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Ankle Sprains and Instability
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What are Ankle Sprains and Instability?
Ankle sprains and instability are common musculoskeletal injuries affecting people across various age groups. These ligaments, primarily located on the outside of the ankle, provide stability by limiting side-to-side movement.
Ankle Sprains
An ankle sprain refers to the stretching or tearing of the ligaments supporting the ankle joint. This injury commonly occurs when a sudden twisting or turning motion overstretches or tears the ligaments. Ankle sprains often happen during physical activities, such as sports, but can also occur during everyday movements.
Ankle Instability
Ankle instability is a condition that often follows repeated ankle sprains. It is characterised by a recurring ‘giving way’ of the outer side of the ankle. This instability can be due to stretched or weakened ligaments that fail to adequately support the ankle joint, leading to frequent injuries or a persistent sense of instability.
Grades of Ankle Sprains
Ankle sprains are categorised into three distinct grades:
Grade 1 Sprains
Characterised by slight stretching and microscopic tearing of the ligament fibres. Symptoms include mild pain, swelling, and tenderness, with minimal impact on joint stability.
Grade 2 Sprains
Involves partial tearing of the ligament. Symptoms are more severe, including moderate pain, noticeable swelling, bruising, and some loss of function.
Grade 3 Sprains
This most severe grade is marked by a complete ligament tear, leading to significant swelling, bruising, and instability. Walking may be difficult or impossible.
Causes
Here are the common causes of ankle sprains:
- Sports and Physical Activities
Sports and activities that involve jumping, quick pivots, and running significantly increase the risk of ankle sprains. Improper landing or abrupt changes in direction are common mechanisms of injury in such activities. - Uneven Surfaces
Walking or exercising on uneven terrain or surfaces that are not level can lead to a misstep, resulting in an ankle sprain. - Footwear
Inadequate or inappropriate footwear that does not provide sufficient support or is not suitable for the activity can contribute to the likelihood of spraining an ankle. - Previous Ankle Injuries
A history of ankle injuries increases the probability of future sprains, as the ligaments may have been weakened or stretched. - Individual Factors
Factors such as balance, body weight, overall physical condition, and muscle strength also contribute to susceptibility to ankle sprains.
Symptoms
The symptoms of an ankle sprain vary depending on the severity of the injury but generally include:
- Pain
Typically immediate and can range from mild to severe, depending on the grade of the sprain. The pain is usually localised around the ankle, particularly where the ligaments were injured. - Swelling and Bruising
Almost always occurs with ankle sprains. Swelling can be significant in more severe sprains. - Restricted Range of Motion
Difficulty moving the ankle, particularly with grade 2 or 3 sprains. - Instability
In cases of severe sprains (Grade 3), the ankle may feel wobbly or unstable. - Tenderness
The ankle area, especially over the injured ligament, is tender to the touch. - Difficulty Bearing Weight
Depending on the severity, standing or walking on the affected foot might be difficult.
Diagnosis
Diagnosing an ankle sprain involves a combination of medical history evaluation, physical examination, and, if necessary, imaging tests. The process typically includes:
- Medical History
Understanding the circumstances of the injury and any previous ankle issues. - Physical Examination
An orthopaedic surgeon will assess the ankle for pain, swelling, tenderness, and range of motion. - Imaging Tests
If a fracture or severe injury is suspected, X-rays, MRIs, or CT scans may be recommended to provide a detailed view of the ankle structures.
Non-Surgical Treatment Options
Non-surgical treatments are typically the first line of management for ankle sprains, especially for Grades 1 and 2. These treatments aim to reduce pain, swelling, and promote healing:
Rest
Limiting movement and weight-bearing activities to allow the ankle to heal.
Ice Therapy
Applying ice packs to the ankle can help reduce swelling and pain.
Compression
An elastic bandage or brace provides support and reduces swelling.
Elevation
Keeping the ankle raised above heart level to minimise swelling.
Pain Relief Medications
Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.
Physical Therapy
Exercises to restore ankle strength, flexibility, and balance are essential for recovery and preventing re-injury.
Surgical Treatment Options
Surgical intervention for ankle sprains is generally considered in severe cases or when non-surgical treatments have not provided sufficient stability. The surgical options include:
- Ligament Repair
This procedure involves directly stitching the torn ligaments, ideal for ligaments that have not completely detached. The aim is to re-establish the normal alignment and function of the ligaments, thus stabilising the ankle. - Ligament Reconstruction
Used when the ligaments are extensively damaged, this surgery reconstructs the ligaments using grafts, often taken from other tendons in the foot or ankle. It is designed to provide long-term stability and prevent recurrent sprains. - Arthroscopy
A minimally invasive technique where a camera is inserted into the ankle joint to guide repair procedures. This method is beneficial for cleaning up the joint, removing loose fragments, and aiding in more precise ligament repairs.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Strategies
Preventing ankle sprains involves a multifaceted approach:
- Proper Footwear: Choosing shoes that provide adequate support and fit well is essential, especially during physical activities.
- Strength and Balance Training: Exercises that strengthen the muscles around the ankle and improve balance can reduce the risk of sprains.
- Warm-Up Exercises: Engaging in warm-up routines before physical activities helps prepare the muscles and ligaments for the stress of exercise.
- Mindful Movement: Being aware of the terrain and avoiding risky movements during activities can prevent missteps that lead to sprains.
- Use of Protective Gear: In some sports, wearing ankle braces or tape can provide additional support.
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Frequently Asked Questions
How Long Does It Take to Recover from an Ankle Sprain?
Recovery time depends on the severity. Grade 1 sprains might heal within 1-3 weeks, while Grade 2 takes about 3-6 weeks. Grade 3 sprains, involving a complete tear of the ligaments, require several months and possibly physical therapy.
Can I Walk on a Sprained Ankle?
Walking on a sprained ankle depends on its severity. Mild sprains may allow some walking with care, but for more severe sprains, it is advised to avoid walking to prevent further injury and facilitate healing.
Will I Need Physical Therapy After an Ankle Sprain?
Physical therapy is often recommended for moderate to severe sprains to enhance recovery. It focuses on restoring strength, improving flexibility, and ensuring proper balance to avoid future injuries.
Are Ankle Sprains Recurrent?
Ankle sprains can recur, especially if the initial injury wasn’t fully rehabilitated. Proper treatment and strengthening exercises are key to preventing recurrence and maintaining ankle stability.