Ankle sprained yet still in pain – why does it hurt months down the track?

You’re in the heat of the game!
Everything is going great, you’re sprinting fast. You’re an athlete!
You’re just about to get your hands on the ball when…

OUUUCCCH!

Fast forward to next week, back to training. Still sore but pushing through.
The ankle is okay day to day, you don’t feel much when you’re walking.
Running is a different story. It’s bloody sore!

Fast forward a month down the track… why is your ankle still sore? It’s just not 100%.
It aches through and around the joint.

Does this sound familiar – have you had pain in the ankle since then?
Does it hurt when running?
Is the ankle weak or unstable now?
You thought it would get better on its own and wouldn’t be a big deal?
We often see and hear things like this all the time!

​Ankle sprains are THE MOST COMMON sporting injury. That’s right, they happen all the time.

What is an ankle sprain?

An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the joint. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.

Most sprains are minor injuries that heal over a couple of weeks with home treatments like rest and applying ice. However, if your ankle is very swollen and painful to walk on, or if you are having trouble putting weight on your ankle at all, be sure to get it assessed by a Podiatrist. 

Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle, making it more likely that you will injure it again. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain and swelling, arthritis, and ongoing instability.

Most sprained ankles occur in the lateral ankle ligaments on the outside of the ankle. Sprains can range from tiny tears in the fibers that make up the ligament to complete tears through the tissue.

If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. Over time, this instability can result in damage to the bones and cartilage of the ankle joint.

Symptoms may include:

• Ankle pain
• Swelling
• Bruising
• Tenderness to touch
• Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
• Pain around and at base of the fifth metatarsal, subtalar joint, calcaneus or back of the ankle 

Your Podiatrist  will diagnose your ankle sprain by performing a careful examination of your foot and ankle. This physical exam may cause pain. 

• Palpate – Your Podiatrist will gently press around the ankle to determine which ligaments are injured.
• Range of motion – They  may also move your ankle in different directions; however, a stiff, swollen ankle usually will not move much.

If there is no broken bone, your Podiatrist may be able to tell the severity of your ankle sprain based upon the amount of swelling, pain, and bruising.

How Long Does a Sprained Ankle Take to Heal?

Grades of Ankle Sprains

After the examination, your Podiatrist will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments.

Grade 1 Sprain (Mild): 1 – 2 weeks

• Slight stretching and microscopic tearing of the ligament fibers
• Mild tenderness and swelling around the ankle

Grade 2 Sprain (Moderate): 2 – 6 weeks

• Partial tearing of the ligament
• Moderate tenderness and swelling around the ankle
• If the Podiatrist moves the ankle in certain ways, there is an abnormal looseness of the ankle joint

Grade 3 Sprain (Severe): 6 – 12 weeks

• Complete tear of the ligament
• Significant tenderness and swelling around the ankle
• If your Podiatrist pulls or pushes on the ankle joint in certain movements, substantial instability occurs

How do I treat my sprained ankle?

Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. Most ankle injuries (roughly 80 percent of cases) require no surgical intervention. (foothealthfacts.org)

A three-phase program guides treatment of ankle sprains—from mild to severe:

• Phase 1 includes resting, protecting the ankle and reducing the swelling.
• Phase 2 includes restoring range of motion, strength and flexibility.
• Phase 3 includes maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities), such as netball, basketball, or football.

This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries. The other 20 percent of patients might have initially neglected their injury, and because they did not seek immediate care, what began as a grade one, may have turned into a more severe grade two or three injury, possibly requiring surgery. (foothealthfacts.org)

Home Treatments

For milder sprains, your Podiatrist may recommend simple home treatment.

The RICE (Rest, Ice, Compression, Elevation) protocol. Follow the RICE protocol as soon as possible after your injury:

• Rest your ankle by not walking on it.
• Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin.
• Compression dressings, bandages or ace-wraps will immobilize and support your injured ankle.
• Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

Medication – Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can really help you deal with pain and swelling. Because they improve function by both reducing swelling and controlling pain, they are a better option for mild sprains than narcotic pain medicines.

How Do You Treat a More Severe Ankle Sprain?

Nonsurgical Treatment

Some sprains will require treatment in addition to the RICE protocol and medications.

Crutches – In most cases, swelling and pain will last from 2 to 3 days. Walking may be difficult during this time and your Podiatrist may recommend that you use crutches as needed.

Immobilization – During the early phase of healing, it is important to support your ankle and protect it from sudden movements. For a Grade 2 sprain, a removable moon boot can provide support. Grade 3 sprains may require a moon boot for 2 to 3 weeks.

Your Podiatrist may encourage you to put some weight on your ankle while it is protected. This can help with healing.

Physical therapy – Rehabilitation exercises play a big role in decreasing stiffness, increasing ankle strength, and preventing chronic ankle issues. 

