A big problem we see with ankle ligament injuries these days:
Undetected ligament tears with ankle sprains
Some patients go the emergency services and the Doctor asks you to move your foot up & down, and even take a few steps if possible. They ask to take X-rays. Remember that X-rays only show the bones, not any soft tissue damage. When there are no fractures are detected, they assume that the ligaments are torn, but they do not refer for a Diagnostic Ultrasound to determine the extent of the damage. They instruct you to walk on crutches for a few days until the pain goes away, sometimes they will also provide you with a moon boot. This scenario seems like a full proof plan but there are a few things that can cause quite a bit of problem later on.
In our experience, if no fracture is visible on x-rays, it is immediately diagnosed as only a ligament sprain. The pasient then assume the injury is minor as the doctor doesn’t seem to concerned. From the statistics mentioned above, you can see that some of those people who developed chronic pain or instability would have rather fractured something. The patient treatement is to take it easy and if it doesn’t improve to go back. If slightly better treatment is received then you will wear a moonboot for 4-6 week.
The problem is now your treatment was delayed by six weeks, and now you have a bunch of complications. The ankle joints have stiffened up, the ligaments are thick with fibrotic tissue and the muscles have weakened. The physiotherapist must ideally see you at day one after the injury. We will explain why this is so important.
Physiotherapists can determine the ligaments that are partially or completely torn and explain why you should follow the PRICE protocol. You should remove the boot every day (without putting any weight on the foot) move the ankle joint in all directions to keep the joint from freezing up and becoming stiff. The movement also helps the muscles to keep its strength and pump blood to the injured site to improve blood supply(help the healing) and take away the swelling.
We also start with early scar tissue massage that helps the fibrous tissue form in the correct direction to prevent the ligament from thickening too much that can lead to pinching of the ligaments between the ankle joints. When a physio oversees your recovery, you will be able to walk without the moon boot at week 6, not only start taking the boot off.
It’s important to complete a rehabilitation program because it makes it less likely that you’ll hurt the same ankle ligaments again. If you don’t complete rehabilitation, you could suffer constant pain, instability and post-traumatic arthritis in your ankle joints. If your ankle still hurts, the sprained ligament has not healed completely. On the other hand, the diagnosis might be incomplete or wrong.
You don’t want to go through this whole process over and over again, just to re-injure it. Unfortunately, this is exactly what we see every day as most people think it is just a minor sprain. The cases of Chronic Ankle Instability (CAI) is increasing and it is preventable. Prevention is better than cure for the ankle!