Chronic Ankle Sprains
Updated 12/12/2011
MRIs may lead to unnecessary ankle surgery
Researchers writing in the Journal of Foot and Ankle Surgery looked at the ankle MRIs of 100 patients who had avergae age of 46 had no lateral (outside) ankle pain.
None of the patients had had a recent lateral ankle injury or any surgery.
MRI showed in approximately 30% of asymptomatic patients abnormalities.
The reaserchers noted “caution is warranted if choosing surgical treatment on the basis of the MRI findings alone.” (1)
Ankle Replacement Surgery
Researchers report high rate of second surgery
Researchers writing in the Acta Orthopaedica medical journal report that in an 18 year period following total ankle replacement that 22% of patients had to go in for a second ankle procedure.
The reported that “780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010.”
“Women below the age of 60 with osteoarthritis were at a higher risk of revision…” (2)
It is estimated that 40% of all people who suffer an ankle sprain will suffer chronic pain and weakness in that ankle long-term. The reason? Your ankle never healed properly. Here is why: Our ankles are held together by ligaments and tendons, strong bands of connective tissue. Ligaments hold the ankle bones together while tendons attach the muscles to the bones.
When ankle sprains occur, the ligaments of the ankle are stretched and torn. Most commonly, ankle sprains occur when the athlete lands unevenly from a leap or jump, or has someone fall on their ankle during contact sports. Sprains can also occur when stepping into a hole or divot on a playing field or golf course. The severest of ankle sprains are the extreme or violent twist or “roll-over” of the ankle causing a hyper-extended turning in or turning out of the foot. The turning out injury causes a sprain of the anterior talofibular ligament, and this is the most commonly injured part of the ankle.
When ankle sprain is suspected, the severity of the injury is then graded by a medical professional and a treatment suggested.
Grading the sprain
Grade 1 sprain:
A grade 1 sprain is the least severe of ankle sprains. The ligaments are slightly stretched with a minimum of tearing to the ligament fibers. More of a discomfort than pain is felt as the athlete can usually “walk it off.”
Grade 2 sprain:
There is stretching of the ligaments and partial tearing causing an unstable or loose joint. The condition is also referred to as ligament laxity as the ligament, now stretched beyond its normal range has become weakened or lax, as an overstretched rubber band. There is noticeable swelling and tenderness and depending on extent of injury, instability when walking.
Grade 3 sprain:
A complete tear of the ligament causing extreme instability, swelling, and pain
Grading the treatment:
Grade 3 sprains are not the most common forms of ankle sprains and surgery may be prescribed, but this is rare since the ligament usually scars over during healing.
Is it the treatment at fault?
The “gold” standard of treatment in Grade 1 and Grade 2 sprains is RICE. Rest, ice, compression, and elevation. Recently however this therapy has been debated by some physicians because of the high incidence of chronic or recurrent ankle sprains.
Among the theories put forth questioning the RICE treatment is that it does not fully allow the ligaments to heal because it reduces and impedes inflammation that is needed to stimulate new tissue regeneration.
Creating inflammation to heal the ankle sprain
Basic medicine tells us that the body’s natural healing response is inflammation. Inflammation is the trigger for the immune system to begin the cascade of events in injury repair. When ligaments do not heal completely, they weaken and put the athlete at risk for chronic ankle sprain.
Preventing with Prolotherapy
When there is not enough inflammation to heal a ligament injury, some physicians have turned back to a new “old-fashioned,” treatment to jump start the healing processes. Prolotherapy was first introduced in the 1950′s as a means to cure chronic pain by strengthening the ligaments of weakened, loose joints by creating inflammation – not suppressing it.
Prolotherapy works by introducing a mild irritant through injection to the exact spot of the ligament damage. This irritant is usually something as benign as simple dextrose. What the dextrose does is create a small, controlled inflammation at the spot of injury accelerating healing and returning strength and resiliency to the ligament and stability to the ankle. In remittent cases, PRP (Platelet Rich Plasma) is used as a stronger proliferant.
Prolotherapy is gaining adherents among athletes because it is minimally invasive, does not require long periods of inactivity and in fact, a Prolotherapy doctor will usually recommend supervised activity or a recommend training plan to get the athlete back on the field as fast as possible.
One to six treatments is typical for the competitive athlete, spaced at weekly intervals.
1. Saxena A, Luhadiya A, Ewen B, Goumas C. Magnetic resonance imaging and incidental findings of lateral ankle pathologic features with asymptomatic ankles. J Foot Ankle Surg. 2011 Jul-Aug;50(4):413-5. Epub 2011 May 12.
2. Henricson A, Nilsson JÅ, Carlsson A. 10-year survival of total ankle arthroplasties.Acta Orthop. 2011 Dec;82(6):655-9. Epub 2011 Nov 9
