Delayed Healing After Ankle Sprain

Before we look at some of the reasons your ankle sprain healing may seem delayed, let’s explore some of the symptoms that suggest your healing is behind schedule. Some symptoms of delayed healing include:

• Consistent or worsening pain
• Swelling the lingers or flares back up
• Inhibited range of motion, even after pain subsides
• Loss of confidence in ankle strength and stability
• Gait dysfunction
• Discomfort returns early during return to physical activity and stress

Sprained ankles can heal slower than anticipated for a number of different reasons. Let’s explore some of the most common reasons you’re not bouncing back from your sprained ankle as quickly as you’d like.

1. More Ligament Damage Than You Realize – Ankle sprains are typically classified based on the severity of the ligament stretching and tearing that has occurred. Grade 1 ankle sprains involve ligament overstretching, Grade 2 sprains involve minor to mild ligament tearing, and Grade 3 sprains involve severe or complete ligament tears. Perhaps your healing is taking longer than expected because you actually suffered a higher grade tear than initially assumed. Grade 1 tears typically resolve in 1-3 weeks, but a Grade 3 sprain may require surgery and up to six months to heal.

2. Damage To Nearby Structures – Sometimes a sprain is more than just a sprain. The forces applied to a foot and ankle area during a sprain can overload nearby structures and lead to additional injuries that can cause symptoms or discomfort to linger. Occult fractures and talar dome lesions are two types of issues that can develop alongside an ankle sprain, and if you’re not also working to care for these injuries, you may feel like it’s taking unreasonably long for your ankle sprain to recover.

3. Ligaments Remain Weak – When it comes to a sprained ankle, it’s not just about resting the area until swelling has subsided. The force of a sprain damages supportive ankle ligaments, and if you don’t proactively work to restrengthen these tissues, your ankle may remain weak and unstable. In order to get back to a pre-injury level of fitness, you need to proactively strengthen the damaged ankle ligaments. Perhaps the reason your symptoms are lingering is because you’re not proactively working to put the sprain behind you.

If you’re wondering why your recovery from a sprained ankle seems delayed, wonder no further. Connect with a foot and ankle specialist who can take a closer look at your ankle in person and with the assistance of medical imaging technology. We’ll get to the bottom of your delayed healing and develop a personalized treatment plan that sees you put symptoms behind you once and for all. For more information on how we can assist with this process, connect with Dr. Silverman and his team today.

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10 Things You Should Know About Ankle Sprains

Here’s what your doctor wants you to know about ankle sprains:

1. They Can Happen To Anyone – Ankle sprains aren’t just reserved for professional athletes. Active or rather sedentary, all it takes is one misstep on an uneven surface to sprain your ankle.

2. Don’t Just Walk It Off – Don’t just keep walking on an injured ankle and assume that eventually things will get back to normal. Without proactive attention, the injured ligaments will remain weak, and that leaves you exposed to another sprain or a more severe injury like a fracture.

3. Sprains Have Three Grades – Ankle sprains are typically graded on a 1-3 scale based on their severity, with a Grade 1 sprain involving some minor disruption of the supportive ankle ligaments, and Grade 3 sprains showcasing significant tearing and joint instability.

4. It’s Wise To Rule Out A Fracture – If you’re dealing with moderate or severe pain or you are struggling to put weight on your foot, it’s a good idea to have the ankle X-rayed to rule out a potential fracture.

5. Recurrent Sprains Are Now More Likely – Once you sprain your ankle, you’re at a heightened risk for another sprain while you’re in the process of recovering. If you don’t work to get your ankle ligaments back to a pre-injury level of strength, you’ll always be at an elevated risk for another sprain.

6. Rest Is Best, But Only In The Beginning – It’s important to rest your ankle and protect it from additional stress, but only for the first few days. Once you have rounded a corner on your recovery, gentle exercise and physical therapy will be your best bet for getting back to full fitness. Don’t assume you can rest your way back to full health.

7. Footwear Choice Is Important – Getting your feet into a well-fitting and supportive shoe can help to protect your ankle while you’re recovering and prevent some ankle sprains for occurring. At a minimum, make sure you are wearing a shoe that’s designed for the activities you’ll be pursuing. You wouldn’t wear sandals at a construction site, so don’t wear the wrong shoes to play sports either.

8. You May Not Need A Doctor – If you want to rule out a fracture, it’s smart to see a doctor, but if you’re just dealing with a minor sprain, you can likely manage it well on your own with RICE, which stands for Rest, Ice, Elevation and Compression. Once you’ve pursued RICE for a few days, add some low impact exercise and physical therapy to the mix, and your ankle should be good as new in short order.

