Showing standard extended lateral approach. US NIH

Ankle sprains are one of the most common injuries sustained through activity.

They normally heal with proper rest, ice massage, compression and elevation therapy for a few days.

However, if pain or instability is persistent, it is advisable to get an early assessment done by a medical practitioner. Some signs of serious injuries are an inability to bear weight, an inability to push off or tiptoe, tenderness over the bony prominences at the side of the ankle (i.e., the medial and lateral malleoli) or a tenderness in the foot.

Among the underlying problems related to persistent instability, the most common is a tear or stretching out of the lateral ligaments of the ankle.

Other causes include dislocations or subluxations of the peroneal tendons, muscle weakness, nerve injury, pain from a structure in the ankle that inhibits the muscles supporting the ankle or deformities of the foot or ankle.

Ankle pain may be due to osteochondral fractures or bruises of the talus, loose bodies, tears of the peroneal tendons, sinus tarsi syndrome or even early ankle arthritis.

The diagnosis of the problem includes a physical examination or even inspection of shoes and footwear, which can give clues to possible problems and abnormalities in gait.

X-rays, ultrasound or MRI scans may be ordered. Sometimes, when diagnosis is difficult, diagnostic injections can be helpful.

For most common ankle injuries, acute treatment consists of RICE therapy (rest, ice, compression and elevation) for the first 48 hours or so, followed by one to two weeks of gradual return to activity. An ankle brace or ankle guard may also be helpful in this phase of recovery. Physiotherapy is often helpful and may speed recovery.

Chill out: An athlete with ice on his ankle after a training session. AFP/Behrouz Mehri

For more serious conditions, surgery may be necessary

For ankle instability '€” which is mainly caused due to a tear or '€˜stretching out'€™ of the lateral ankle ligaments '€” the affected ligaments can be repaired using a small incision. The ligaments are stitched back together in the proper position. Immediately after surgery the foot is protected in a cast for about four weeks.

This may be followed by another one to two of physiotherapy '€” a progressive programme of regaining motion, strength, balance and agility '€” ensures the maximal benefit of the surgery and allow the patients to return to their normal daily routine.

Other options include arthroscopic or '€œkeyhole'€ surgery, which can be done for removal of the unhealthy cartilage and '€œmicro-fractures'€ to stimulate new cartilage growth.

w Larger bone-cartilage lesions can be repaired with bone-cartilage or artificial transplants and even cartilage cell culture and repair.

The rehabilitation procedure after an ankle arthroscopy depends on the diagnosis and treatment done. In most cases, the leg can actually bear weight on the same day, and achieve full recovery within a month.
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The writer, a physician and visiting consultant at Alexandra Hospital, Changi General Hospital, and the National University Hospital, graduated from the National University of Singapore in 1989 and was admitted as a Fellow to the Royal College of Surgeons (Edinburgh) in 1994. He also manages sports medicine injuries. For more information, visit ortho-intl.com.