Molly S. Judge DPM, FACFAS

Trauma (Foot And Ankle)

Are Ankle Sprains bad?

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Ankle injuries are frequently shrugged off as a “simple sprain” when often they are much more than that. In general, a severe sprain is just shy of breaking or fracturing the ankle. In an ankle sprain, there may be nothing on a routine x-ray to suggest that there is anything out of place and there is no evidence of bone injury that would require surgery. As a consequence, it is presumed that the ankle will simply heal itself since it is “just a sprain.”
The anatomy of the foot and ankle is fairly complicated, and so it is common that injuries within the foot and ankle are simply missed on the first examination. Oftentimes, the foot and ankle are so tender immediately after the injury that it is hard to examine, and so it should be recommended that patients follow up with a foot and ankle specialist to ensure that there isn’t a major underlying injury.
The following is a list of injuries commonly associated with the “simple ankle sprain.” These conditions, if left unchecked, can result in ankle instability, chronic pain, arthritis, and even unhealed bone fractures (nonunion of bone). These conditions often require aggressive therapies ranging from physical therapy to surgery for fracture repair and stabilization.

Ankle Cartilage Damage


This occurs when the leg bone (tibia) compresses onto the ankle bone (talus), resulting in a fracture of the cartilage covering of the joint. This fracture often remains in good position, and so it may look relatively normal on an x-ray taken immediately after the injury. This results in a painful ankle that pops and clicks with motion. Some patients have a deep sense of pain and stiffness until they get the ankle to pop, and then it feels better to walk on it.
An example of this is seen on the x-ray provided. The bone that looks like a solid square fitting into a square hole is the talus bone. In the top left corner of that bone, you see a darkened triangular shape, and that is the region of cartilage damage.

Ankle Ligament Rupture, Medial or Lateral


Both the inner and outer aspects of the ankle may suffer from ligament injury after a severe ankle sprain. These ligaments work together like stirrups on the ankle to help support and stabilize the joint. When a ligament ruptures, it may result in major ankle instability and a sense of the ankle giving out.
In simple cases, an air cast can be of benefit to keep the ankle in a good position while the ligaments heal over time. In severe injuries, surgery may be required to directly repair these ligaments to provide the best stabilization. In severe cases, special x-ray views, stress x-rays, are taken and these views recreate the position of the original injury, showing if there is ankle instability.
When surgery is required, the patient must stay off the ankle in a cast until the ligaments heal, and that can be 6 weeks or more. When this is the case, it may have been better to have broken a bone in the first place. If the bone had been broken, it would have been seen on x-ray and fixed right away avoiding the pain and instability that required surgery in the end anyway.

Do you want to Learn More?

Here are other references from Dr. Judges work on Ankle Sprains

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Is It Really Better To Sprain Your Ankle Than To Break It?


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Chronic Ankle Conditions


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How To Achieve Optimal Treatment Of Puncture Wounds


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Vessel Loop Closure


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Expert Insights On Managing Traumatic Wounds


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Study Sparks Debate About Treatment Options For Ingrown Toenails


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Oak Extract Is Key Ingredient In Wound Dressing


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Inside Insights On Treating Puncture Wounds


Picture of female in sportswear stretching in exterior with foot on railing.

Molly S. Judge DPM, FACFAS

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