Ankle sprain injuries are among the most common injuries to the foot and ankle. Individuals, especially young athletes, tend to ignore the usual “ankle roll” and continue participating in activity after injury. The most common way to sprain your ankle is by inverting and plantarflexing, which simply means turning the foot in and pointing it down under the ankle. This issue could cause long-term pathology if ignored.
The most commonly injured ligament in the foot and ankle is the anterior talofibular ligament, also known as the ATFL. It connects the talus bone (the bone that makes up the “floor” of the ankle joint) to the fibula (bone on the outside of the ankle). There is also a possibility that other ankle ligaments could be injured during a typical ankle sprain. However, the ATFL is the most common.
Pain and swelling will linger for weeks post-ankle sprain. One may also experience ankle instability after one severe ankle sprain or a few minor ankle sprains.
The ligaments of the lateral ankle most commonly injured include the anterior talofibular ligament and the calcaneofibular ligament. It is possible but less common to injure the deltoid ligament complex, which is at the ankle’s medial aspect (inner side).
Ankle sprains usually involve one or more injured ligaments. Ligament injuries take approximately 4 to 6 weeks to heal if treated properly.
When a ligament tear occurs, the ankle will continue to feel unstable and have a localized area of swelling at the ATFL region. There will be pain to palpation of the area if firm pressure is applied. A patient with a torn ankle ligament may begin to experience pain and fatigue in other areas of the ankle after a few weeks post-ankle injury, as other soft tissue structures surrounding the ankle joint overcompensate to stabilize the ankle.
A compression bandage, sleeve, or brace can help control swelling immediately after a sprain. A foot and ankle specialist should evaluate an individual to ensure that a walking cast boot is not warranted.
Putting weight on a sprained ankle immediately after injury is not recommended until an evaluation by a specialist is performed. If an ankle ligament is ruptured, the ankle is unstable and more prone to further injury if walked on.
An ankle can stay swollen for three months to a year after injury, depending on the extent of ligament or even boney pathology.
Many minor ankle sprains, especially if it is a patient’s first sprain, can be treated conservatively without surgery. Conservative treatment involves a period of time spent in an orthopedic boot and a course of physical therapy.
Repair of the anterior talofibular ligament takes approximately 45 minutes. It is common for the surgeon to do ankle arthroscopy to evaluate the ankle joint further before ligament repair. If arthroscopy and ligament repair take place, the surgery may take 1 to 2 hours.
Ankle ligament repair and ankle arthroscopy are “same-day” surgical procedures, meaning the patient can return to their home after the surgical case and a short anesthesia recovery period are complete.
The patient must be non-weight bearing and wear a cast on the affected limb for the first three weeks after surgery. For the post-operative period from week 3 to week 6, the patient may bear weight on the affected limb but must remain in an orthopedic boot at all times. After six weeks, the patient is gradually transitioned out of the boot and into a supportive brace. Physical therapy is initiated at six weeks. Twelve weeks of recovery is necessary before resuming high-impact activity, such as jumping or running.
The patient is required to remain in an orthopedic boot up until six weeks post-surgery and may bear weight on the ankle three weeks after the procedure.
I cannot overemphasize the importance of physical therapy after ankle surgery. The fastest way to recover from ankle surgery is to commit to a rigorous course of physical therapy for at least 6 to 12 weeks to strengthen and stabilize the ankle.
Heels can be worn post ankle surgery as soon as the ankle is strengthened and stabilized through physical therapy modalities.
Yes, I find that most of my post-surgical ankle patients tell me that they feel even stronger and more stable when returning to sports than they felt before injury and surgery.
Immediate post-operative rest, ice, compression, and elevation are extremely important. When considering ankle surgery, one must remember that following the procedure with a strict course of physical therapy is key to a full recovery without complication.
Author
Dr. Maria Battaglia, foot and ankle surgeon at Gotham Footcare
At Gotham Footcare in NYC, we strive at recognizing your individual needs and desired outcomes while formulating an effective and personalized treatment plan with the highest quality care available.
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