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Ankle sprains
 
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

NonSurgical Treatment and Rehabilitation

In the case of an ankle sprain, rehabilitation is crucial—and it starts the moment treatment begins. A foot and ankle surgeon may recommend one or more of the following treatment options:

Immobilization - Depending on the severity of the injury, a short-leg cast, a walking boot, or a brace will keep the ankle from moving. Crutches may also be needed.

Early Physical Therapy - A doctor will start a rehabilitation program as soon as possible to promote healing and increase range of motion. This includes doing prescribed exercises.

Medications - Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.

Icing - Applying ice to the injury several times a day until the pain and swelling resolves is advised. Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on the skin.

Compression Wraps - To prevent further swelling, keep the ankle wrapped in an elastic bandage or stocking.

When is Surgery Needed?

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for each case based on the type and severity of the injury as well as a patient’s activity level.

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.

High Ankle Sprain 

This condition occurs when the sprain injures the large ligament above the ankle that joins the two bones of the lower leg together. These two leg bones, the fibula and the tibia, are joined together by the syndesmotic ligament and run from the knee down to the ankle.

High ankle sprains simply tend not to heal as quickly as the more common ankle sprains. That is why coaches, trainers, and the affected athlete are always so concerned about this injury. An orthopaedic physician will begin treatment by first determining if the injury is stable or unstable. A stable injury can be treated in a cast that will be worn for approximately six weeks.

If the injury is unstable then a “syndesmotic screw” can be placed between the fibula and tibia to secure the bones in proper position while the ligament heals. This treatment is generally considered a relatively safe and trusted surgical procedure.

The afflicted patient will have the screw in place for three months while the ligament heals. It is strongly recommended by some doctors that their patients do not attempt to walk on the leg while the syndesmotic screw remains in their leg. This is due to the normal motion that is present between the bones when a person walks. These doctors would prefer to perform a second operation to remove the screw before the patient is allowed to place pressure on the leg again. Other doctors will simply leave the screw in and even allow it to break.

Ankle fractures 

A fracture is a partial or complete break in a bone. In the ankle, fractures can range from the less-serious avulsion injuries (small pieces of bone that have been pulled off) to severe, shattering-type breaks of the tibia, fibula or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. Both can occur simultaneously.

An ankle fracture is accompanied by one or all of these signs and symptoms:
· Pain at the site of the fracture, which in some cases can extend from the foot to the knee.
· Significant swelling, which may occur along the length of the leg or may be more localized.
· Blisters may occur over the fracture site. These should be promptly treated by a surgeon.
· Bruising, which develops soon after the injury.
· Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured.
· Change in the appearance of the ankle so that it differs from the other ankle.
· Bone protruding through the skin—a sign that immediate care is needed! Fractures that pierce the skin require urgent attention because they can lead to severe infection and prolonged recovery.

Treatment

Ice and elevation - Swelling is almost universally seen following a broken ankle. An important part of treatment of an ankle fracture is to minimize swelling. Limiting swelling will help control the pain from the ankle fracture and minimize the damage to the surrounding tissues.

X-rays - Most patients with an ankle fracture are seen in the doctor’s office or emergency room. The first step is to obtain X-rays to see what the fracture pattern is, how badly displaced the fracture is, and what the condition of the bone looks like. Depending on the appearance of the ankle fracture on X-ray, treatment decisions can be made.

Splint - Splinting an ankle fracture is commonly performed in the emergency room. A splint is often done for a few days, followed by a cast. The splint will allow more room than a cast in case there is continued swelling. If the ankle fracture is not badly displaced, the splint may be put on without moving the broken ankle. If there is displacement, a "reduction" will be performed. After being given anesthesia, the ankle fracture will be reset to improve the alignment and displacement of the broken bones.

Cast - A cast is usually done after a few days, unless the swelling is minimal and it may be done early after the injury. A cast is made either of plaster or fiberglass. Plaster molds to the skin better, and is preferred if the cast is needed to hold the broken bone in a specific place. If the fracture is not unstable, or if some healing has taken place, a fiberglass cast may be used. The fiberglass is lighter-weight and more resilient to wear.

Crutches - Crutches are important, because almost all types of ankle fractures will require some level of immobilization and rest following the injury. Sometimes, patients will not be able to place any weight on the ankle for several months, other times within days to weeks. Determining the broken ankle can bear weight depends on the type of ankle fracture; this will have to be discussed with a doctor.

Surgery - Surgery is needed for many types of ankle fractures. While not always necessary, surgery for ankle fractures is not uncommon. The need for surgery depends on the appearance of the ankle joint on X-ray and the type of ankle fracture present. Achieving and maintaining alignment of the broken ankle is of utmost importance. Arthritis is common after an ankle fracture, and the best way to reduce the risk of arthritis is to obtain a normal looking ankle joint. If surgery is needed to achieve this goal, a doctor may recommend an operation.