An ankle sprain is a common injury occurring when ligaments, which support the ankle joint, are stretched beyond their limits or torn. This often happens after an unexpected twist, roll, or fall. While many sprained ankles heal with non-surgical approaches, severe cases may require surgery to restore stability and function.
Ankle Sprain Severity Levels
Ankle sprains are categorized into different grades based on the extent of damage to the ligaments. A Grade 1 sprain involves slight stretching or microscopic tearing of ligament fibers. Individuals with a Grade 1 sprain experience mild tenderness, swelling, and stiffness, but can usually bear weight and walk with minimal pain.
A Grade 2 sprain indicates a partial ligament tear. This injury results in more noticeable pain, swelling, and bruising, and walking can become painful and difficult. The ankle may feel unstable.
A Grade 3 sprain involves a complete tear of one or more ankle ligaments. This injury causes significant pain, swelling, and bruising, often with a popping sound at the time of injury. The ankle joint feels unstable, and bearing weight or walking is not possible.
Non-Surgical Treatment Options
For most ankle sprains, especially Grade 1 and 2, and often as an initial approach for Grade 3, non-surgical treatment is effective. The RICE protocol—Rest, Ice, Compression, and Elevation—is recommended after injury. Rest involves avoiding activities that stress the injured ankle; crutches or supportive devices may be used to limit weight-bearing.
Applying ice to the injured area for 15-20 minutes at a time, several times a day, helps reduce swelling and pain. Compression with an elastic bandage helps minimize swelling and provide support, while elevation of the ankle above heart level aids fluid drainage. Over-the-counter pain relievers, such as ibuprofen, help manage pain and inflammation.
Once initial swelling subsides, physical therapy aids recovery. This begins with gentle range-of-motion exercises to prevent stiffness, followed by strengthening exercises for the muscles supporting the ankle and leg. Balance training, also known as proprioception retraining, helps the ankle respond appropriately to movement and prevent future sprains. Most mild to moderate sprains heal within 4-6 weeks, with severe cases requiring a longer recovery period, several months, to regain full function.
When Surgery May Be Necessary
Surgery for an ankle sprain is not the first line of treatment and is reserved for specific circumstances. A primary indication is chronic ankle instability, where individuals experience repeated ankle sprains despite comprehensive non-surgical treatment, including physical therapy and bracing. This persistent instability means damaged ligaments have healed in a stretched-out position or are unable to provide adequate support.
Severe Grade 3 sprains, particularly those with complete ligament tears and joint instability that does not improve with conservative management, may warrant surgical consideration. Surgery is also necessary if other injuries, such as fractures, cartilage damage, or tendon ruptures, are present alongside the sprain. A medical professional makes the decision for surgery after a thorough evaluation, including physical examination and imaging studies like X-rays or MRI, to assess the injury’s full extent.
Surgical Procedures and Recovery
When surgery is indicated for an ankle sprain, the goal is to repair or reconstruct the damaged ligaments to restore stability. One common approach is arthroscopy, a minimally invasive procedure where a small camera and instruments are inserted through tiny incisions to visualize and repair issues inside the joint. Arthroscopy can remove loose bone fragments or damaged cartilage and address torn ligaments.
For direct ligament repair, a procedure like the Broström procedure is performed, especially for chronic instability. This involves tightening and reattaching the stretched or torn ligaments on the outside of the ankle. If ligaments are insufficient for direct repair, a reconstruction might be performed using a tendon graft or artificial ligament to replace the damaged structures.
Following surgery, the ankle is immobilized with a cast or boot to protect the healing ligaments, and crutches are used to avoid weight-bearing initially. Pain management is provided during the immediate post-operative period. Rehabilitation involves physical therapy, starting with controlled motion and gradually progressing to strengthening and balance exercises. Full recovery can take several months, emphasizing patient commitment to the prescribed therapy to achieve good outcomes and prevent future issues.