Ankle Sprains and Instability

I’ve sprained my ankle, what should I do?

If you are unable to bear weight on the foot or the pain or swelling is very severe then the sensible course of action is to see your GP or attend A&E so someone can examine your ankle and decide whether an x-ray is necessary.

What is an ankle sprain?

The ankle joint is made up from the surfaces of the tibia, the fibula and the talus. Strong bands of tissue called ligaments help to bind the bones together and stabilise the joint.  If the ankle joint is twisted abnormally (e.g. rolling over on a curb) the ligaments can be stretched or torn completely. A single ligament can be injured or multiple ligaments. Sometimes tiny pieces of bone are pulled off where the ligaments attach to the ankle (‘avulsion’).

What is the treatment?

Most sprains will settle down with simple measure. Resting the leg, elevating the foot and the use of compression and ice packs all help reduce the swelling.  In a severe sprain you may need crutches for a short time.  Physiotherapy helps to retrain the balance (proprioception) and to maintain strength and range of movement.

Will it get better?

Most people recover from ankle sprains with no long term problems. Return to full sporting activities can be expected.  The time to return to sport will depend on the severity of the initial injury but can range from a few weeks to a few months.

I have ongoing pain.

If your ankle continues to be painful after 3-4 months and shows no sign of improving then you may have suffered more than a simple sprain.  When you twist your ankle occasionally it is not just the ligaments that are damaged.  It is possible to tear tendons around the ankle and to damage the cartilage inside the joint.  Sometimes scar tissue builds up in the joint and this can cause painful pinching on moving the joint (impingement).  After a careful examination, further investigation in the form of an MRI will usually be requested. Depending on the findings, an open operation or an arthroscopy (telescope) may be advised.

I keep going over on my ankle.

Sometimes, although the pain settles down, the ankle feels unsteady and patients complain that they keep turning their ankle over.  An unstable ankle may require a ligament reconstruction operation to stabilise the joint.  This is followed by 6 weeks in a plaster or boot, followed by intensive physiotherapy.