Symptoms & Treatments

Chronic Ankle Problems

The most common orthopedic injury sustained by athletes is the simple inversion ankle sprain. Nearly every athlete can remember at one time or another catching their foot and sustaining a sprain of the ligaments on the outside of the ankle. Often the entire foot and ankle swell and a considerable amount of bruising will develop over the following days. For the most part, these symptoms resolve with the classic R.I.C.E. (Rest, Ice, Compression, Elevation) treatment protocol. Every high school trainer knows the fundamentals of treatment.

Although swelling and discoloration may be dramatic, most ligament tears are only partial. After the initial inflammation resolves, an athlete can return to sports participation provided that the ankle is taped or they are wearing some form of an ankle brace. Usually, athletics can be resumed within a week or two of the injury.

Unfortunately, in rare episodes, the sequence of events is not always so simple. Often, after what appears to be a simple twisting of the ankle, the athlete has persistent pain which does not respond to simple rest and ice treatments. Physical therapy modalities may be utilized but are not always entirely effective at relieving persistent complaints.

X-rays often reveal normal bony alignment with no evidence of chip fracture or displacement of the normal anatomy about the ankle. The orthopedic examination reveals some discomfort, but no real instability when stressing the ligament complexes. Often in these cases the problem is damage to the cartilage of the ankle bone, which can only be detected with specific diagnostic studies. This injury is known as a chondral fracture and represents a disruption of the cartilage coating over the ankle bone (talus). This injury is noted on a magnetic resonance imaging (MRI) scan and can have a poor prognosis. Treatment is avoidance of athletic activities, anti-inflammatory medications for pain and swelling, and protected weight-bearing with crutches. Often, arthroscopic surgery of the ankle is necessary to debride the torn cartilage, preventing further elevation of the cartilage flap and exposing more underlying bone. The ankle bone surface can be drilled arthroscopically with small pins or drill bits. This promotes the growth of a fibrous tissue which will coat the bone but, unfortunately, will not function as well as the original cartilage lining.

These defects can increase in size and eventually result in arthritic changes in the future. It is important that the ankle sprain be treated aggressively to determine who has a simple soft tissue injury and who may require the rare surgical procedure. For the most part, all ankle sprains should be treated immediately with physical therapy modalities and daily taping. Athletes are allowed to return to their sport when they are able to run without a limp and drive off of the involved extremity. For individuals with persistent pain, after the normal healing time span, more extensive diagnostic studies are necessary to investigate whether or not a chondral lesion is present. If symptoms do not respond to prolong rest, then the individual is definitely a surgical candidate and will need to modify their activities in the future. Prompt and appropriate treatment can help prevent future post-traumatic arthritis.