It’s Not Just an Ankle Sprain

“It’s not just an ankle sprain,” said board certified foot and ankle surgeon Sara E. Zelinskas, DPM, ABFAS. A sprain to the ankle may hurt temporarily, but if left untreated, can lead to a future filled with pain, stress, and chronic ankle instability. If you’ve injured your ankle and the pain has lingered on for more than two days, it’s time to seek treatment.

What Is Chronic Ankle Instability?

Chronic ankle instability occurs when recurrent ankle sprains cause the ligaments in the body to become weak and unable to control the ankle, which leads to an ankle sprain. Pain and swelling in the lateral ankle typically accompany recurrent sprains, indicating a rupture of the anterior talofibular ligament (ATFL). Peroneal tendons may also be torn or dislocated.

  • Anterior talofibular ligament (ATFL) – ATFL is the weakest ligament in the ankle. Due to its weakness, it is one of the most commonly injured ligaments following ankle sprains.*
  • Peroneal tendons – There are two peroneal tendons in each foot, which help stabilize movement. These tendons connect the ankle to the foot and the muscles to the bone.*

Chronic ankle instability is common in people required to be on their toes, including basketball players, gymnasts, and dancers. Children are also at high risk for this condition as they often hurt themselves while playing and continue without being examined. Following trauma, the ankle must heal appropriately to avoid further complications.

What are the Levels of Ankle Sprains?

Grade 1: The ankle is sprained, but nothing has torn. After a couple of days, the pain resolves.

Grade 2: There is a tiny tear in the ankle ligament that can be treated with an ankle brace. This grade is a little more severe and can lead to instability if it happens repeatedly.

Grade 3: There is a complete tear of one of the ligaments that must be treated as a fracture. This tear could cause instability if treated inappropriately.

How is Chronic Ankle Instability Treated?

If chronic ankle instability is present, Dr. Zelinskas treats the sprain conservatively in a boot. If there is no improvement, she orders an MRI to determine if there are problems in the bones, tendons, or ligaments. Treatment may vary depending on the amount of time since the trauma.

  • Non-surgically, if it has been years, you may need physical therapy to strengthen the surrounding muscles and then bracing, which is more permanent.
  • If it’s acute, wear a lace-up ankle brace or a walking boot for a few weeks and then attend physical therapy.

If left untreated, this condition can lead to osteochondral defect, a defect in the ankle or cartilage.

Getting Back to Normal!

The post-operation healing process usually lasts for two weeks with non-weightbearing in a splint. At that time, patients are only allowed to walk in a walking boot.  A total of six weeks is spent in a walking boot. At four weeks, physical therapy is recommended.  After treatment, get right back to the things you love!

“They can fully recover and resume their normal activities if treated appropriately…All of my athletes get back to their sports,” said Dr. Zelinskas.

Always look into lingering pains that can be treated quickly rather than waiting, which may result in surgery. Remember, it’s never just an ankle sprain.

*Sources linked to terms.

Sara E. Zelinskas, DPM

About Sara E. Zelinskas, DPM, ABFAS

Sara E. Zelinskas, DPM, ABFAS, is a board certified foot and ankle surgeon in Virginia Beach. In her clinical practice, she focuses on the needs of each individual patient to help them achieve their individual training goals, whether as a weekend warrior or budding marathon runner. She takes a conservative approach to treatment, utilizing therapies such as stem cell injections when possible; however, in cases where surgery is the appropriate course of treatment, Dr. Zelinskas performs surgical procedures to include foot and ankle reconstruction and total ankle joint replacement.

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