Why are ankle sprains so painful and debilitating? Ankle sprains are very common among sports injuries, casual joggers, or even just in daily movement. Ankle sprains can range from tender to incapacitating due to the injury of ligaments and/or bone structures in the ankle. An ankle sprain feels like a “stretching” or partial dislocation of the ankle joint as it bowstrings out of alignment. There are many ligaments, tendons and bones of the ankle and foot which can be injured. One of the most common ligaments injured is called the anterior talofibular ligament, located on the outside of the ankle joint. This ligament is usually the first of many ligaments which can be torn, stretched or even completely ruptured. Typically when a ligament is injured there is localized swelling over the outside of the ankle which also becomes very tender to touch. When the ankle is injured it is difficult to walk and the patient ends up limping for the next several days. There are multiple other structures which can be injured including another ligament called the calcaneofibular ligament which is located on the outside of the ankle as well. These first two ligaments are the most common ligaments which can be ruptured or damaged.
Ligaments are not the only structures which can be injured. Tendons, such as the peroneal brevis and longus, on the outside of the ankle, can be damaged or torn. The peroneal brevis tendon can be stretched, or even torn. In severe cases it can be torn away from the bone with can cause fracturing or breakage of the bone as well.
In a severe ankle sprain the inside bone of the ankle joint called the talus can actually rub up against the ankle walls where the tibia and fibula are located. This forces an erosion of the cartilage of the talus and/or tibia. The bones of the ankle are involved in the most severe ankle sprains. The most common fracture is of the fibular bone located on the outside of the ankle which can (depending on the severity of the ankle sprain) lead to a non-displaced or displaced fracture. An additional fracture can also occur on the inside of the ankle joint of the tibia. In severe trauma of the ankle such as falling from a height the heel bone can be broken into multiple pieces including the ankle joint.
In a severe ankle sprain it is imperative that the injury be evaluated by a foot and ankle specialist to identify the type of injury and the best type of treatment. Severe ankle sprains with potential fracture of the ankle may require surgery to fix and stabilize the fracture. In some cases ankle trauma can lead to loss of sensation of the ankle and foot, loss of movement, and loss of blood flow. This is a medical emergency and would require immediate intervention to restore sensation and blood flow to the foot. This is called compartment syndrome in which the neurovascular structures are compressed with acute swelling preventing blood flow to the foot.
With less severe ankle injuries it is ideal to be evaluated by a foot and ankle specialist to determine the type of injury and best action of treatment. With any ankle injury if proper treatment does not occur this can lead to laxity of the ankle joint and chronic pain.