Not Just a Sprain: When Persistent Ankle Pain Requires a Specialist’s Eye

An acute ankle sprain is a common injury, both in athletes and nonathletes. If you twisted your ankle and have ongoing pain and instability, a specialist is in the best position to help you get back to normal activity levels. A regular urgent care can confirm you haven’t broken a bone and can give you a brace, but only a specialty hospital like NCSH can provide full diagnostics and offer a range of treatments.

Chronic ankle instability treatment may begin with conservative care, but surgery is necessary for some patients with persistent pain and poor stability. Is your ankle injury keeping you from hiking in Umstead Park or strolling downtown Durham? Our specialists can get you back to your favorite activities sooner.

What Is an Ankle Sprain?

A sprained ankle is typically an acute, or sudden onset, injury. It’s common in athletes and active individuals. It’s also common in people who are not particularly active. A sprain occurs when ligaments are stretched or torn. A ligament is a type of connective tissue that attaches one bone to another.

An ankle sprain occurs when the ligaments supporting and stabilizing the ankle joint overstretch or even tear. The severity of a sprained ankle depends on how many ligaments are involved and how badly they have been damaged, from a small—even microscopic—tear to a completely torn ligament.

Most ankle sprains heal with conservative treatment. This includes rest and immobilization for a period of time and ice, compression, and over-the-counter medications to manage pain and swelling. Some patients also benefit from physical therapy.

What Is Chronic Ankle Instability?

Chronic ankle instability (CAI), or ankle laxity, is just what it sounds like: instability in the ankle joint that persists over time, leading to wobbliness and weak ankles. For the individual with this orthopedic condition, it feels like the ankle giving way, especially on uneven surfaces.

According to researchers, up to 40% of people who have had an acute ankle sprain develop instability in the ankle joint. This can become a chronic issue that persists over time, but it is treatable. Less commonly, CAI might be caused by structural abnormalities, like alignment issues, osteoarthritis, or poor recovery after another ankle injury or surgery.

Symptoms of CAI include a feeling of the joint giving way, rolling, or turning; swelling and chronic pain in the joint; and difficulty walking, running, and even doing everyday tasks.

Not getting specialist treatment for recurrent ankle sprains and ongoing instability can lead to further joint damage and even arthritis. The right care for this persistent issue helps you get back to your active NC lifestyle.

Conservative Treatment for Chronic Ankle Instability

For most patients, treatment for CAI starts with conservative approaches to improve mobility, manage pain, and make the joint more stable. The appropriate plan for each patient depends on his or her injury, symptoms, and needs, but these are some of the common approaches:

• Exercises and Physical Therapy. Patients with chronic ankle instability can benefit from specific exercises to strengthen the joint and improve balance and proprioception. Physical therapists guide these movements and give patients exercises they can do at home.

• Activity Modification. An orthopedist and physical therapist can help patients change how they do normal activities to make them safer and to support more stable ankle movements.

• Bracing and Taping. Taping and using braces help stabilize an unstable joint. They are especially useful as patients increase activity levels and frequencies.

• Footwear Support. As bracing and taping can add stability to the joint, so can the right footwear. Better ankle support keeps the joint safer during movements and reduces the risk of additional injuries.

• Pain Medications. If CAI continues to cause pain or swelling, over-the-counter medications can help. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the typical choice for ankle pain and swelling.

Surgical Treatment for Chronic Ankle Instability

Not everyone will respond adequately to conservative care for chronic ankle instability. According to some studies, 20% to 30% of patients have ongoing symptoms, continue to struggle with reduced mobility, and have an increased risk of reinjury. These patients are often good candidates for orthopedic surgery.

The type of surgery a patient might get depends on the specifics of their injury. One option includes arthroscopy, a minimally invasive approach to repair minor damage or remove loose pieces of tissue.

Other patients may need a more involved ankle ligament repair surgery to reconstruct the torn ligaments using the patient’s own tissue as grafts. One common procedure is the Brostrom repair, which is a type of lateral ankle ligament reconstruction.

When osteoarthritis causes instability, a patient may benefit from an ankle replacement procedure. The surgery replaces two parts of the joint, securing each to the lower leg and ankle to create an artificial joint with greater mobility and stability.

If you’ve been struggling with persistent ankle pain and instability that’s been keeping you off your favorite local trails, like the American Tobacco Trail or Eno River State Park, our orthopedic foot and ankle specialists can help. Make an appointment today for expert assessment and treatment suggestions.