9. Know The Emergency Symptoms – If you’re dealing with any of the following symptoms, you should seek out care at an emergency department or urgent care facility:

• Visible ankle deformity
• Inability to bear weight
• Loss of sensation/numbness
• Worsening pain

10. Be The Tortoise, Not The Hare – Finally, we always tell athletes who are looking to recover from an ankle sprain to be like the tortoise, not the hare. Take things slowly and gradual with your rehab and return to sports. If you try to rush back to athletics before your ankle is back to full strength, you’re risking another serious ankle sprain. Make sure your body can handle the increased stress you’re about to put on it before you dive back in to athletics at full speed. The best way to do this is with a targeted physical therapy program.

Keep these tips in mind, and we’re confident you’ll be able to prevent ankle sprains or make a masterful recovery when one does occur. For individualized advice for overcoming your ankle sprain or related foot issue, connect with Dr. Silverman today!

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Complications Of Untreated Ankle Sprains

Ankle sprains are far from the most serious injury, but at the same time, ignoring the problem can lead to much more annoying issues down the road, so it’s important to throw yourself into a proactive treatment program. Rest and ice are great at the outset, but eventually you’re going to need to push your ankle with exercise, stretches and physical therapy to get back to a pre-injury level of fitness. If you don’t, there’s a possibility that these two problems could develop down the road:

Ankle Instability – Ankle instability is one of the most common issues that Dr. Silverman sees in his clinic. Ankle instability develops when the supportive ligaments in the ankle joint are injured and remain weakened, in turn making them less able to support the joint during normal movements. An ankle sprain occurs when you overstretch these supportive ligaments, so a sprain is the most common precursor to ankle instability. However, very few ankle sprains will lead to long-term instability if the patient takes a proactive approach to care. After a short period of rest, activity limitations and anti-inflammatory medications, you’ll want to pursue some targeted active interventions like controlled exercise and physical therapy. This will restore strength to the injured ligaments while also helping to stabilize your ankle joint as a whole. This will ensure you’ll continue to be able to handle the stress you put on your ankle during normal and athletic movements.

Posttraumatic Ankle Arthritis – Posttraumatic ankle arthritis isn’t something that will set in overnight after an ankle sprain, but it can be exacerbated by a sprain that is not properly treated. If that sprain inhibits normal ankle function, soft tissues and cartilage in the ankle joint can break down faster, speeding up the arthritis process. Again, it’s important to work to restrengthen injured structures and restore your gait to a pre-injury level so that different areas of your ankle are not taking on more stress as they try to compensate for lingering weakness. Working with a physical therapist or an ankle specialist can ensure that not only has ankle strength returned, but your movement patterns and gait are not putting excessive stress on the joint as a result of the original sprain.

Don’t let a minor ankle sprain snowball into a much bigger issue because you tried to ignore the problem and walk it off. Sprains can be effectively managed, but they require proactive treatment, so give your ankle the attention it deserves after a sprain. Of course, if you need assistance assessing the scope of your ankle sprain or want help developing a specific physical therapy routine, reach out to an expert in your area. For more information, reach out to Dr. Silverman by filling out this contact form.

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How Common Is Ankle Instability After A Sprain?

The development of ankle instability following a sprain is more common than most people realize. Although estimates vary, the general consensus is that roughly 25 percent of individuals will develop at least a mild form of CAI in the wake of an ankle sprain. That means for every four people who sprain their ankle, one can expect to develop chronic instability and general weakness in the ankle. Considering tens of thousands of Americans sprain their ankle every single day, that means thousands of Americans find that they are now dealing with a long-term ankle issue following what they originally perceived to be a mild ankle sprain.

Fortunately, there are a few things you can do to greatly reduce your risk of becoming another statistic after spraining your ankle. In fact, simply being just a little proactive can have a major impact on your CAI likelihood. Taking a few simple steps can provide the right environment for your supportive ankle ligaments to heal and eventually strengthen so that they can get back to providing a pre-injury level of stability to the ankle complex. Those treatments include:

Rest – First and foremost, protect the ligaments from further damage by resting or limiting stress on the ankle for the first 24-72 hours after the injury. You may need to rest even longer depending on the severity of your sprain, but the goal here is to avoid doing further damage to the ankle ligaments.

Physical Therapy/Exercise – Studies have found that physical therapy or targeted exercises are the single best thing you can do to strengthen injured ankle ligaments and prevent the onset of chronic ankle instability following a sprain. You can find some generic exercises on the internet, or you can connect with an ankle specialist or a physical therapist to get set up with a personalized recovery program. A couple weeks of physical therapy can greatly reduce your risk of long-term instability issues after a sprain.

