What is an ankle sprain?
Have you recently rolled your ankle or have an ankle sprain, and it’s still painful or tends to swell?
Do you find you’re not able to trust your ankle, or it keeps giving way?
Are you finding it difficult to get back to sport because of pain or stiffness in your ankle?
Don’t ignore a sprained ankle.
Many people dismiss having ankle sprain as being ‘just one of those things’; they are common after all, but did you know that 40% of people who sprain their ankle will continue to have ankle pain, months and years after the injured occurred?
What happens during an ankle sprain?
The commonest way we injure an ankle is what’s called an inversion injury. This is when you ‘go over’ on your ankle, and you roll the sole of your foot so that it’s pointing to the middle. Several things can happen internally in the ankle if you invert it violently. For instance, there are three ligaments on the outside (lateral side) of the ankle joint – the AFTL (anterior talofibular ligament), the CFL (calcaneofibular ligament), and the PTFL (posterior talofibular ligament). You can rupture or stretch any one, or all of these.
In addition, an inversion injury might damage the articular cartilage which covers the ankle hinge bone (the ‘talus’), and you can also disrupt the peroneal tendons on the outside (lateral side) of the ankle.
High Ankle Sprain (aka Syndesmosis Injury)
This is an injury that is, unfortunately, frequently missed – which is bad news because there’s a short window of time to get this injury to heal well.
Sometimes we have an injury to the ankle, when we know we’ve not rolled it (like in an inversion injury), but rather, we’ve kind of gone over the top of the ankle and externally rotated it. You can sense you’ve really hurt it, big time, and this kind of injury is called a high ankle sprain. In this kind of injury, the gristle ‘spot weld’ (aka ‘syndesmosis’) that links together the bottom of the tibia and fibula bones (which form the roof of the ankle joint or ‘mortise’), get forced apart by the violent rotation of the talus bone.
The syndesmosis has a front component, and a back component, and if you disrupt both, your ankle is going to be unstable and painful long-term.
The good news is, if it’s spotted early, we can get your ankle better.
What signs mean I should go to the hospital?
1. If your ankle is too painful to bear your weight.
If you’ve just injured your ankle, and you’re finding it almost impossible, or extremely painful to weight bear on your ankle, you need to get to A & E.
When you’re there, you’ll likely be examined by a Clinician, and they will be using the ‘Ottawa Rules’ to determine if you need an X-ray. These rules help the Clinician to spot a fracture.
Ankle X-rays can be helpful in looking for fractures, but they can’t tell you what has happened to the soft tissues, and it’s difficult to spot a partial syndesmosis injury on an X-ray.
2. If you’ve obviously lost movement in your ankle.
If you’re finding that your ankle is very limited in its movement, you might have a fracture, or, you might have a syndesmosis injury. Typically, with a syndesmosis injury, the ability to be able to point your foot all the way down (aka ‘plantarflexion’) is limited, and you’ll likely find that you can’t pull your ankle up towards you (aka ‘dorsiflexion’).
3. If there’s a huge amount of swelling, bruising, or it looks deformed.
It’s not uncommon to fracture the end of the fibula bone during an inversion injury, so if you have a big, well-localised swelling on the outside of your ankle (aka ‘lateral malleolus’), you need to get to A & E to exclude a break.
A very personable and knowledgeable specialist that I would thoroughly recommend!
What if I’ve been told that I don’t have a fracture?
Whilst it’s great to know you don’t have a broken bone, you may be wondering ‘what happens next?’ If you’ve been to A & E they may have given you some basic advice about getting your ankle going, or sometimes you’ll be asked to attend a fracture clinic if you’re still having trouble.
Many of the patients who come to my clinic have been advised to try to walk normally on their ankle, and often that’s ok, but what if it’s too uncomfortable?
Because syndesmosis injuries and cartilage damage can be difficult to assess on a plain X-ray, if you’re still finding it painful to walk on your ankle, I’d recommend that you get yourself onto a pair of crutches, and then come for a further assessment. There is just a narrow window of time (2 weeks) to be able to treat some syndesmosis injuries and so if you’re in doubt, don’t wait.
I’m concerned my ankle still isn’t getting better…
Thankfully, most ankle sprains will be well on their way to mended at around six weeks. So, if you’re not substantially better at that point in time (especially if you’ve been seeing a wonderful physio or osteo), then it means something structural is holding you back, and you need to get it checked out.
Sometimes you might experience an ankle that almost gets better – so you might be able to walk around OK, but when you try to return to running, it swells up or gets achy.
That’s another sign that the ankle has an internal issue that needs addressing.
Finally, you might be experiencing subtle symptoms of ankle instability (which is when the supportive ligaments are stretched or torn). This can feel like you’re about to, or are, regularly tipping your ankle over. It can also mean your ankle swells or feels a bit ‘untrustworthy’. If your ankle is misbehaving like this, it needs further assessment.
If you’re not close to getting back to your sport or you’re concerned about your ankle, book an appointment.