Foot pain and ankle sprains – most of us are so busy and constantly on the go that we somewhat neglect foot pain, sprains of the ankle and foot, or numb toes, until such a time that they reach a point where day-to-day activities and walking become debilitating. Even if we do take action, more often than not we overlook the root cause of such problems, which means that they are never well and truly cured.
Men and woman alike very frequently hurt their ankles by going over or rolling them in various ways. Football injuries, stepping off a kerb or a step without paying attention, or twisting your ankle when on a night out with fancy heels are all very common presenting stories that foot surgeons hear routinely.
Most sprains are followed by quite worrisome bruising and pain, and most likely trips to A&E show no bony injuries on X-rays. Sometimes, there can be associated fractures, like those of the 5th metatarsal, due to the pull on this bone from the attached tendon, or in some cases hairline fractures of the fibula, which do not get picked up on routine X-rays.
The usual advice follows the basic principles of P.R.I.C.E., which stands for Protection, Rest, Ice, Compression and Elevation. Most often than not, these seemingly innocent sprains have quite a significant component of ligament tears to the lateral ankle ligaments, which often needs assessing by musculoskeletal specialists at Week-1 or 10 days post-injury, for a detailed examination. This could be from either an Orthopaedic Clinician or a trained and experienced Sports Physician or Sports Physio, and there needs to be a high index of suspicion for potential instability as a consequence of such injuries.
Dynamic ultrasound scans or MRI scans in cases of the painful ankle can diagnose most ligament tears and / or associated issues, including tears of the syndesmotic ligaments as well as cartilage damage in the ankle.
Most often than not, treatment is supportive and works on managing the acute phase of the swelling and pain by providing protected weight-bearing and rest, instituting an early period of resumed activity and rehabilitation once the acute phase settles. The astute physio knows when to commence proprioceptive work, in terms of balance board exercises and strengthening of the ankle, which is mostly around 8 to 10 weeks post-injury. This requires a complete buy-in from the patient to get the best outcome. In most cases of isolated ankle sprains and Grade 1 & 2 ligament injuries, one can expect a return to pre-injury status within 3 to 6 months. However, in a minority of cases, and in those with high sporting demands, early intervention from an Orthopaedic Surgeon may be required.
Surgical management of such injuries in the acute situation would be mostly in cases where:
1. there is an associated bony component, including associated fractures or open wounds or joint dislocations,
2. if there are significant ligament tears, including syndesmotic ligament tears, or
3. where there is associated articular cartilage damage in the ankle joint, which gets picked up on MRI scans.
Surgical management will also be recommended when in spite of physio / rehab and strengthening of the ankle,
A. the patient feels unable to trust their ankle on a daily basis, for fear of it giving way,
B. the patient is unable to run and carry out pre-injury fitness activities due to fear of instability, or
C. if there is constant pain and swelling in the ankle and worsening of symptoms with activity.
The take home message from this is blog is that whilst most ankle sprains are harmless and recover well with the right advice and support and rehabilitation, one should not hesitate to seek specialist orthopaedic advice if the injured ankle or foot continues to be swollen, painful or bruised or if the patient complains of instability.