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Ankle Sprains Specialist
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is an Ankle Sprain/Instability?
An ankle sprain is an injury characterised by the stretching or tearing of ligaments, which are the strong bands of tissue that support the ankle joints. This condition primarily affects the lateral ligaments on the outside of the ankle. Ankle sprains are caused by the ankle turning, rolling, or twisting beyond its normal range of motion, often during physical activities.
Ankle sprains are classified into different grades based on their severity:
- Grade 1 sprains involve slight stretching and minor tears in the ligament fibres, leading to mild tenderness and swelling.
- Grade 2 sprains are marked by partial tearing of the ligament, moderate tenderness and swelling, and possible abnormal looseness of the ankle joint.
- Grade 3 sprains signify a complete tear of the ligament, resulting in severe tenderness, swelling, and substantial instability of the ankle.
Chronic ankle instability is a related condition where the ligaments do not heal adequately after a sprain, causing repeated instances of the ankle giving way. This can result from insufficient healing post-injury, leading to ongoing instability and recurrent sprains.
Causes of Ankle Sprains and Instability
Ankle sprains and instability can arise from various factors, often related to physical activities and environmental conditions.
- Walking or Exercising on Uneven Surfaces
Participating in activities on uneven terrain can elevate the risk of twisting or turning the ankle unnaturally, potentially causing sprains. - Engaging in Strenuous Sports
Sports that require abrupt changes in direction, jumping, or rolling of the foot, such as basketball, football, and tennis, are common settings for ankle sprains. - Accidental Falls
Falling or slipping can cause the ankle to twist unexpectedly, stretching the ligaments beyond their normal range. - Improper Footwear
Shoes that do not provide adequate support or fit incorrectly can contribute to ankle instability, potentially increasing the likelihood of sprains. - Previous Ankle Injuries
Individuals with a history of ankle injuries are more prone to future sprains due to weakened ligaments or reduced ankle stability.
Symptoms and Signs
The common indicators of an ankle sprain include:
- Pain: Typically, the most immediate and noticeable symptom, pain is often more intense when bearing weight on the affected foot.
- Swelling: This is a natural response to injury, indicating inflammation of the affected area.
- Bruising: Bruises may appear around the ankle, reflecting underlying tissue damage.
- Tenderness to Touch: The injured area may be sensitive to touch or pressure.
- Restricted Range of Motion: Swelling and pain can limit the movement of the ankle joint.
- Instability of the Ankle: In more severe cases, the ankle may feel loose or unstable, indicating potential ligament damage.
- Popping Sensation or Sound: Some individuals may experience a popping sound or sensation at the time of injury, indicative of a ligament tear.
Diagnosis
The process of diagnosing an ankle sprain involves several steps to assess the extent of the injury and to rule out other possible conditions.
- Physical Examination: Diagnosis typically starts with a physical examination, which involves assessing areas of swelling and tenderness and evaluating the ankle’s range of motion.
- Specialised Stress Tests: These tests can be employed to help determine the specific ligaments that have been injured.
- Imaging Tests: X-rays are often used to rule out any fractures. MRI scans can also be conducted to provide detailed images of the ankle’s ligaments and cartilage, to help assess ligamentous or cartilage injuries.
Non-Surgical Treatment Options
Non-surgical treatments for ankle sprains focus on relieving pain, reducing swelling, and promoting healing.
RICE Therapy |
An ankle specialist may suggest this immediate care approach to aid in the initial management of ankle sprains. It involves rest to prevent further injury, application of ice to reduce swelling and alleviate pain, compression using elastic bandages to support the injured area and minimise swelling, and elevation of the ankle above heart level to reduce swelling. |
Medication |
Anti-inflammatory drugs, such as ibuprofen, are commonly used to manage pain and reduce inflammation associated with ankle sprains. These can help control the acute symptoms and facilitate a more comfortable recovery phase. |
Physical Therapy |
Physical therapy includes tailored exercises and treatments designed to restore strength, flexibility, and the range of motion of the injured ankle. It can help prevent chronic instability and aid the return to previous levels of activity. |
Ankle Braces or Supports |
The use of ankle braces or supports provides additional external stability to the injured ankle. These devices are particularly beneficial in preventing further injury and facilitating the healing process, especially during the gradual return to daily activities and sports. |
Activity Modification |
During the later stages of treatment, the ankle specialist may recommend modifying daily activities to avoid additional stress on the healing ankle. This includes limiting weight-bearing activities and avoiding movements that could exacerbate the injury. This can help lead to a steady recovery and reduce the risk of re-injury. |
Surgical Treatment Options
Surgical intervention for ankle sprains is considered when non-surgical treatments have not provided adequate stability or in cases of severe injury.
Arthroscopic Surgery
This minimally invasive procedure is often employed for severe ankle sprains involving multiple ligament injuries. Arthroscopy allows for a detailed examination and repair of the damaged ligaments through small incisions, facilitating a faster recovery compared to open surgery.
Open Ligament Reconstruction
In cases of severe ankle instability, open ligament reconstruction may be necessary. This procedure involves using a tissue graft to reconstruct the damaged ligaments. It is a more extensive surgery and is usually reserved for patients with severe ligament tears or chronic instability.
Surgery for Chronic Instability
Surgery may be considered for patients with chronic ankle instability, particularly when the ligaments have not adequately healed following repeated sprains. This often involves repairing or reinforcing the weakened ligaments to prevent future episodes.
Prevention Strategies
Preventing ankle sprains and instability involves a combination of lifestyle adjustments, physical conditioning, and awareness during activities.
- Proper Warm-Up to Prevent Injury - Engaging in a thorough warm-up routine before exercise or sports activities can help prepare the muscles and joints, reducing the risk of injury.
- Mindful Movement on Uneven Surfaces - Be careful when walking, running, or performing activities on uneven terrain to avoid awkward foot placement.
- Supportive Footwear and Ankle Supports for Stability - Choosing shoes that fit well and are appropriate for the activity can decrease the risk of ankle injuries. Individuals with a history of ankle sprains may also benefit from wearing ankle braces or using tape to provide additional stability.
- Strength and Flexibility Training for the Ankles - Regular exercises to strengthen and increase flexibility in the ankles can improve joint stability and reduce injury risk.
- Avoid Overexertion - Refrain from engaging in sports or activities beyond one's physical conditioning or skill level.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 20 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can I Engage in Physical Activities with a Sprained Ankle?
You should not engage in physical activities immediately after an ankle sprain. The healing process requires rest, especially during the acute phase of the injury. Resuming activities too soon may exacerbate the injury and prolong recovery. A gradual return to activities is recommended under the guidance of an ankle specialist.
What Happens If You Sprain Your Ankle Too Many Times?
Frequent ankle sprains may result in chronic ankle instability, characterised by stretched or weakened ligaments, which could make the ankle more susceptible to future sprains. Persistent instability can also lead to changes in walking patterns and an increased risk of other ankle and foot problems. To prevent recurring sprains and address instability, seek evaluation and treatment from an ankle specialist.
How Long Does It Take for an Ankle Sprain or Instability to Heal?
The healing time for an ankle sprain varies depending on the severity of the injury. Grade 1 sprains may take a few weeks to heal, while Grade 2 and 3 sprains might require several weeks to several months. Chronic ankle instability is a condition that develops over time and may require ongoing management. Timely and appropriate treatment from an ankle specialist can help lead to effective management and prevent long-term instability.