FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

REPEATED SPRAINS CAN PERMANENTLY DAMAGE ANKLE

Question: I sprained my ankle while hiking in a state park. This is the third or fourth time I've sprained the same ankle. Will it always be weak and sprain easily?

Answer: Ankle sprain is the term we use to describe a condition where the ligaments in the ankle become stretched or torn. These ligaments connect leg bones to other bones in the ankle, and help to stabilize the ankle and hold all of its parts together. Although the ligaments are quite strong, they can be stretched beyond their normal limits, partially torn or torn in two. These conditions causes pain, swelling, and bruising the typical signs of a sprained ankle.

Let me try to explain the ankle and the role of ligaments a little better. The lower leg bones, the tibia and fibula, together form a deep "u-shaped" receptacle which supports the foot bones. This structure, the ankle joint, supports the weight of the body without any support from ligaments as long as the person is standing still. The ligaments serve the important role of limiting the amount of forward/backward and turning-in/turning-out motion in the ankle. In fact, if it weren't for the ligaments and attached muscles, gravity could pull the foot out of the ankle joint every time the foot was lifted off the ground.

Ankle sprains are not the same as ankle fractures. While a sprain involves an injury to the ligaments that hold the bones together, fractures mean the bones themselves have been damaged. A fracture is the same thing as a "broken bone."

The same type of injury that causes a sprain can also produce a fracture. Typically this happens when the foot turns in and all of your weight comes down on the twisted ankle. The ligaments usually tear first. Frequently, however, there is also enough force to break bones, often at the point where the ligaments attach.

In a mild sprain, one in which a few of the fibers of the supporting ligaments have been torn (like breaking a few strands of a rope), the pain may be bearable and walking still possible. For this type of sprained ankle, elevation and an ice pack and rest may be all that's necessary to get relief.

More serious sprains, ones with more fibers torn, require a doctor's attention. With this type of sprain it is usually very difficult or impossible to walk because of intense pain. The ankle may seem very unstable; that is, it "gives way" very easily. In this case, you should have a doctor evaluate your injury to determine the degree of the sprain and whether or not there is also a fracture present. External support for the ankle, a cast or a splint, is usually necessary. Ice, elevation and pain medication are also important parts of the treatment.

When you elevate your leg, make sure that it is kept high enough. Usually, this means lying down with the ankle several inches above the level of the heart. Four or five pillows placed under the foot often will do the trick. Just putting your foot up on a stool is not adequate.

I should mention that surgery to place the bones in their proper position is sometimes necessary with ankle injuries. It is also possible to tear ligaments completely in two when there is no fracture. This condition, too, requires surgery.

Healing of an ankle injury takes many weeks. It is important to avoid over-stressing the healing ligaments, but it is equally important to encourage full flexibility of the joint. Your doctor will talk to you about the specific exercises and activities which are necessary for the rehabilitation of your ankle. In a case like yours, with repeated sprains, your ankle may never be as strong as it once was. You might ask your doctor about the need for wearing ankle supports, particularly when you're hiking or engaging in other strenuous activities.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.