Ankle sprains can lead to chronic pain and long-term problems

August 23, 2013 7:45 am  •  

An ankle sprain can happen to anyone, anywhere, while playing sports, walking on ice or stepping on uneven ground.

The ligaments of the ankle are like a rubber band, according to Valerie Tallerico, a podiatrist with UnityPoint Clinic Podiatry. The first sprain, she said, tears and stretches the ligaments, which can be made strong again with proper rehabilitation.

Subsequent sprains, however, Tallerico said, stretch the ligaments to the point that they lose all tension and stability.

Every year an estimated two million people in the United States suffer acute ankle sprains. Between 60 and 70 percent of these people wind up at emergency rooms, according to Tallerico's husband, Kosta Antonopoulos, also a podiatrist with UnityPoint Clinic Podiatry. He said some people recover just fine after getting a boot from the ER. Others, without additional treatment, he said, risk repeatedly hurting their ankle again, resulting in a severe, chronic injury.

Many patients, according to Antonopoulos, suffer ankle pain for months after a sprain, before they arrive at his office. An MRI, he said, often reveals cysts or bone lesions, which wouldn't be detected on X-rays taken in the ER.

"We like to see them initially because a lot of time it's just a simple brace or just a little bit of off-loading for like a week," he said. "Usually when we get them it's more chronic in nature. It's been present for a period of time. That makes treatment harder because the braces don't usually work."

Podiatrists provide care for foot and ankle ailments beyond corns, callouses and hammer toes. Tallerico said she is trained to treat Achilles tendonitis, strains, foot and ankle fractures, as well as sprains, which fall into two categories -- functional and mechanical.

"We like to refer to ourselves as a foot and ankle specialist or foot and ankle surgeon," she explained. "A lot of the work we do now is sports-related and reconstructive in nature, as well as trauma in nature."

Swelling, bruising and pain around the ankle, as well as trouble walking are signs of an ankle sprain, according to Tallerico.

She said patients with functional ankle sprains, where the ankle just feels unstable due a disconnect between the nervous system and muscular system, but really isn't, usually do well with physical therapy. 

Those with mechanical sprains, where the ankle is actually unstable, she said, tend to require surgery.

A chronic ankle sprain, Tallerico said, can actually be worse than breaking your ankle, because the injury may lead to the development of tendonitis and additional boney injuries.

"Unfortunately 30 percent of our patients will go on to having chronic ankle sprains or chronic ankle instability," she said. "They'll continuously sprain their ankles. Their ankle will feel wobbly or unstable for them."

With ankle arthroscopy, a minimally invasive surgical technique that involves inserting a camera into the ankle joint, Tallerico and Antonopoulos can repair the ligaments and help prevent patients from rolling their ankle again. Recovery time for the scope, on average, is a couple of weeks. If the ligaments require stabilization, Antonopoulos said patients will be out six to eight weeks.

"You look for inflamed tissue or some boney injury that might be going on," Tallerico said. "Essentially what we can do is clean up that ankle joint and remove that inflamed tissue and hopefully alleviate their pain."

Antonopoulos said people with high arches are predisposed to ankle sprains because the ligaments on the outside of their feet are unstable.

"A lot of times fixing their ligaments or getting them a brace won't necessarily help them because their foot type does not allow them to walk bio-mechanically sound," he said.

The solution for patients with high arches, Tallerico said, is reconstructing their feet by cutting and moving bone.

"Essentially you give them a more flatter foot type," she said. "Just making a more neutral foot or stable foot that they can walk on and prevent them from commonly rolling their ankle or walking on the outside. That's something we're completely capable of doing."

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