healing response or even repairing the damaged portion of the joint surface with graft material. Seeking treatment with an orthopedic foot and ankle surgeon specialist is advisable when this type of problem is suspected.