Orthopaedic care by a specialized team of professional doctors, nurses and administrators.

Mount Elizabeth Novena Specialist Centre
(65) 6684 5828
(65) 6684 5829
Parkway East Medical Centre
(65) 6348 2605
(65) 6348 2606
Connexion Farrer Park Medical Centre (Opens on 1 March 2020)
(65) 6738 2628
(65) 6738 2629
Ankle Injuries
1. How do we injure our ankle?

Ankle injuries are common sports injuries. They can occur during running, football or racket games due to the great amount of twisting and pivoting motions in our ankles. Injuries may even occur from everyday activities like missing a step at home or slipping on a wet surface. The ankle twists inwards or outwards excessively, injuring ligaments and bones in the ankle. It is important to recognise the simpler ankle injuries from the more serious ones.

ankleinjuries1

 Picture showing an inversion sprain and a tear of the outer ankle ligament

2. What are the injuries that can occur?

Five commonest types of ankle injuries:

  1. Simple ligament sprains
  2. Ligament tears
  3. Tendon injuries
  4. Ankle cartilage injuries
  5. Bone fractures

Patients present with acute ankle swelling, pain on walking and limitation of ankle movement. Sometimes there is bruising over the ankle due to the bleeding from torn structures or from stretching of the skin. A bruised and swollen ankle could represent a torn ankle ligament or a broken bone.

A complex ankle sprain showing swelling & bruising
3. Initial Management

The immediate home management of ankle sprains is R.I.C.E (Rest, Ice, Compression, Elevation). It is important to stop the sporting activity and rest the ankle. Try not to weight bear on that ankle. However, signs that the ankle injury may be more than just a simple ankle sprain are – excessive pain, bruising and persistent swelling that does not settle within 3-5 days. This is when it’s important to seek a specialist’s opinion.

4. Further Management

Your doctor would assess the injury and recommend a treatment protocol. Initial treatment for the simple ankle sprains includes structured physiotherapy or a period of immobilization in a Jones bandage if necessary. It is important to exclude more serious types of ankle injuries before embarking on a physiotherapy regime. Occasionally your specialist may order an X-ray or an MRI scan to evaluate the injury.

5. Non-Surgical Management

The type of management depends on the injury. Initial physiotherapy regime will involve swelling control, ankle range of motion exercises and prevention of scar tissue formation by manual therapy. This helps to align the fibres in a manner to heal the torn ligaments to prevent scar tissue formation. Some modalities like ice, ultrasound and taping may be utilised.

ankleinjuries3&4

Some tendon and ligament injuries may need to be treated in an immobilization walker boot to allow the ligaments to heal. An undisplaced bony fracture of the ankle may have to be immobilized in a rigid cast or a boot to allow the fracture to heal.

6. What happens if I ignore my ankle injury?

A missed or a neglected ankle injury can lead to several consequences.

  1. Chronic scar tissue formation in the ankle from the torn ligaments can cause ankle impingement (block) when climbing stairs or squatting. The patient feels sharp pain and a subjective feeling of instability.

ankleinjuries5&6

  1. A chronic unstable ankle with instability. The patient complaints of a wobbly ankle that rolls easily with frequent sprains or an “ankle that does not feel right”. The patient experiences difficulty walking on uneven surfaces and is unable to participate in sports. This should be addressed as a loose ankle can lead to slow ankle cartilage damage and eventual ankle arthritis.

 

 

7. Surgical Treatment of Ankle Injuries

The treatment again depends on the diagnosis of the injury.

  1. Ankle bone fracture may need to be surgically fixed if the fracture is displaced.
  2. A chronically unstable ankle with torn ligaments may need surgical repair and reconstruction.
  3. If there is ankle cartilage injury, the ankle cartilage would need repair and resurfacing by a procedure known as arthroscopic chondroplasty.

Nowadays, almost all sports surgery of the ankle is done arthroscopically (keyhole). These surgeries are done as a day surgery with keyhole techniques. The patients are started immediately on a period of rehabilitation to maximise recovery. Depending on the type of surgery performed, the patient can usually resume normal activity within 4 to 6 weeks.

Arthroscopy of the ankle
An arthroscopic lateral ligament reconstruction
Arthroscopic picture of suture anchor reconstruction of ligament
8. Conclusion

It is always best to prevent ankle injuries. Ankle injury prevention is an important aspect of any sporting activity. It is important to use the correct footwear, do adequate stretching and warm-ups as well as embark on sporting activities in a graduated manner. Your orthopaedic foot & ankle specialist surgeon will decide on surgical or non-surgical treatment of the ankle injuries depending on the diagnosis and your response to therapy.

 

ask our orthopaedic surgeon

If you would like to find out more details about bunion, please use the enquiry form below to ask our orthopaedic surgeon, Dr K Kannan. You may attach medical reports on the enquiry form as well.

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