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Chronic Ankle Sprain 

    



What is a chronic ankle sprain?
 

A chronic ankle sprain is often also known as chronic ankle instability.  This is almost always a result of repetitive accidents to the ankle joint.

An acute ankle sprain is when an injury occurs to one or more of the ligaments of the ankle.  The ankle joint is comprised of three bones - the tibia, fibula, and talus.  See ankle sprain for more information on this topic.  A chronic ankle sprain is different than a normal acute ankle sprain.  In the chronic ankle sprain condition, the ligaments have become stretched out to the point that the ankle continually subluxes or "turns under".  Usually a chronic ankle sprain is the result of multiple acute sprains where the ligaments have not been allowed to heal correctly.  This can range from a mild nuisance to a severely debilitating condition with associated other issues.

                           

The severity of an chronic ankle sprain is dependent upon several factors.  There are two basic ways to evaluate these issues: subjective and objective.  Subjective is how painful and unstable it is to you when you walk and perform normal activities.  Objective is looking at the biomechanical and functional aspects of how your foot and ankle function with this issue.  Both are important in this evaluation.  A foot and ankle surgeon will evaluate you with specific objective tests to look for functional and biomechanical stability of your ankle. 


Etiology:

An ankle sprain is generally the result of a twisting type of motion to the ankle joint, or a direct blow that forces the ankle out of its normal anatomic alignment.  Ankle sprains can occur while doing virtually any activity although they are most common while playing sports or while wearing inappropriate shoes.  When this becomes a chronic ankle sprain, uneven surfaces will likely produce the symptoms, or it may even occur when walking normally if the ligaments have become too stretched out.


Symptoms of a chronic ankle sprain:

Symptoms of an acute sprain usually include pain, swelling, and bruising.  Often times the ankle joint will become stiff from all the swelling and inflammation (the body's attempt to immobilize itself).  Also, pain deep within the ankle joint may present.  Walking may be difficult or impossible depending upon the severity of the sprain. 

Pain and swelling may be absent in people who have a chronic ankle sprain.  The ankle may feel unstable and "floppy" when walking.   If an acute sprain is left untreated, the ankle may develop chronic ankle instability - a condition with persistent discomfort and a continual "giving way" of the ankle.  Additionally, a sprain may be accompanied by a more severe ankle injury such as an ankle fracture, or an osteochondral defect (damage to the cartilage within the ankle joint.)  It always advised to follow-up with your doctor for these recurrent type sprains.  Since the ligaments are no longer providing their normal anatomic support, other structures about the ankle joint can be damaged.  You may sustain damage to the surrounding bones, the joint cartilage surfaces, tendons around the ankle joint, or even other ligaments or joints than the ankle joint. 
 

Treatment:
In contrast to an acute ligament injury, treatment for the chronic condition primarily involves strengthening other supporting structures such as tendons and muscles around the ankle joint.  Although the ligaments may be damaged completely, other tendons with strengthening  will often compensate for the ligament laxity.  

  • Support Long Term: Generally, an ankle brace will be recommended to stabilize the ligaments indefinitely until the other muscles and tendons become strong enough to compensate.  This may be several months in time.  Also, since this is a recurrent condition, it is especially important to wear the brace when performing aggressive sports/activities to hopefully prevent any further ligament damage.
  • Complete Immobilization (sometimes needed) If physical therapy has failed to help compensate for this issue and to alleviate the pain, A CAM walker can be used.  With this treatment, you will still be able to walk around but the ankle joint will be dramatically stabilized.  Occasionally a non-weight bearing cast is prescribed and applied to allow your body the chance to heal.  This should always be attempted prior to any surgical intervention. 

 




Ankle sprain grading and treatment review
Grade 1 - stretched ligament = lace up ankle brace
Grade 2 - partially torn ligament= aircast, transition to lace up ankle brace
Grade 3 - complete tear of ligament = CAM Walker until pain subsides, then aircast with PT, Lace up brace once back to activity. 
Chronic Ankle Sprain can result from any of the above - Grade III most likely to turn chronic if not allowed to heal appropriately. 



Occasionally surgery is indicated for chronic ankle instability.

Different types of surgery may include:
Repair of the lateral ankle ligaments (on the outside)
Ankle arthroscopy (for osteochondral defects, or impingement syndrome)
Peroneal tendon debridement and repair (tendons on the outside of the ankle that can get damaged)
 

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