Ankle Sprain

By Richard A. Zell, M.D.

Ankle injuries can occur in the workplace. Two common injuries include: ankle sprains, and ankle fractures. The bones that make up the ankle include: the Tibia, Fibula and Talus. The bones of the ankle joint are stabilized by ligaments. These include the medial or inside ligaments (Deltoid ligament) and the outside or lateral ligaments. There are also ligaments that connect the Fibula and Tibia above the ankle called Syndesmotic ligaments. Ankle sprains are injuries to these ligaments. They occur after inversion (the ankle rolling in) or twisting injuries. Sprains typically involve the lateral ligaments but can also involve the Syndesmotic or Deltoid ligament. Injuries to the Syndesmtoic ligaments are called high ankle sprains and are common injuries in football players but can also occur in the workplace. There are three grades of ankle sprains (1-3) that describe a progression from a stretch injury to complete disruption of the ligaments.

Treatment of ankle sprains typically involves RICE (rest, ice, compression and elevation). Lower grade sprains are managed with an ankle brace/Aircast while higher grade sprains are managed in a walking or CAM boot. The CAM walker allows the patient to weight bear without the ankle having to move and become more inflamed. Patients are allowed to weight bear as tolerated with assist of crutches as required. Physical therapy is helpful in the recovery of ankle sprains. PT is not started initially in order to allow the swelling / inflammation to decrease.

ankle-joint.jpgThe great majority of lateral ankle sprains can be managed without surgery. Studies have shown that even with complete disruption/tearing of the ligaments, patients do better with nonoperative treatment rather than surgery to repair the ligaments. There are some exceptions where surgery is required such as patients that have an ankle sprain associated with a bone chip or osteochondral defect. These patients require an ankle arthroscopy to remove / repair the bone fragment. At times, injuries to the ligaments above the ankle (Syndesmotic ligaments) can be associated with a shift of the bones of the ankle and this injury also requires surgery. Some patients may have continued or chronic symptoms several months after an ankle sprain and may require surgery to tighten the lateral ligaments if they are loose (Brostrom procedure). Other patients have continued inflammation/ scarring after a sprain and may require an ankle arthroscopy and debridement.

The amount of time out of work following an ankle sprain depends on the grade of the injury and the patient’s job. Grade I sprains typically heal in approximately 2-3 weeks. Grade III sprains can take 6-8 weeks or longer to fully heal. Patients with ankle sprains can typically be sent back to work on modified duty as the treatment of ankle sprains typically allows weight bearing to tolerance with a brace or boot. Patients will likely need time off for physical therapy and allowances may be required for use of a brace / limited walking. Patients with jobs that include working on unprotected heights / ladders / etc may not be able to return to full duty for several weeks.

© 2012 Richard A. Zell, MD Not to be reproduced without the express permission of the author