M L HEALTH
ANKLE SPRAINS : WHAT ARE THEY AND HOW SHOULD THEY BE TREATED ?
by Dr Andy Molloy , Consultant Orthopaedic Surgeon at Spire Liverpool Hospital .
Andy Molloy is a graduate of the University of Leeds . He carried out his surgical training in the Mersey Region and completed his training with a 6-month fellowship in USA with one of the world ’ s most eminent surgeons .
He is a highly experienced Consultant orthopaedic surgeon specialising in foot and ankle surgery at Spire Liverpool Hospital and Liverpool University Hospitals NHS Foundation Trust . He is an Honorary Clinical Senior Lecturer at the University of Liverpool . He treats all disorders of the foot and ankle including bunions , flat feet , big toe arthritis , keyhole surgery , deformity correction , trauma and arthritis ( including ankle replacements ). He also has a special interest in foot and ankle sporting injuries ( treating both professional and amateur sportspeople ). Andy has a strong research interest , having published many research articles and book chapters . He regularly lectures nationally and internationally as well as running courses for the education of other consultants . He has served on national committees , including setting up a national foot and ankle surgery registry .
What is an ankle sprain ? An ankle sprain is a partial or full tear of ligaments in the ankle . This usually involves the ligament on the outside of the ankle but may involve ligaments on the inside and centre of the ankle with more severe grades of sprain . They are very common , accounting for around 40 % of athletic injuries . Up to 10 % of these injuries can cause long term instability and pain .
How should it be treated ? Following a twisting injury , medical attention should be sought if you are unable to weightbear properly or if there is significant bony tenderness . Rest , ice , compression and elevation all help initially . Some form of splintage may be well be necessary , especially for the more severe grades of injury . Physiotherapy is essential is moving the joint , stabilisation exercises and balance training . Speed of recovery tends to worsen with the more severe the tear is and how many ligaments are involved .
What are the warning signs ? More severe sprains have a higher chance of causing ongoing pain and instability . These sprains will be associated with significant swelling and tenderness over the ligaments on both sides of the ankle . In these cases , I would recommend early assessment by an experienced physiotherapist or surgeon . Whatever the severity , if there is ongoing instability and lack of confidence and / or significant pain at up to 6 to 8 weeks , then there is an increased chance of a tear that may not heal properly or of damage to the cartilage . In these cases , I would advise assessment by a surgeon , and most likely an MRI scan . When this happens , it is well know that patients do better the earlier it is surgically dealt with .
What does surgery involve ? Traditionally the surgery had a long rehabilitation process with 6 weeks in a plaster whilst mostly keeping weight of it . After , there is up to 6 weeks in a boot with it taking a long time to return to full activities .
The technique I have published on , involves a combination of keyhole and open surgery . The strength of ligament reconstruction allows for a quicker rehabilitation regime . The patient requires 2 weeks of plaster followed by a walker boot for 3 to 4 weeks . During this time the patient can put weight through it and will start physiotherapy including bike work . Patients can normally carry out sports specific exercise by 9-12 weeks , usually leading to a return to pre-injury activity levels . There is no difference in the operation and the rehabilitation allowed from elite sportspeople to those less active .
What is the expected outcome ? There is a small complication rate , with the majority being minor . The huge majority of patients get back to previous levels of activity and sports participation , even at the highest level .
What happens if it doesn ’ t get treated ? Most importantly people miss out on the activities they enjoy . If someone is left with an unstable ankle , there is a significantly increased chance of arthritis . If severe enough this can be treated with operations such as ankle replacements , but obviously this scenario is best avoided .
Overall , ligament reconstruction surgery has a relatively short rehabilitation period and excellent results in the vast majority of patients .
For more information , contact Spire Liverpool on 0151 522 1881 .
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