Chronic Ankle Sprains: Why Do They Keep Happening?

Chronic Ankle Sprains: Why Do They Keep Happening?

Thank you for tuning in to OrthoPedia Patient, where we are going to discuss ankle sprains and why they keep happening. To answer that question, we are going to cover a couple of things, such as how ankle sprains happen and what we call the mechanism of injury. We are going to look at the anatomy, what you can do at home if you do have an ankle sprain, when to see a doctor, some of the surgical options, and then some take-home points.

What happens when you sprain your ankle? As we watch this video, you will see that the ankle rolls on the outer side, and then the foot turns inwards, injuring the ligament between the 2 bones. Let us take a look at some of the bony anatomy. This is the outer side of the foot, what we call a lateral view. What you will see here are some of the bones. The bones that we have in view are the fibula, we have got the tibia underneath is going to be the talus, and then the calcaneus, which is the heel bone.

If we look at a front-on view or an anterior view, what you will notice is the ATFL. ATFL is short for anterior talofibular ligament. It is the ligament that joins the fibula to the talus, and this tends to be the one that is injured during an ankle sprain. Keep your eye on that as we watch the video. You will see the foot turn around, and you can just see how it connects the 2 bones. There are other ligaments in that area, but the ATFL is the main one that is injured during a sprain in most cases.

Now that we have an understanding of some of the ankle anatomy, we can talk about what actually happens when you sprain your ankle. Here is your normal ankle. You can see the ATFL in here, just in green. When you roll your ankle or you have a sprain, you will see that the ligament is kind of stretched or torn. In most cases, about 80% to 90% of these will heal by themselves with what we call conservative treatment. Conservative treatment is going to be resting, icing, compression, and some elevation, really just to reduce that swelling and the bruising.

Some people will go into an ankle brace or a supportive boot, and they may need physical therapy for 6 to 12 weeks just to kind of strengthen the area again. However, for that kind of 10% to 20% of patients that do not recover from that conservative treatment, what you will see is that sometimes people get an unstable ankle and they get recurrent ankle sprains. This is for people that have recurrent ankle sprains, you are spraining your ankle frequently. At that point, it is worth seeing a physical therapist, surgeon, or doctor to kind of make sure there is not any long-term damage because what we would not want to happen is for people to get long-term problems with the ankle joint itself, called arthritis.

There are a couple of options with regards to surgical treatment. There is a Brostrom repair. This is where that torn ATFL tissue is sutured back together. The Brostrom-Gould repair is not only repairing that ATFL tissue, but it is also uses some local tissue called the inferior extensor retinaculum. There is also an option of the InternalBrace repair. The InternalBrace repair uses a FiberTape suture over the top of the regular repair, so you would still have your Brostrom or your Brostrom-Gould repair, but this will help support repair itself.

If people do use the InternalBrace repair, you can just kind of compare the two options. This is a postoperative regime, and you can see that people who did have the Brostrom with the InternalBrace repair really got going a lot quicker at weeks 8 to 12 compared to sometimes at least 6 months if you do not have the InternalBrace repair. This is a novel technique, so this is the InternalBrace ligament augmentation for ATFL repair this novel technique helps protect that native ligament repair that they would already be doing and allows for earlier motion and accelerated rehab, ultimately getting you back to your everyday activities a little bit quicker.

How do you manage this at home? Well, if you can, resting, icing, compression, and elevation will all help reduce the pain and the swelling. In most cases over the next couple of weeks that will reduce down and your movement will get back to normal. Can you stop it from happening again? Well, if you find that you are having recurrent ankle sprains, then it is probably worth seeing a physical therapist, a doctor, or a surgeon just to make sure that there is no long-term damage to the ligament.

If you do want to find out more information, I know that there is a lot of stuff on the Internet. If you are not sure where to go, anklesprain.com is a great resource. If you go to the homepage you can really look through a lot of information on this page. You can look at why your ankle keeps rolling. There are lots of images and figures. You can see some of the chronic ankle instability options and what is available to you if you are having recurrent ankle sprains. Lots of questions are answered as well, like what might happen if you do go to see a surgeon, what they will probably do during the appointment, and some videos to watch to kind of make it simple to understand it in everyday terms of what is going on with the ankle sprain itself.

There are some details on the InternalBrace if you do decide to have that option. There are also some patient stories. These are people that have had the InternalBrace ligament augmentation for their repair. Then, if you want to find somebody locally that is performing the procedure, you can put in your local zip code and see who is close by to you. If you want more information at an everyday level, not too in-depth, then you also have an educational resource.

In summary, what is your ankle sprain, why does it keep happening, and what did we cover? Well, we went over the anatomy, and you looked at the ligament itself; what is damaged? Long-term, if we do not get that corrected, then it can cause joint damage in the ankle. We looked at the mechanism of injury, so why you keep rolling your ankle, the recovery and what you can do. That is going to be different for everybody: different ages, different weights, different activity levels, so it is a little bit different for everybody. Then, some of the rehabilitation options, whether it is physical therapy and how quickly we can get you to return to your sport or your everyday activities. Thank you very much for listening.