BMI St Edmunds: Taking the pain out of sprain

Miss Vigdis Thorisdottir, consultant orthopaedic surgeon at BMI St Edmunds Hospital

Miss Vigdis Thorisdottir, consultant orthopaedic surgeon at BMI St Edmunds Hospital - Credit: Archant

You know it is ‘just a sprain’ but why is it taking so long for your ankle to heal? Vigdis Thorisdottir, consultant orthopaedic surgeon at BMI St Edmunds Hospital, takes a look at a very common problem.

Ankle sprains are common and occur at all ages. They are often sustained while playing sports but you can just as easily go over while stepping awkwardly off a kerb.

The ankle swells and bruising can run down to the toes making it painful to put any weight through the ankle.

Initially, I would recommend resting, elevation and ice to reduce swelling.

The majority of simple ankle injuries do not require medical attention and can improve within the first three weeks if you follow advice.

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However, more severe sprains can take twice that time and a return to sporting activities could take three months or more.

There are times when the ankle doesn’t get better and remains painful, often swollen.

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If the ankle doesn’t improve in the expected timeframe I would seek medical advice. At times, all that may be needed is reassurance or input from a physio.

On occasions however, further investigations are warranted. X-rays of the ankle will diagnose most fractures but some are more difficult to see.

Small fragments of bone from the front of the heel bone or side of the ankle can cause persistent pain while cartilage injury can lead to a deep-seated pain for which a CT or MRI scan will aid diagnosis.

Some of these injuries may improve without intervention but others require surgery. Lesions within the ankle are usually approached with keyhole surgery when special instruments are used to operate within the joint through two small holes over the front of it.

Following ankle sprains, people can develop scarring within the joint, inflammation and bone-spur formation. Complaints of locking or catching sensation are common and pain is usually felt over the front of the joint.

This is exacerbated with the ankle bent up, when walking up a steep hill or squatting down.

Physiotherapy is usually helpful but if symptoms persist, surgery may be the answer.

Two tendons, the peroneal tendons, sit tethered on the outer aspect of the ankle and run down into the foot. They are important for the ankle’s stability and can become inflamed or develop small tears following ankle sprains.

The pain associated is usually felt over the outer ankle, just behind the ankle bone. Occasionally the tendons displace, giving rise to a snapping sensation.

Inflamed tendons may need to be rested or treated with exercises whereas torn or snapping tendons often need surgical repair.

Finally, ankle instability can develop after injuries. The ankle gives way more readily than before, especially when walking over uneven surfaces.

Instability is usually multifactorial and treatment is aimed at correcting the underlying problems. For most people this involves physiotherapy while, occasionally, insoles and ankle braces can be helpful.

If this conservative approach fails, especially if the ankle ligaments have become too lax, then repairing the ligaments surgically can help restore stability.

Residual pain and swelling following ankle sprains should get better and recover within two to six weeks.

On those few occasions when the ankle remains symptomatic, any of the conditions outlined in this article may be contributing to lack of full recovery.

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