Chronic Ankle Sprain

Chronic ankle sprains are often marked by a frequent feeling of the outer (lateral) ankle “giving way.” It commonly develops following multiple ankle sprains. The sensation of the ankle giving way can occur during activities like walking or even when standing still. Both athletes and non-athletes can experience this condition.

Symptoms

Chronic ankle sprains stem from repeated stretching or tearing of the ligaments in the ankle, resulting in ongoing pain and instability. The severity of symptoms can vary, but they commonly include:

• Persistent pain or discomfort
• Swelling
• Instability
• Stiffness
• Tenderness
• Bruising
• Weakness
• Frequent strains due to weakened ligaments
• Difficulty bearing weight
• A sensation of grinding or popping in the ankle when moving

Causes

Several ligaments that control too much side-to-side movement enable confident and comfortable walking and support the ankle. An ankle sprain develops when the ankle rolls outward; widening the ligaments and tissues past their safe, normal limits and as a result, leads to ligament damage and pain.

Diagnosis

To diagnose chronic ankle sprain, our physicians at The Joint Pain Clinic begin by reviewing medical and injury history, with a focus on previous ankle sprains as well as the rehabilitation measures you’ve undertaken. A thorough foot and ankle assessment follows, which entails video gait and in-shoe pressure analysis. The aim of this evaluation is to:

• Assess the current stability, strength, and function of the ankle
• Detect any symptoms
• Rule out other possible causes of ankle pain

If needed, we may recommend imaging tests, including X-rays or ultrasounds, to gain a clearer understanding of the condition.

Treatment

Treatment for chronic ankle sprain varies based on the severity of the condition and the individual activity levels. However, we often recommend the following options:

• Physiotherapy

Physiotherapy is often the first treatment option and has proven to be effective. It focuses on retraining the injured proprioceptive nerves to help them respond properly to ankle movements. Strengthening exercises for the muscles near the ankle also play a key role in improving stability. If your foot structure places extra strain on the ankle ligaments, a custom-molded insole may be a solution to help reduce this tension.

• Surgery

Surgery can be recommended if ankle instability and pain do not resolve with conservative treatments and based on the extent of ligament weakness. There are two primary surgical options for chronic ankle sprain:

Brostrum’s procedure: This surgery involves tightening the damaged ligaments and reattaching them to the bone.

Tenodesis procedure: This involves using a strip of hamstring tendon to make new ligaments. It’s typically considered a last choice when the pain is severe; and when the ankle is under significant stress.

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