According to estimates, ankle sprains are common in the United States, affecting approximately 2,000,000 people annually. Most of these injuries (85%) are caused by rolling or inversion of the ankle, which typically results in stretching or tearing of the ligaments on the outside of the ankle.
What is a Sprained Ankle?
Before we delve into the reasons why some people suffer from chronic ankle pain after a sprain, let’s take a closer look at what exactly happens during an ankle sprain. An ankle sprain occurs when the ligaments in the ankle are stretched or torn. Ligaments are tough, fibrous bands of tissue that connect bones to each other. They provide stability and support to joints.
When the ankle is twisted or turned beyond its normal range of motion, the ligaments can become overstretched or even tear. This can result in pain, swelling, bruising, and difficulty moving the ankle joint.
Ankle sprains are classified based on the severity of the injury:
- Grade 1 ankle sprains involve mild stretching of the ligament without any tearing. This type of sprain usually results in minor pain and swelling but does not significantly affect the function of the ankle joint.
- Grade 2 ankle sprains involve partial tearing of the ligament. This type of sprain usually results in moderate pain, swelling, and difficulty bearing weight on the affected ankle.
- Grade 3 ankle sprains involve complete tearing of the ligament. This type of sprain usually results in severe pain, swelling, bruising, and significant difficulty moving the ankle joint.
Following immobilization, rehabilitation is necessary to prevent re-sprains. Unfortunately, many patients do not seek appropriate treatment or return to physical activity too soon, leading to long-term effects in 20-30% of patients. Chronic pain along the outside of the ankle is the most common long-term complication.
Why Do I Have Chronic Ankle Pain After a Bad Sprain?
Several potential causes of pain following an ankle injury include impingement, peroneal tendon tear, osteochondral defect of the talus, and ankle instability.
Impingement may occur due to tearing of the joint capsule or lining of the ankle, leading to scar tissue that can get pinched between the leg and foot bones during walking or activity. This can cause pain in the front of the ankle, which may be intermittent.
Peroneal tendon tear
Peroneal tendon tears occur when the peroneus brevis or peroneus longus tendons, which run behind the outside ankle bone, are pressed against the fibula during an inward ankle turn. Early detection and immobilization can lead to healing within 5-6 weeks, but chronic pain is common in cases where the tear has gone untreated for several weeks or months. Surgical repair of the torn tendon may be necessary.
Osteochondral defect of the talus
Osteochondral defects of the talus involve a broken piece of cartilage, often attached to a small piece of the underlying bone, in the talus bone of the foot. These injuries most commonly occur on the outside of the ankle and result in deep pain, as well as clicking or popping with activity. Treatment involves the removal of the broken cartilage and bone, typically through ankle arthroscopy.
Either mechanical or functional instability may cause chronic instability of the ankle. Functional instability occurs when the ligaments are intact, but the patient experiences a feeling of giving way due to improper muscle function or other issues. This is treated with physical therapy. Mechanical instability, on the other hand, results from improper healing or stretching of the ankle ligaments, leading to laxity or instability of the ankle joint. Bracing may be effective in some patients, but surgical repair or reconstruction of the ligaments may be necessary in more severe cases. Although the problems outlined above are the most common causes of pain following an ankle sprain, they are by no means the only potential complications. Patients need to seek appropriate treatment for ankle injuries, as prompt diagnosis and treatment can help prevent long-term complications and reduce the risk of re-injury.
Although the aforementioned problems are the most common causes of pain following an ankle sprain, they are not the only potential complications. Ankle sprains are very common and, left untreated, can go on to cause other orthopedic issues as we age. Patients need to seek appropriate treatment for ankle injuries, as prompt diagnosis and treatment can help prevent long-term complications and reduce the risk of re-injury. Here is a short video using somatic movement principles that help restore proper alignment between the bones that make up the ankle joint while improving the neurological relationship between the Center of Mass and Base of Support.