Each year a significant number of high school students participate in sports. Sports-related injuries are a common reason for orthopaedic visits.  Injuries are a source of concern and disappointment for coaches, parents and athletes, and return to play is always an important consideration.

One of the more common, but not always benign, injuries that I treat frequently is an ankle sprain.  As a foot and ankle specialist, I see numerous sprains throughout the year.  While most sprains heal within 4-6 weeks, some remain nagging and painful.

The typical treatment for an ankle sprain is the RICE protocol – rest, ice, compression and elevation.  As long as x-rays do not show a fracture, I usually encourage my patients to wear an ankle brace and begin early functional rehabilitation.  This includes physical therapy exercises either at home or with a physical therapist to promote early motion and strengthening.  I believe that the main reason that there is an incomplete recovery from an ankle sprain is that therapy does not start early enough, allowing the ankle to stiffen.

After three weeks, most sprains will show progress in the healing process.  If I see a patient at the three week mark and they are complaining of significant pain and still having a great deal of swelling, I’ll order advanced imaging to look for damage that may not have been visible on the original x-ray.  This can include small fractures, tendon tears or bony contusions or bruises.  Yes – you can bruise the bone, and it is a painful injury that can persist for months.  This happens when the foot is suddenly turned inward and the two major bones of the ankle joint – the tibia and the talus – collide.

One of the unfortunate consequences of returning to sports too quickly without adequate rehabilitation is chronic pain and weakness in the ankle.  I take care of numerous patients each year with chronic ankle instability – a condition in which the ligaments on the outside of the ankle become weak and unable to provide stability after repeated sprains or an inadequately rehabbed sprain.  The patient typically comes to me complaining of a sensation that the ankle is going to “give way.”  As you can imagine, this is a significant problem in an athlete where quick starts and stops and cutting movements introduce maximum stress to the ankle joint.  I’ll usually try a course of rehab to see if conservative measures will allow the athlete to accommodate for the instability.  If the problem persists, I recommend a surgery known as a Brostrom-Gould repair where the ligaments are tightened, the soft tissue repaired and the patient rehabbed to restore strength and function.

Bracing is a common concern that I hear from many of my student athletes. Particularly in sports like volleyball, basketball and soccer where the ankle is put to the test in each game, some athletes inquire about the usefulness of bracing in preventing injury. I’ll usually recommend a brace for several weeks when they return to sports after rehab.  Once full strength and stability is achieved through rehab, I’ll typically encourage them to go without a brace as natural use of the ankle helps to maintain tone and strength.

As the parent of a high school athlete, I understand the desire to return quickly to competitive play, particularly when playoff games or scholarship opportunities are on the line.  My typical in-office assessment will include having the athlete jump up and down on the injured ankle and make cutting movements from side to side.  If these motions can be accomplished without pain or feelings of weakness or instability, the athlete may be ready to resume play.

My take-home message about ankle sprains is that early, functional rehabilitation helps with optimal recovery and listening to the body’s cues when returning to competition contributes to safe play.

 

2 comments

  1. Madeleine Sharp

    Severely sore right ankle. Please help!

  2. Chloe morrison

    I had a severe ankle sprain about 6 years ago, I remember as soon as it happened it swelled instantly and couldn’t put any weight what so ever on it. My uncle carried me back and I had ice on it for over an hour. I felt pretty good and thought maybe I could put a little bit of weight to get me something. As I put my left foot down first then slowly putting my right down.. I collapsed as soon as my toes touched the ground. The doctors said I tore my ligaments after I went to hospital and took x-rays and they also said there might be a fracture and call if we find anything but I guess there wasn’t as they never called.

    Over the years I’ve easily sprained it and few times pretty bad but not as bad as the incident six years ago. Lately I’ve been feeling moderate to severe pain in my ankle even just sitting or laying down and I haven’t even had an injury or done anything to cause one. I’ve been to many doctors and took many scans, when I went to an orthopaedic surgeon I finally thought I was going somewhere and he told me to see a physiotherapist for at least 2 months before we decided to take action for a surgery. So I agreed and I went but not for two months sadly, I went for two sessions, the first session well he said that my bio mechanics are terrible and I have duck feet but not as bad and he said that the incident six years ago may have triggered this and the way you have been walking may have caused pain and that my feet are really narrow and my arches are long and high, so he gave me these souls to put in my shoes and see how they go for two weeks and then come back. So therefore I did but I wondered why only the right foot though, why would pain just randomly appear even when I’m sitting or laying, yes I also get pain sometimes while active, usually within five mins of running, sometimes more, sometimes less, but it makes it hard for me to enjoy running now. I went back two weeks after and he asked how much pain have I experienced the past two weeks and I replied little and he said great! And asked on a scale of 1 to 10 how bad was the pain and I said 3-5 and replied awesome you have improved this is working, continue with the souls and should improve and if it gets worse come back. Sadly as I left I thought I didn’t do much past two weeks, no running at all part from few meters one day but that’s nothing. And ever since it’s been up and down but lately the pain is occurring more often and I just want it to stop and go away I’m only 16 years old, if anyone has any ideas what could be wrong I’d love to hear any possible solutions. :))

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