HealthONE - October 13, 2021

Ankle sprains occur every day. A step off the curb twists the ankle, a jump to slam dunk lands wrong on the ankle, a motor vehicle accident crushes the ankle. Ankles especially are susceptible to injury because of how crucial they are in every step we take. “The ankle allows your foot to move up and down as well as side to side,” explains Gary Schmidt, MD, a foot and ankle surgeon with OrthoONE Swedish Medical Center. “The key components of the ankle include bones, joints, ligaments, muscles, nerves and blood vessels. Ligaments are in place to stabilize the joint. When an ankle ligament is forced outside the normal range of motion, an ankle sprain occurs.” For patients with severe sprains and those continually strain their ankles, ankle reconstruction surgery is an option to restore function and live a life without pain.

What is an ankle sprain?

An ankle sprain occurs when the ankle is rolled, twisted, or turned in an awkward way. While ankle sprains are a common sports injury, anyone at any age or level of fitness can experience an ankle sprain. People who have had an ankle sprain are more likely to have another in the future. Ankle sprains can be classified into grades.  A grade one ankle sprain involves a minimal amount of stretching to the ligament and is associated with mild pain. Grade two is a partial ligament tear that has moderate pain, swelling and tenderness. A grade three ankle sprain is severe involving a full tear or complete rupture of the ligament. “Typically, surgery is not necessary unless the ankle sprain is a grade three; it also may be needed for someone who has repeated ankle sprains,” Dr. Schmidt explains.

What are the symptoms of an ankle sprain?

Ankle sprains can be very painful. Symptoms often include swelling, tenderness, bruising, pain, stiffness, skin discoloration and inability to put weight on the ankle. Swelling may be significant enough that when you press on the skin with your finger, it leaves an imprint. “Swelling may begin immediately and can continue to progress even 48 hours after the injury,” Dr. Schmidt details. “Most ankle sprains will heal with home treatment within a few weeks. If the pain is significant, lasting more than a week and isn’t improving, or if you are completely unable to place weight on your ankle, seek medical attention.”

What treatments are available for ankle sprain?

The first course of treatment for most ankle sprains includes rest, ice, compression, and elevation, also know as RICE. Anti-inflammatory medications can help reduce swelling and relieve pain. If symptoms are not improving within a week, or you are unable to place any weight on your ankle, you should talk to a doctor. “Your doctor will likely perform a physical exam, touching the area to determine the extent of the swelling,” Dr. Schmidt states. “The provider also will likely order imaging exams such as an X-ray or ultrasound to determine if any bones are broken and the degree of damage to the ligament.” The next level of treatment is to use bracing, ankle wrapping and/or casting to further provide rest to the ankle. Corticosteroid injections also may be beneficial at reducing pain and increasing function. Some patients benefit from physical therapy as well. However, if the ankle does not improve, regular strains are occurring, or the ligament tear is complete, you may need reconstructive surgery to correct and restabilize the ankle.

What is ankle reconstructive surgery?

The goal of ankle reconstructive surgery is to stabilize the ankle. This may be done for ankle ligaments damaged during a significant trauma or because the ankle ligament is continually damaged with repeated sprains. Often ankle surgery can be performed using minimally invasive techniques in which surgeon can operate through tiny incisions, instead of one large incision. Using advanced cameras and advanced instrumentation, the surgeon tightens the ligament with sutures, restoring its strength. This type of surgery is called Brostrom-Gould. Another surgical option is tendon transfer. In this type of surgery, the weakened or damaged ligament is replaced with a tendon from another part of the body or from a donor. It is held in place with hardware such as pins and screws.

“Your doctor will work with you to find a treatment that meets your needs and helps you get back to the level of activity you desire,” Dr. Schmidt clarifies. “We make a plan for each patient that is specific for that person to ensure the best possible outcome. Whenever possible, we use minimally invasive surgical techniques, to lessen the trauma to the body and surrounding tissue. This often leads to less blood loss, reduced pain, fewer complications and a faster return to normal activity.”

Dr. Schmidt continues, “My hope for every patient is to get them back to the activities they love. When an ankle sprain is severe or occurs chronically, it can be debilitating. My mission as a foot and ankle surgeon is to repair these types of injuries so everyone can enjoy happy, healthy, active lives.”

Dr. Gary Schmidt is a board-certified, fellowship-trained orthopedic foot and ankle surgeon specializing in post-traumatic reconstruction of the foot and ankle, foot and ankle deformity in adults and athletic injuries. He also treats patients with common foot problems, including bunions and heel pain.