Bracing/Anti-Inflammatories – Finally, anti-inflammatory medication and a supportive brace can help to provide an improved environment for healing, but these are not active treatments like exercise or physical therapy, so they shouldn’t be the only treatments you pursue. Many people find that bracing and anti-inflammatories can help to control swelling, tenderness and pain that may inhibit your ability to effectively pursue physical therapy or other active recovery techniques.

Simply put, if you are proactive in your approach to preventing chronic ankle instability, we’re confident that you’ll be able to avoid developing long-term instability following a sprain. And if conservative care does fail to provide you with the level of relief you seek, Dr. Silverman can provide some individualized hands-on care to restore strength and function to these damaged ligaments.

For more information, reach out to Dr. Silverman by filling out this contact form.

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Unfortunately for many, what they assumed was just a short-term injury ends up continuing to bother them months down the road. Why is this the case, and more importantly, how can you overcome ankle sprain symptoms that have persisted for months? We explain how to overcome lingering ankle sprain symptoms in today’s blog.

Why Do Ankle Sprain Symptoms Persist?

Ankle sprains, especially very minor ones, can sometimes heal on their own without much effort from the individual who suffered the sprain. These sprains have have healed without direct treatment efforts, but that doesn’t mean that you can always just push through an ankle sprain and eventually you’ll feel back to normal. For more moderate and severe sprains, you’re not going to be able to “walk it off” and feel better a few days later.

In these more severe sprains, the ankle ligaments that provide support to your ankle joint are damaged. This makes it much harder for them to do their job effectively. If these ligaments remain weak, you may notice a host of symptoms including general discomfort, pain, instability or looseness in the ankle, especially during movement or athletic activities. Even though the inflammation, swelling and soft tissue tearing that is present shortly after the injury have subsided, the ligaments have been structurally compromised because of the tearing and healing. If you don’t recognize this damage and work to counteract it, it shouldn’t be surprising that symptoms persist months after a sprain.

Simply put, it’s not that your body hasn’t worked to address the sprain internally, it’s that you’re not providing the additional treatment needed to help your body get back to a pre-injury level of fitness. You need to address this ankle ligament weakening in order to put your symptoms in the past for good.

Overcoming Persistent Ankle Sprain Symptoms

Even though you may not have treated your ankle sprain perfectly following its onset, it’s never too late to pursue active treatment and work to reduce or eliminate persistent symptoms. In many instances, your best move in these cases is to connect with a foot and ankle specialist in your area. Dr. Silverman would be more than happy to examine your ankle and really get to the bottom of your symptoms. Oftentimes ligament weakening is a factor, but if the injury has affected your gait or how stress is dispersed on your foot, additional treatments may be warranted.

In many instances, persistent ankle sprain symptoms can be effectively managed with weeks of targeted physical therapy. PT will strengthen the injured ligaments and ensure they can adequately handle the stress you throw at it, but restoring strength isn’t the only benefit of physical therapy. It will also work to restore range of motion, flexibility, balance and confidence in your ankle, ensuring you can get back to doing all the activities you enjoyed prior to your injury.

Other treatments that may prove helpful alongside physical therapy include:

• Orthotic shoe inserts
• Low-impact exercise
• Heating pads
• Anti-inflammatory medication

Don’t accept that ankle discomfort is your “new normal” as a result of a lingering ankle sprain injury. Attack the problem head on with the help of a foot specialist like Dr. Silverman and get back to all your favorite physical activities. For more information, reach out to Dr. Silverman by filling out this contact form.

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Ankle Sprain Surgery

An ankle sprain occurs when you put so much stress on your ankle joint that the supportive ankle ligaments on either side of your ankle are overstretched as the joint bends inwards or outwards. These ligaments suffer minor, major or even complete tearing during this process, and you’ll be dealing with some ankle discomfort in the days and weeks that follow.

Mild ankle sprains only result in microtearing in the supportive ligaments, and you can usually get back to a pre-injury level of ankle strength by protecting the area for a short period before diving into some physical therapy and range of motion exercises. Even more moderate ankle sprains can follow this trajectory, although they may need to rehab for a much longer period in order to get back to a pre-injury level of fitness.

For those who suffer a severe ankle sprain or whose moderate sprain isn’t responding well to conservative treatment, ankle sprain surgery may be the best option. You’ve suffered some significant ligament damage during your ankle sprain injury, and if these ligaments aren’t restrengthened, they will remain weak an unable to provide the necessary support to your ankle joint. This means you’ll likely develop chronic instability in the ankle, and you’ll also be at a heightened risk for subsequent sprains or similar foot injuries.

