ANKLE SPRAINS: CHRONIC


Although all sorts of ankle injuries are possible, there are essentially two main ways that an individual can sprain an ankle. The first is the most common and it is called an Inversion Sprain or Lateral Ankle Sprain. During this dynamic the person sprains the ankle and for visualization purposes the bottom of the foot pointing in the direction of the other foot. The second sprain is called an Eversion Sprain or Medial Ankle Sprain. This type of sprain the foot is pointing or facing away from the other foot. Eversion Sprains although less common, have a tendency to cause greater damage to the ankle joint often resulting in terrible fractures requiring surgery with plates and screws procedurally labeled as "Open Reduction Internal Fixation" or ORIF. This type of sprain, when severely damaged, tends to be a highly unstable fracture with an inability to walk after the injury because it involves the weight bearing Tibia bone. Inversion Sprains, even when an avulsion fracture occurs, the injured person very often is able to bear their weight on that foot and leg because it involves the non-weight bearing Fibula bone. Once again, inversion sprains are incredibly common, while in the last 20 years I haven't seen many Medial Ankle Sprains. Medial Ankle Sprains often occur during sports events when another person rolls up onto their ankle or falls directly on the ankle like you might see in football game or other contact sports.

Ankle Sprain Diagnostic Grading System:

  • GRADE I: A Grade I is a very simple injury. Tissues are “stretched” but not torn. The prognosis for this type of injury is essentially 100%

  • GRADE II: A Grade II is more severe. There is some tearing of the ligaments and tissues. There will be some of the standard features of an ankle sprain; swelling, heat, pain, some diminished ability to bear weight, etc. If these are dealt with the proper way, the prognosis is good, and healing and rehab will take a few weeks to a couple of months. If they are not rehabbed properly and the ankle is exposed to occur over again the condition becomes chronic with an increased proliferation of scar tissue and as such chronic pain patterns will develop.

  • GRADE III: Grade III sprains are severe and the foot and ankle are very unstable. Similar to a Grade II regarding the dynamics of injury, only worse. You will likely spend some time on crutches, and the healing time will be measured in months. Your ankle will never be the same after a Grade III sprain. Proper rehab is absolutely critical as are chiropractic adjustments to improve joint functionality not only at the ankle but being that we are talking about a kinetic chain, adjustments to the knee, hip, mid to lower spinal region are very often necessary.

Tibial Fracture Avulsion Fracture of the Fibula

  • AVULSION FRACTURE: This is a fracture of the Fibular head which is the smaller bone the outside of the shin (Tibial) bone. An avulsion fracture of the ankle is not a fracture like you are probably thinking of. Ligaments and tendons anchor themselves to bones via microscopic Velcro-like “hooks” called Sharpey’s Fibers. When your ankle is twisted violently enough to pull ligaments and tendons off of bones, they usually take a tiny chunk of bone along with them. Sometimes these are big enough to show up on x-ray, sometimes they are not. An Avulsion Fracture is simply a Grade III sprain that has pulled small pieces of the bone away from their attachment points. This is a highly unstable fractured condition and should not be taken lightly and you cannot diagnose this yourself. Sometimes these require a cast, sometimes they do not. I have never had avulsion fracture but I have experienced Grade III ankle sprains in both ankles during high school sporting activities. Don't take it lightly, seek professional help because bone is the only tissue in your body that requires immobilization to heal properly. Soft tissues must have movement to heal properly, otherwise they heal with massive amounts of scar tissue. The more controlled the movements (within the margins of safe motion) the more synovial fluid and other fluids bathe the inside the joint and the better the outcome or resolution of the injury.

REHABILITATION OF A CHRONIC ANKLE SPRAIN?

You have been through the initial pain, and dysfunction of an ankle sprain and it appears to have healed over the months but unfortunately you are left with chronic ankle joint pain, occasional foot pain and a feeling that the ankle is unstable and prone to re-injury. That's because it most likely is unstable. The ankle feels like, if you stepped off of a curb or onto a small rock or abrupt change in walking surfaces just the wrong way the ankle could "roll" once again causing greater damage. Your feeling is correct. What can you do to eliminate the pain and also stabilize the ankle to minimize this from recurring. Well I hate to tell you this but, once an ankle sprainer always an ankle sprainer. What do I mean this statement? The ankle joint complex is a highly complex structure and once the ligaments have been sprained (permanently stretched) you will always have the tendency to re-sprain those structures, so it becomes very important that you treat it appropriately and thoroughly. Why? Because the long term result of non treatment is a future of falls and the potential for greater ankle injuries as well as fractured hips and other bones.

