Ankle Sprains / Instability
Background
An ankle sprain occurs when one or more ligaments that support the ankle are stretched or torn. Most sprains affect the ligaments on the outside of the ankle and happen when the foot rolls inward during a landing, sudden change in direction, or misstep.
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Many ankle sprains heal well, but recovery involves more than waiting for the swelling to go away. Without adequate rehabilitation, some people continue to experience pain, repeated sprains, or a feeling that the ankle cannot be trusted. This is called chronic ankle instability.
Symptoms
An ankle sprain may cause:
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Pain and swelling around the ankle
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Bruising or tenderness over the injured ligaments
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Difficulty walking or putting weight on the foot
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Stiffness and reduced motion
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A feeling that the ankle may give way
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With chronic instability, the ankle may repeatedly roll during sports or even on uneven ground. Persistent pain, catching, or swelling can also suggest an injury to the cartilage or another structure inside the ankle.
Diagnosis
Dr. Fliegel will ask how the injury occurred and examine the ankle for tenderness, swelling, motion, and stability. He will also check for signs of a fracture, tendon injury, or a high ankle sprain, which involves different ligaments above the ankle joint.
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X-rays may be obtained to evaluate for a fracture. If symptoms persist, the ankle repeatedly gives way, or another injury is suspected, an MRI may help evaluate the ligaments, tendons, and cartilage.
Treament Options
Treatment depends on the severity of the sprain, your symptoms, and whether this is a first injury or a recurring problem.
Acute Ankle Sprains
Most ankle sprains improve without surgery. Early treatment may include a brace or boot, ice, elevation, and a gradual return to walking as pain allows. Physical therapy helps restore motion, strength, balance, and control before returning to running or sport.
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The goal is to recover a stable, confident ankle, not simply to wait until the pain subsides.
Chronic Ankle Instability
When the ankle repeatedly gives way, treatment usually begins with focused physical therapy and bracing during higher risk activities. Rehabilitation works on the muscles that support the ankle, balance, and the ability to control the foot during cutting and landing.
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If instability continues despite appropriate rehabilitation, surgery may be considered. When the existing ligaments are suitable, they can often be tightened and repaired with a procedure commonly called a Broström repair. In selected cases with poor ligament tissue or more complex instability, ligament reconstruction with a tendon graft may be needed. Dr. Fliegel will discuss which approach fits the findings and your activity goals.
Return to Sport
A mild sprain may allow a relatively quick return, while a severe sprain or repeated instability can take much longer. There is no single evidence based minimum that fits every ankle sprain. Before returning, patients should be able to move comfortably, balance, hop, change direction, and complete the demands of their sport without the ankle giving way.