Foot and ankle injuries are very common. They are one of the most common orthopaedic injuries and most people will sprain their ankles at some stage in their lives. Patients usually report spraining or rolling their ankles going down hill or on uneven ground.
It can happen on flat ground while wearing high heels but is most commonly caused by sports injuries. The person tries to change direction and their body keep going over their planted foot causing either a foot injury or ankle injury.
If the ankle is swollen enough the person will usually go to a hospital where ankle x-rays are performed and reported. As normal Ankle x-rays may sometimes show a small chip of bone off one of either the tibia, the fibula, the talus, the calcaneus or the cuboid. The small avulsion fractures are still treated as an ankle sprain but do indicate a more severe sprain.
Initial management of an ankle sprain is rest, sometimes in a removable plaster or boot. Remaining Non-weight bearing on crutches is important initially but many injuries are stable enough to walk on in a special type of boot. Swelling reduction with either ice or compression bandaging is very helpful. Physiotherapists employ a sequential compression device called a masman pump to reduce the swelling.
Ankle sprains can be very painful if a large haematoma (blood clot) is present under the skin and very occasionally the blood clot needs to be drained to give relief of pain. Most ankle sprains improve without ligament repair surgery. Some ankle sprains however remain painful, swollen, stiff or unstable.
Ankle physiotherapy will help many patients regain their range of motion and strength. Wobble board exercises will help the patient regain their sense of balance and joint position (proprioception). Failure to rehabilitate the ankle properly will lead to further episodes of ankle injury.
Ankle sprains that do not improve in a reasonable time frame (like 3 – 4 weeks) may have one of the following pathologies: synovitis (inflammation of the lining of the joint), cartilage injury (talar dome injury), nerve injury, tendon injury, associated fracture not seen on plain x-rays. These patients are best imaged with MRI (magnetic reasonance imaging) scanning of the ankle. This gives excellent images of the ankle joint lining and ligaments and helps to direct treatment.
Some of the patients who have sprained their ankles will require ankle injections, some will have more physiotherapy to the foot and ankle, some medications and some wiil need ankle surgery.
Arthroscopic surgery of the ankle is where a small fibreoptic telescope is inserted in the ankle to visualize the joint internal structures. Using a device that works something like a pool cleaner, one can remove the inflamed lining of the joint (synovectomy), remove loose pieces of bone or cartilage and grind down bone spurs within the ankle.
Arthroscopic surgery of the ankle is popular among sports people because smaller incisions often means shorter convalescence and therefore less time off sport.
Patients with unstable ankles that fail a good physiotherapy rehabilitation program should consider ankle ligament reconstruction surgery. The surgery can be performed as a day only procedure and is successful approximately 90% of the time. As long as the patient’s joint surfaces are in good condition most patients report a general feeling of improved stability after an ankle ligament reconstruction. Of course a dedicated ankle rehabilitation programme is needed after ankle surgery.