TREATMENT

  • PROPER NUTRITION: How in the world can elastic, collagen based connective tissues have any chance of healing properly without the raw materials present for regenerating these injured tissues? They cannot! If you really want to rehab the ankle, it needs to start with nutrition. The one supplement that is an absolute must is a Standard Process proprietary supplement called Ligaplex.

  • CHIROPRACTIC ADJUSTMENTS: When an ankle is sprained the mechanism of injury creates what is called an "Altered Instantaneous Axis of Rotation" or AIAR. This AIAR is a pathological motion (improper joint motion) that can cause dysfunction and pain with a dynamic for accelerated degenerative joint disease over time. Very much like having four new tires put on your car, but the installer forgot to balance one of the tires leaving it with a slight "shimmy" causing accelerated wear and tear to that particular tire. This is exactly what happens to the joint(s) causing an increase in friction coefficients, a decrease in synovial fluid, abnormal alteration of neurological information to the spinal cord and brain as well as an abnormal alteration of relayed information from the brain back to the muscles that move and secondarily support the joint(s). There will also be an increase in chronic deposition of inflammatory exudates resulting in joint(s) destruction over time. Chiropractic Adjustments improve the Instantaneous Axis of Rotation improving joint mechanics, improving neurological to and from information, increase in the joints lubrication and a decreased production of inflammatory exudates tp slow the degenerative process.

  • PROPRIOCEPTIVE TRAINING: Proprioception is your body’s ability to sense where it is at in space, without proprioceptive information to the brain we would perish very quickly. Proprioceptive nerves are very thick heavily insulated nerves that convey information at a very high rate of speed. For example, have you ever tripped over something and almost by instinct corrected your falling posture and reacted quickly enough to stop the fall. Or better yet you begin to roll your ankle and the muscles quickly contract in time to stop the ankle from going into a full inversion sprain. These are two examples of proprioception at work. Increasing proprioception can be done in numerous ways including Wobble Boards, Alphabets, Bosu Balls, specific exercises, balance and stability training, figure eights, etc. I realize that you probably have never heard of “proprioception” before. Just understand that proper proprioception is so important that diminished proprioception can lead to fractures and even death as we decline neurologically and cognitively with older age.

  • STRENGTHENING AND STRETCHING EXERCISES: Increasing ranges of motion and strength of injured ligaments, muscles, and tendons, is critical for avoiding re-injury. Be aware that each and every individual joint in the foot must move properly, for this reason chiropractic adjustments to the foot and ankle are so critical.

  • SCAR TISSUE REMODELING: Injuries to the Elastic, Collagen-Based Connective Tissues such as those seen in chronic ankle sprainers cause microscopic scarring. The worse the sprain, the more scarring will be present. And remember, I speak from both ankle spraining personal experience as well as over two decades of treating patients. Our feet and ankles have to carry us into old age, so don't allow this problem to adversely alter your life. Removing this microscopic scarring and restoring normal function is critical. Scar Tissue Remodeling and low level laser therapy are also treatments of choice to reduce pain patterns and encourage proper fiber orientation improving proprioception to reduce the possibility of future injury and degenerative arthritic changes in the ankle joint. Give us a call.

Disclaimer: The information found on this webpage is not a substitute for medical advice from a licensed physician or legal advice from a licensed attorney. Any concerns or questions related to your injuries or pain patterns whether acute or chronic, and their legal impact and consequences, if any, need to be conducted with appropriate legal counsel. Any concerns or questions related to your injuries and/or pain patterns whether they are deemed acute or chronic, and their short term or long term physical impact and consequences, need to be conducted with an appropriate licensed physician. The information found on this page is for informational purposes only and is not meant to diagnose, treat and/or educate for purposes of treatment and/or educate for the purposes in the self treatment of your injury or injuries or pain patterns.