Persistent Pain After Ankle Sprains – Causes and Treatment

 

Ankle Sprains

• 1/10,000 persons/day
• 23,000 ankle sprains in the U.S. each day
• 40-45% of sports injuries are ankle injuries
• 85% of ankle injuries are sprains
• 85% of sprains are due to inversion with injury to the lateral ligaments

Lateral Ankle Ligaments

• ATFL
  anterior talo-fibular ligament

  CFL
  calcaneo-fibular ligament

  PTFL
  Posterior talo-fibular ligament
  

Diagnosis

• The clinical diagnosis is suspected from history and confirmed by the physical examination, which includes the posterolateral rotatory instability test.
• This test often is best performed under general anaesthesia.
  

Surgical Treatment

• Usually the instability is managed with either a repair of the ligament or an isometric reconstruction using a tendon graft.

Acute Treatment of Ankle Sprains

• PRICEM
  Protection: (orthosis or brace)
  Rest: limit weight bearing until not painful
  Ice,
  Compression, and
  Elevation
  Most important component acutely
  
• Limiting inflammation and swelling has been shown to speed recovery
  Mobilize: early range of motion has also been shown to speed recovery

Prognosis Inversely Related to Grade

• Grade I
  Require an average 11.7 days before full resumption of athletic activity
• Grade II
  Require approximately 2-6 weeks
• Grade III
  Average duration of disability ranges 4.5-26 wks
  Only 25-60% being symptom free 1-4 yrs after injury
  

Chronic Ankle Pain

• Patient Profile
• Previous injury of weeks to months
  
• Activity limiting pain described as "soreness"
• Generalized "weakness" with locking, giving way, and swelling
  Frustrated
  

Persistent Pain After Ankle Sprains

• Chronic Instability
• Soft Tissue Impingement
• Osteochondral Lesion of the Talus
• Missed Fractures
• Peroneal Tendon Injuries
• Syndesmosis Injuries
  

Chronic Ankle Instability

• A condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle
• Repeated turning of the ankle, especially on uneven surfaces or when participating in sports
• Persistent discomfort and swelling
• Pain
• These patients have ligaments that were torn and have not healed properly, leaving the ankle joint too loose
  

Treatment

• Physiotherapy
• Bracing
• Surgery
• Physiotherapy
• Re-train nerves to respond to movements of the ankle
• Strengthen the muscles around the ankle
• Stretch out stiff ankle or stiff Achilles tendon

Please note that the information contained herein is for general medical information only.
If you have any specific medical condition or queries, please consult your medical doctor.

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