Torn and Sprained Ankles Explained
How do ankle ligament injuries happen?
Ankle sprains are the most common sporting injury, accounting for up to 40% of these injuries. This includes sprained and torn ankle ligaments. The ankle is a very stable joint allowing movement in one plane (upwards and downwards). A lot of its stability is due to the three bones in the ankle. The rest of its stability is provided by the ankle ligaments. On the outside there is the lateral ligament complex (which is in three parts) and the deltoid ligament on the inside of the ankle.
Because of the position that the foot and ankle are in when they strike the ground and the relative strengths of the muscles on the inside and the outside of the ankle, there is a tendency for the foot to twist inwards. This causes injuries to the outside ligaments of ankle. Depending on the force involved, the injury can range from a minor sprain (with minor tears / stretching of ligament fibres) to a major sprain (complete tear). With major force ankle fractures can also be sustained. If there is severe sudden onset pain then immediate medical attention should be sought.
How to treat ankle ligament injuries
The initial management for almost all sprains is the same, that of functional rehabilitation. Initial treatment involves rest, ice, compression and elevation. The more severe sprains usually require bracing. Physiotherapy is then usually required and this focuses on two main areas, balance and speed and strength and speed of muscle action. More than 90% of ankle sprains and torn ankle ligaments will heal well with a programme of functional physiotherapy. If it is a severe injury or the pain from the sprain does not start to settle within 2 to 3 months then the ankle needs to be assessed. It is possible to have damaged the cartilage within the ankle joint. As well as clinical examination, a MRI scan is often required.
Ankle keyhole surgery (arthroscopy)
Injuries to the cartliage can normally be treated very successfully with ankle keyhole surgery (arthroscopy). Sometimes chronic pain after a sprain can be due to overgrowth of healing tissue from one of the damaged ligaments, which gets trapped in the ankle joint intermittently. This again can be highly successfully treated with ankle keyhole surgery (arthroscopy). This type of surgery involves 2 or 3 small cuts 9around 1cm) over the front of the ankle. The treatment can then be carried out through these small cuts with specialized instruments
In up to 10% of people the ankle ligaments do not heal or heal in a stretched position. This can cause people to have repeated sprains or to avoid activities where the go over on their ankle (chronic ankle instability). If this does not improve and affects quality of life, surgery may well be beneficial.
The operation usually involves keyhole surgery. This is to treat any areas of scar tissue that are getting caught in the joint or any damage to the joint surface. The ligament reconstruction is a highly successful operation which is carried out through a small incision on the outside of the ankle. Mr Molloy has developed a modern variation of the traditional technique. This technique has produced better results than the traditional method with regards to stability and ongoing function. These results have been presented at national and international research meetings.