Chronic Ankle Sprains

Most of us have had ankle sprains at some time or other. The vast majority of sprains recover on its own. Most acute sprains do not require treatment other than simple RICE therapy (Rest Ice Compression and Elevation). Some patients may prefer to have physiotherapy in addition.

However, there is a small group of patients that continue to have persistent pain, recurrent sprains, and swelling. This small group fails to improve despite all forms of physiotherapy and other non operative measures.

While the main problem in some of these patients is Chronic Instability from the torn Ligaments, it is necessary to do a complete examination to assess the patient for other possibilities. Other than a good history and physical examination, an MRI scan may be necessary. The main things that we are looking for are Cartilage Injuries (OsteoChondral Injuries of the Talus), Chronic Bone or Soft Tissue Impingement, and also the possibility of a High Ankle Sprain (Syndesmosis Injury).

An OsteoChondral Injury is damage to the Cartilage and adjacent bone in the Talar bone of the ankle. It is commonly related to recurrent sprains, but may also happen on the first sprain. This is easily diagnosed on an MRI. The treatment is relatively simple and excellent results are achieved with Arthroscopic Microfracture techniques. A new advance is the use of Bioabsorbable Scaffolds which allow the Stem Cells from the Marrow to form Hyaline cartilage and allowing to excellent resurfacing of the cartilage defect.

As for soft tissue and bony impingement (Also known as Footballer’s Ankle), excess tissue develops across the front of the ankle causing pain on movement. This can also be treated with Arthroscopic Techniques to remove the impingement.

Finally, if the main problem is Chronic Instability due to the stretched or torn ankle ligaments, these may need to be Reconstructed if the patient continues to be unstable despite physiotherapy. If there is remnant ankle ligament tissue, this can be “repaired” directly and tightened up. If the tissue is poor, then putting in a graft is probably the best option. This is similar to an ACL reconstruction in the knee.

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OCD Lat

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OCD Coronal

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Ankle bone spurs