Anatomy of the Ankle
The ankle is a complex structure because it contains many small bones and therefore many joints. Each time a bone meets another bone, there is a layer of cartilage between them that functions to protect the bones from rubbing against one another, called joints. The greater function of these joints is to provide stability within the foot and allow for a range of motion.
A greater source of support for the ankle is found in the ligaments. These are tough pieces of cartilage that connect bones to other bones within the foot. There are three major ligaments in the ankle, the anterior tibiofibular ligament, lateral collateral ligament, and the deltoid ligaments. Each is responsible for connecting different bones to each other and providing support for the ankle overall. Most ankle sprains occur in the lateral ligaments, or those on the outside of the ankle.
An ankle sprain is what occurs when a ligament of the ankle becomes damaged, torn, or completely broken. There are three “grades” of ankle sprain:
- Grade I: as one of the most common injuries, this is characterized by slight tenderness, swelling, and mild pain. The ligament which has been damaged is still intact – pain comes from unnatural stretching of the ligament – allowing for a short healing process of less than one month.
- Grade II: this grade of ankle injury is slightly more severe than grade I. In the case of a grade II ankle sprain, the ligament has torn partially. The symptoms are more noticeable as well, including instability, smaller range of motion within the ankle, inability to bear weight for long periods of time, and the usual bruising, swelling, and tenderness. Recovery typically takes three to six weeks.
- Grade III: the most serious form of ankle strain, characterized by a rupture of the ligament or a full tear. This form of injury is characterized by an inability to bear weight, significantly reduced range of motion, bruising, swelling, tenderness, and severe pain. The recovery time for this form of injury is several months.
Athletes are at the most risk of spraining their ankles, but this injury can happen to anyone at any time, regardless of activity level. The injury most often occurs when the ankle is bent in an unnatural way, placing strain on the ligaments. This can happen because of a fall, improper footwear, or even simply walking on an uneven surface. There are many instances which can lead to sprain.
Diagnosing an Ankle Sprain
Many individuals who have experienced a mild ankle injury simply ignore it until it heals. While this may be effective for some, it is generally recommended that a doctor’s visit occurs so that the injury can be treated properly. If an injury is not treated by a professional the injury may not heal correctly. If an injury does not heal correctly it can lead to further issues with the joint in the future.
The diagnosis process begins with a medical consultation. Doctors will ask about symptoms and history of injury. They will examine the injured area, testing for the location of the pain and range of motion within the foot. If the patient is able, doctors may watch them walk to check for a limp.
Once a doctor has examined the joint, they may order imaging tests to determine the root cause. Knowing exactly which ligament is damaged and the extent of the damage can lead to more efficient treatment. Some of the tests used to diagnose an ankle sprain include:
- MRI: this form of imaging uses magnetic resonance to develop a picture of soft tissue. Having the ability to examine ligaments, muscles, and joint cartilage, doctors can often spot the cause of pain in the ankle using this imaging technique.
- Ultrasound: this imaging technique is minimally invasive and can help provide doctors with an image of the soft tissue within the ankle.
- Ottawa Ankle Tests: this series of tests examines the location of pain and range of motion in order to rule out the need for an X-Ray or other imaging. This is a highly effective method of diagnosing ankle pain and oftentimes eliminates the need for expensive imaging.
- X-Ray: this type of imaging capture the alignment of bones. Though it may not always be useful in detecting a sprain in the ankle, as it is most often damage to soft tissue, X-Rays may be used to rule out the possibility of a broken bone in the area or misaligned bone structure that may be causing pain.
Once the injury has been properly diagnosed, doctors can use this information to formulate a treatment plan that is specific to each patient’s needs.
Treatment of Ankle Sprains
Conventional treatment methods for ankle sprains depends on the severity of the injury as well as the patient’s needs. The recovery process typically follows a similar path, however, regardless of injury:
- RICE Method: Rest, Ice, Compression, and Elevation can all help an injury. This is especially recommended to be applied within the first 48 hours of treatment, as applying this method could prevent further injury. Employing these techniques can also allow patients to navigate their world more comfortably, as they may reduce pain.
- Pain Relief: the use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen or Naproxen can alleviate pain temporarily, making it easier for a patient to perform important strengthening exercises.
- Exercises: performing certain ankle exercises within the first 48 hours after injury can also help the joint maintain its stability and range of motion.
- Support Wear: using a wrap or brace on the ankle after injury can help it to heal in the correct position, as well as provide support to the ankle as it heals. This is often the next step if the RICE method does not alleviate symptoms. Some more severe injuries will require a brace or cast for the first few weeks after injury.
