Ankle


Frequently Asked Questions

I have sprained my ankle several times but recently suffered a high ankle sprain for the first time. This sprain is taking so much longer to heal. Is this normal? Why would it take so long?

A review on ankle syndesmotic sprains identified a recent systematic review of six research studies comparing high ankle sprains to lateral ankle sprains. Athletes in these studies who suffered high anklesprains missed significantly more games, reported more residual symptoms long-term, and reported longer average recovery time compared to lateral ankle sprains. Understanding why it takes longer for a syndesomotic sprain to heal involves understanding a bit of the anatomy of the ankle. The ankle is formed from above by the distal fibula and tibia and below by the talus and the malleolus (heel bone) below the talus. The fibula and tibia together form a syndesmotic articulation and require specific congruency and mobility to accommodate the underlying talus. The fibula must be able to rotate, translate and migrate to allow for normal ankle movement. The syndesmotic articulation must also be stable, and thus comprises four distinct ligaments. The anterior inferior tibiofobular ligament and the deep posterior inferior tibiofibular ligament contribute the most to ankle stability, combining to provide 68 per cent of the stability to the joint. The most common mechanism of injury resulting in a syndesmotic sprain is externally rotates and hyperdorsiflexes, often with sports such as soccer and football or with trauma such as a slip and fall on the ice or stairs. The injury can lead to just an isolated sprain or a sprain with fracture, often of the fibula. It is important to get a proper diagnosis from a healthcare professional before proceeding with treatment. If your injury is an isolated sprain without fracture, conservative treatment is warranted. Typically, treatment takes place in three phases: Phase I includes rest, ice, compression, and elevation to manage edema and protect the ankle. Simple range of motion exercises can begin in this phase as well. Phase II begins when you can walk without a limp and your pain and swelling are under control. In Phase II you will continue with range of motion and add strength and proprioception exercises such as balance. If your goal is to return to sports, Phase III begins when you can jump and hop without pain. Phase III includes return to sport activities with more rigorous strengthening, running and sport-specific drills. This process typically takes over a month.

Tyler J. Van Heest and Paul M. Lafferty. Current Concepts Review: Injuries to the Ankle Syndesmosis. In The Journal of Bone and Joint Surgery. April 2014. Volume 96A. No 7. Pp 603-613.

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