• Early motion – To prevent stiffness, your Podiatrist will provide you with exercises that involve range-of-motion or controlled movements of your ankle without resistance.
• Strengthening exercises – Once you can bear weight without increased pain or swelling, exercises to strengthen the muscles and tendons in the front and back of your knee, leg, ankle and foot will be added to your treatment plan. Exercises with resistance are added as tolerated.
• Proprioception (balance) training – Poor balance often leads to repeat sprains and ankle instability. A good example of a balance exercise is standing on the affected foot with the opposite foot raised and eyes closed. Balance boards are often used in this stage of rehabilitation.
• Endurance and agility exercises – Once you are pain-free, other exercises may be added, such as agility drills to improve agility and calf and ankle strength. The goal is to increase strength and range of motion as balance improves over time.

What Happens When an Ankle Sprain Will Not Heal?

Surgical Treatment

Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for patients who experience persistent pain and swelling, and ankle instability after 3 months of rehabilitation and nonsurgical treatment. It is common to require surgery in 5 to 10 percent of ankle sprains treated with appropriate conservative care. (podiatrytoday.com)

Surgical options may include:

• Arthroscopy – During arthroscopy, your foot and ankle surgeon uses a small camera, called an arthroscope, to look inside your ankle joint and region. Miniature instruments are used to remove any loose fragments of bone or cartilage injury, or parts of the ligament that may be caught in the joint.
• Reconstruction – Your foot and ankle surgeon may be able to repair the torn ligament with stitches or sutures. In some cases, they will reconstruct the damaged ligament by replacing it with a tissue graft obtained from other ligaments and/or tendons found in the foot and around the ankle.
• Immobilization –  There is typically a period of immobilization following surgery for an ankle sprain. Your foot and ankle surgeon may apply a cast or protective boot to protect the repaired or reconstructed ligament. At the end of this period of time you will require rehabilitation. 
• Rehabilitation – Rehabilitation after surgery involves time and attention to restore strength and range of motion so you can return to pre-injury function. The length of time you can expect to spend recovering depends upon the extent of injury and the amount of surgery that was done. Rehabilitation may take from weeks to months.

Outcomes

Outcomes for ankle sprains are generally quite good. When properly treated, most patients are able to resume their day-to-day activities after a period of time.

Why won’t my ankle sprain heal?

Most importantly, successful outcomes are dependent upon patient commitment to rehabilitation exercises. Incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain. If a patient stops doing the strengthening exercises, the injured ligaments will weaken and put the patient at risk for continued ankle sprains. Studies have shown that 10 to 30 percent of sprains will have symptoms later. (dancemagazine.com)

Why are we not always able to heal a sprained ankle?

Chronic Ankle Sprains

Once you have sprained your ankle, you may continue to sprain it if the ligaments do not have time to completely heal. It can be hard for patients with a history of ankle sprains to tell if a sprain has healed because even an ankle with a chronic tear can be highly functional because overlying tendons help with stability and motion (even if it was years ago). 

If pain continues for more than 4 to 6 weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces and participating in sports that require cutting actions or rolling and twisting of the foot.

Abnormal proprioception, a common complication of ankle sprains that can also lead to repeat sprains. There may be imbalance and muscle weakness that causes a reinjury. If you sprain your ankle over and over again, a chronic situation may persist with instability, a sense of the ankle giving way, and chronic pain. This can also happen if you return to work, sports, or other activities before your ankle heals and is rehabilitated.

How can I prevent an ankle sprain?

The best way to prevent ankle sprains is to maintain good muscle strength, balance, and flexibility. The following precautions will help prevent sprains:

• Warm up thoroughly before exercise and physical activity
• Pay careful attention when walking, running, or working on an uneven surface
• Wear shoes that are made for your activity
• Slow down or stop activities when you feel pain or fatigue

​Hot Tip: Don’t stay off your ankle for too long if you can help it.

Depending on severity, generally 24-72 hours if needed is adequate for a “simple” ankle sprain. Evidence suggests the longer you stay off your ankle, the more delayed recovery will be!

BALANCE Training Is Just As Important As STRENGTH Work

Balance training has been proven to reduce the risk of ankle sprains. It is an essential part of rehab. Below we have some simple exercises that you can perform quickly at home. You could even do it while you’re brushing your teeth each day or waiting for dinner to cook!

1. Start of by standing on a flat surface on one leg
2. Record how long you can hold this for
3. Repeat with the other leg

Remember to keep challenging yourself & work your way up every day!

If you find this too easy – work your way through these challenges:

• Single leg eyes open
• Single leg eyes closed
• Single leg standing on a pillow eyes open
• Single leg standing on a pillow eyes closed

f you’re wondering why your ankle is still sore or feels unstable, come see us for a long term
rehabilitation program tailored to your needs! Podiatrists are experts when it comes to the ankle.