Surgery helps by artificially strengthening and shortening the affected ankle ligaments. These ligaments have been overstretched as a result of your sprain and need to get back to a tight and supportive formation, and artificially tightening the ligaments can give you a leg up during recovery. You’ll still need to progress through a rehab plan that involves many of the previously listed conservative treatments, but oftentimes this artificial reinforcement makes it much easier for patients to regain strength and confidence in their injured ankle, while also greatly reducing their risk of a subsequent injury.

During ankle sprain surgery, your surgeon will make a couple small incision on your ankles above the ligaments that are being addressed. They will then use specialized tools to navigate to the ligaments before tightening them with sutures or similar hardware. Once your surgeon is satisfied that the ligaments have been appropriately tightened, the tools will be removed and the incision sites closed. You will then be taken to a recovery room before being discharged shortly thereafter.

You will likely be non-weight bearing for a short period of time to protect the ligaments before transitioning to a walking boot. Eventually you’ll begin weeks of physical therapy, and you can get back into your normal shoes around the 6-week mark. Most patients will be back to normal activities within three months, but your specific recovery timeline may vary.

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Treating Regular Ankle Sprains

If you’re regularly rolling or spraining your ankle and you want to put a stop to it for good, a first helpful step is setting up a consultation with your primary care physician or a foot and ankle specialist. They’ll be able to take a closer look at your ankle, how it responds to movement and stress, and they can order some imaging tests to take an inside look at the bones and soft tissues in your ankle. There’s a good chance that your chronic ankle sprains are tied to damage to your supportive ankle ligaments, but they can see if any other issues are at play.

Your ankle ligaments provide an immense amount of support and stability to your ankle joint as you move, and when these ligaments are weakened, your ankle can sprain when too much stress is applied. The most common reason for weak ankle ligaments is due to a previous injury. In many athletes, an initial ankle sprain beckons more sprains because of inadequate treatment. Athletes may push to get back on the field as soon as possible, and while pain and discomfort may have subsided, if the ligaments aren’t restrengthened, they may still show the physical scars of the initial injury. Continuing to put high levels of stress on the ankle joint can lead to subsequent sprains, which only further damages the ligaments, and the cycle continues.

Fortunately, it’s never too late to work to restrengthen your supportive ankle ligaments. Whether it’s been seven days or seven years since your original ankle injury, you can still take steps to restore stability in these soft tissues, and this will be the key to putting an end to your ankle sprains once and for all. But what is the best way to do this?

For the majority of patients with mild or moderate ligament damage, a heavy dose of physical therapy is the recommended course of care. Targeted strength training exercises performed on your own or with the oversight of a trained professional can help you slowly and steadily regain strength in these supportive ligaments. Many patients are asked to perform 4-12 weeks of physical therapy exercises, but your specific schedule will be dictated by your injury and your physical activity goals. When paired with other interventions like ice/heat, rest and a gradual reintroduction to high-stress activities, many patients can put an end to their repetitive ankle sprains once and for all.

If the ligament damage is more severe, or if you just aren’t responding to physical therapy, more hands-on treatment may be required. This is where Dr. Silverman can be an incredible asset. One of his specialties is ligament stabilization surgery. During this operation, Dr. Silverman will make a couple very small incisions on your ankle in order to access the affected ligaments. He will then artificially tighten and strengthen the soft tissues using sutures or a similar device before closing the incision sites and sending you on your way.

Patients can expect to be on crutches for a couple weeks before transitioning to a walking boot. Eventually you will be asked to participate in weeks of physical therapy, and a full recovery takes about 3-4 months. The majority of patients say that not only does the procedure put an end to their chronic ankle sprains, but they feel like their ankle is stronger than it was prior to their original injury.

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For the study, researchers took a closer look at the ankle strength of a group of Greek soccer plays. Ankle sprains are the most common type of injury among soccer players, and researchers wanted to learn more about some of the factors that contribute to their onset. Researchers did preseason tests of ankle strength and stability for 100 players from four professional soccer teams in Greece and followed the players over the next 10 months. 17 players ended up suffering one or more non-contact sprains during the season.

After looking closer at the data they collected, researchers came to learn that players with considerable strength differences between their left and right ankles were nine times more likely to suffer sprains as those whose ankles were about the same strength.

Researchers believe that when a player is jumping or landing, it is better for their ankle health if they have symmetrical activation of two sets of ankle muscles to help the joints absorb the impact and prevent strains. They also found that heavier players were more prone to sprains, which stands to reason considering their ankles would absorb a larger force when they land or cut.

