The beginning of school hallmarks the increasing incidents of ankle sprains. Many are directly related to the extra-curricular activity of sports. The actual cause of a sprain to the ankle joint is due to a force which is contrary to the anatomical function of this joint. Thus, rupture or partial rupture of ligaments, tendons, and/or the joint capsule may occur. This leads to either temporary or permanent instability of the ankle joint which, in turn, leads to future sprains.

The anatomy of the ankle is comprised of three bones: the tibia, the fibula, and the talus. The tibia is the inside (medial) contour and the fibula is the outside (lateral). Together these bones encompass the talus to form the ankle joint. Its range of motion is primarily straight up and down in a gliding fashion. Trouble occurs when a rotary twist or an inversion or eversion force happens to this joint.

The soft tissue structures of the ankle joint include ligaments, tendons, and the capsule of the joint. The ligaments are designed to limit abnormal motion. The tendons connect muscle to bone, and through contraction, afford motion. The capsule is a soft tissue that envelops the joint which contains the synovial fluid. The disruption of any of these structures leads to dysfunction of the ankle joint. Recurring sprains will ensue. Proper assessment and treatment by a qualified foot and ankle specialist is necessary to achieve the best return to function.

Injuries of the ankle occur in various degrees, each classified by the number of ligaments involved. A "Grade I" injury is named as such when a rupture has been limited to one ligament, "Grade II" when two ligaments have ruptured, and "Grade III," the most severe, when a rupture has occurred in three ligaments. Various diagnostic maneuvers lead to the proper diagnosis and appropriate treatment to speed recovery.

Too often, anti-inflammatory medication and an ACE wrap are prescribed when three weeks use of a non weight bearing cast is indicated. By employing a complete history and physical examination, this can be avoided. X-rays are used to reveal not only a bone’s defects, but also its loss of soft tissue integrity. Other visual aids such as MRIs and CAT scans are ordered to enable proper treatment to achieve restoration of as much function as possible. The ankle will never be the same as prior to the injury. However, proper diagnosis and treatment will lessen the morbidity and repetition of this injury.

Conservative care includes rest, ice, compression, and elevation. Non-steroidal anti-inflammatory medications will customarily be prescribed as well. Depending on the injury, an ankle air cast or non-weight bearing cast may be utilized for three to four weeks. Surgical primary repair of ligaments and tendinous structures may be indicated as a necessary treatment based on the severity of the injury and the activity level of the patient. Physical therapy modalities may also be prescribed for further help. However, the most important factor in healing an ankle injury is a proper exam and treatment plan prescribed by your Podiatrist.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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