Chronic Ankle Pain: When is It Time to See a Doctor?
Millions of people—from athletes to people who walk to work—experience a sprained ankle each year. In fact, we typically see four to five a week at MedStar Washington Hospital Center. Sprained ankles often leave patients with:
- Inability to bear weight
In some cases, people experience several or more ankle sprains in the same foot over a span of years, resulting in a condition called chronic ankle pain or spraining. If individuals with chronic ankle pain visit a doctor, they can receive treatment to help them avoid much larger procedures when they are older, such as an ankle fusion or replacement.
LISTEN: Dr. Rahnama discusses chronic ankle pain in the Medical Intel podcast.
Caring for Sprained Ankles
Once we determine someone has an ankle sprain through an overview of their symptoms and an X-ray to ensure they don’t have a fracture in the ankle, we typically divide first-line treatment into three categories:
- Rest and protect the ankle with a brace, boot, and sometimes a splint
- Begin working on range of motion, strength, and stability exercises
- Begin exercises that gradually get people back to intense physical activity
A mild to moderate ankle sprain typically heals in two to four weeks, depending on the person and what ligaments are affected. Severe ankle sprains, meanwhile, normally take up to six to 12 weeks to heal.
People with severe ankle sprains initially should elevate and ice their ankle, as well as use crutches to get around. Then, it is crucial for them to begin physical therapy, where they will perform exercises to strengthen their tendons and muscles in and around the foot and ankle. These exercises will help individuals avoid similar injuries in the future.
We typically consider minimally invasive surgery when sprained ankles have not healed after seven to 12 weeks, or when people experience frequent recurrences of ankle sprains.
When a #sprainedankle hasn’t healed after seven to 12 weeks, minimally invasive surgery might be the best solution to treat it, says Dr. Ali Rahnama. https://bit.ly/2SKyNkq via @MedStarWHC
How Surgery Works
Minimally invasive surgery for chronic ankle pain consists of:
- Making a small incision
- Entering the joint
- Identifying and removing any type of pre-arthritic or inflammatory tissue that does not belong in the joint with a tiny shaver instrument and camera and repairing the damaged ligaments or tendons
During this time, we can also perform a lateral ankle repair if a patient’s ligaments are damaged. Surgery allows people with chronic ankle pain to get back to pain-free physical activity much faster than rest and strength training.
Following surgery, patients typically have to stay off of the operated ankle for two to three weeks before they undergo resistance and strength exercises to strengthen the muscles and tissues around the foot and ankle.
Conditions Sometimes Mistaken for Sprained Ankles
We sometimes see patients who visit us with different conditions that have symptoms similar to chronic ankle pain. Some of the most common include:
- Osteochondral defects: These are areas of damage to the surface of bones in the ankle that cause pain, especially if there are loose pieces of cartilage from the injury that now are in the joint.
- Tendon injuries: A tendon tear or rupture sometimes is mistaken for a chronic ankle sprain.
- Fractures: We sometimes see patients who were referred to us that did not have X-rays, so the patient visits us thinking they have a sprain until an X-ray shows a fracture.
Patients should make sure they see a doctor to ensure they receive an accurate diagnosis for their pain, so they can receive the best treatment possible.
How to Avoid Sprained Ankles
To avoid ankle sprains, people should ensure their shoes are tied nice and snug to provide optimal ankle support and be aware of the type of activities they engage in. For example, runners should avoid running in the rain, snow, and dark to avoid landing on their feet irregularly or slipping. Moreover, when running trails or in a park, it is important that they know the course so they do not turn into any surprises, such as a ditch or hole.
Ankle sprains can cause a lot of pain, especially when they occur frequently. Make sure to visit a doctor to treat chronic ankle pain and avoid further damage down the road.