Dr. Silverman Comments

Major discrepancies in muscle strength is a common source of injury in other areas of the body, so it’s not all that surprising to see the same issue in the ankles. For example, if an athlete has very strong quadriceps muscles but weaker hamstrings muscles, they may be at an increased risk of injury because of the discrepancy in the muscles that work in opposition of one another. While the ankle ligaments don’t work in opposition of one another, if you’re regularly exposing both feet to the same stress patterns and one ankle is significantly weaker than the other, it stands to reason that those athletes would face an additional injury risk.

Aside from working to maintain a healthy weight, athletes should make sure that they are targeting both sides of their body equally to avoid strength discrepancies. Also, if you’ve had an ankle injury in the past, you can’t just rest your way back to full health. You need to proactively treat the problem and pursue physical therapy so that you can return to a pre-injury level of strength. If you don’t, your weaker ankle will always keep you at an elevated risk for another sprain.

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High Top Shoe Study

A high top athletic shoe is one where the section around the side of the shoe (also known as the collar) extends further up the ankle. The collar height can vary significantly between high top and low top shoes.

Researchers found that in some situations, high top shoes can help to prevent ankle sprains, while they actually may serve to increase a person’s risk of a sprain in other situations. For example, one study found that high top athletic shoes provide additional stability when an outside force may cause an ankle to sprain while the person is standing still, like if you are knocked off balance while standing upright. However, once the athlete starts moving, the research tells a different story.

One study found that high top shoes may actually increase an athlete’s risk of injury because they can cause the supportive muscles on the outside of the lower leg to engage later and not work as strongly to stiffen the ankle as compared to when someone wears low top shoes. This risk was even greater in athletes with a history of chronic ankle sprains, leading researchers to conclude that high top shoes may not be the best choice for athletes with a history of ankle sprains.

At the end of the day, it’s important to remember that what works for one athlete may not work for another, and when it comes to picking out the right pair of athletic shoes, you need to choose a pair that is both comfortable and supportive. High, mid or low top styles are more of a personal preference, and you should gravitate towards something that fits well and feels comfortable.

A high top shoe may not be the best option for athletes with a history of chronic ankle sprains, but the most important thing for any athlete working to overcome a history of ankle sprains is that they try to proactively address the problem with other methods. Don’t assume a shoe will be able to prevent any and all ankle sprains. Instead, connect with a foot and ankle specialist and pursue some physical therapy exercises to strengthen the ankle and ensure it is better prepared for the stress you will put on it during a practice or game. Proactive treatments will prove much more fruitful at preventing future sprains than a specific shoe style.

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Avoiding Setbacks During Ankle Ligament Injury Recovery

Here are some of the potential pitfalls you’ll want to work to avoid as you attempt to help your ankle ligaments heal following a sprain.

1. Returning To Athletics Too Soon – Nobody wants to feel like they are letting the team down by missing time with an injury, but we see athletes worsen their original injuries all the time by returning to athletics before they are fully healed. Don’t rush back to athletics, especially on a weakened ankle, because there’s a good chance you’ll do additional damage to the ligaments.

2. Settling For “Good Enough” – Our ankles will progressively improve as our rehab goes along, and at some point you’re going to get the the point where your ankle feels good enough to walk or jog on. Don’t assume that your road to recovery stops here. You need to keep pursuing physical therapy and strength training once you’ve reached this point if you want to get back to a pre-injury level of fitness. Don’t settle for good enough, keep pushing on with your recovery exercises.

3. Wrong Treatment – Another common barrier to full recovery after an ankle sprain is caused by pursuing the wrong course of treatment. Rest is great in the short term, but that should quickly change to physical therapy and moderate exercise. Don’t assume that time will heal all wounds, because rest alone won’t help your ankle get back to a pre-injury level of fitness. You also need to pursue active interventions.

4. Ignoring The Problem – Some people don’t even pursue the wrong treatments, they just flat out ignore the problem. Assuming your ankle will eventually get back to normal if you just keep pushing through the discomfort is a recipe for continued discomfort in your ankle. Don’t just grit your teeth and assume all will eventually be well. You need to proactively treat a sprain.

5. Only Strength Training – Your ankles need to be able to handle a fair amount of stress during athletic activity, but strength training can’t be the only exercises you pursue during recovery. You’ll also want to work in some flexibility exercises with the help of a resistance band. Restoring strength and flexibility is key to getting back to a pre-injury level of confidence in your ankles.

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