- Physical Therapy: if at-home exercises fail to provide relief, patients may consult a physical therapist. These therapists are trained professionals who provide guidance through exercises, while often providing an explanation as to why the exercises are helpful. The goals of physical therapy are to ultimately restore a joint to its level of functionality before the injury occurred. These exercises can provide support to the joint and strengthen the muscles surrounding it.
- Surgery: surgery is regarded as a last resort for patients who are suffering from chronic ankle pain. Doctors will often try many treatment methods before suggesting surgery. Patients facing ankle surgery will have spent months in recovery with little results. Two types of surgery exist for ankle sprains:
- Arthroscopy: surgeons place a tiny camera into the joint and use other small tools to remove unnecessary or detached tissue.
- Reconstruction: surgeons can attempt to repair the ligaments by sewing them back together. They may also use place a tissue graft on the tear.
Recovery Timeline For Ankle Sprains
Each patient will experience a different recovery process, depending on their needs. This is a general timeline, but may not fit your needs exactly. The severity of injury also impacts the recovery process.
- First 48 Hours After Injury: during this time period, for mild to moderately severe injuries, it is important to apply the RICE method. If you are able, performing simple range of motion exercises for the ankle is recommended. Doing so can help the joint heal without stiffness. If the injury is more severe, see a doctor for the next steps. It is typically recommended that a brace or cast be applied as soon as possible for severe injuries.
- First Two Weeks After Injury: for mild to moderate injuries, this time period is used to restrengthen the muscles surrounding the ankle. It is highly recommended that patients participate in exercising and stretching the ankle at this time. If it is a mild injury and you have been exercising the joint, you should start to see an improvement within the first two weeks. For more severe injuries, this time is often used to heal the joint by wearing a brace, cast, using a cane, or other support methods.
- First Month After Injury: for mild injuries, the pain, swelling, and tenderness should be reduced at this point. If symptoms persist, consult your doctor. For moderate injuries, this time is where you may begin to see results, but ankle exercises should continue as they are recommended. In more severe cases, patients should be wearing a brace less often and exercising the ankle joint as they are able.
- Two Months After Injury: if pain and other symptoms have not experienced some form of relief at this point, consult your doctor. For severe injury, discomfort should be reduced by the first two months and range of motion should begin to return. Stability and support surrounding the joint should be gradually returning.
- Three to Four Months After Injury: mild and moderate injuries should be healed at this point. Severe injuries begin to cause less trouble for the patient, and mobility is restored. Severe ankle injuries are likely healed within four months, but this will vary from patient to patient.
Some factors that may impact a patient’s recovery time include whether or not they are a smoker, if they are overweight, if they have arthritis, diabetes, and more. It is important to inform doctors and physiotherapists of concurrent medical conditions, as they may impact treatment.
Regenerative Medicine’s Role in Alleviating Symptoms
The burgeoning field of regenerative medicine seeks to use a patient’s own healing cells, which it produces naturally, to enhance the healing process. CELLAXYS offers two forms of regenerative therapy:
- Stem Cell Therapy: this form of therapy begins with taking a patient’s stem cells, which are harvested using blood cells, fat cells, or bone marrow. The cells are then processed to be more concentrated, then reinjected into the injury site. Stem cells contain healing properties that the body already uses when a strain occurs. Placing a concentrated stem cell solution into a part of the body that is healing can help the damaged ligaments heal faster.
- Platelet-Rich Plasma Therapy: beginning with a simple blood draw, the patient’s blood is then placed in a centrifuge to separate platelets in the blood from other components. The platelets are then injected into the injury site. Platelets contain proteins and growth factors that the body uses naturally to heal damage. Increasing the amount of these properties where damage has occurred could help the injury heal faster.
These therapies work particularly well on soft tissue, and hope to not only heal the injury but also provide pain relief. It is an outpatient procedure that takes less than two hours to complete. Patients typically see results in a matter of days, many experiencing near-immediate relief.
Ligaments that have been damaged in an ankle sprain can begin to heal more quickly if the treatment is coupled with regenerative medicine. It is generally recommended that patients continue to exercise the ankle as it is suggested to do so. These therapies hope to provide a more comfortable, and shorter, recovery process.
As one of the most common injuries, doctors have a good understanding of how to diagnose and ankle sprains. All of the grades of injury have a clear recovery process. Ankle sprains are generally improved within months, so it is likely that patients can return to normal life relatively quickly. If ankle issues persist past this point, consult your doctor. The recovery process will vary from patient to patient, so it is important to maintain an open dialog with physicians throughout the recovery process. Regenerative medicine offers hope for patients who want to return to daily life more quickly – helping to heal the injury and relieve pain associated with it.