Get a Proper Diagnosis
If you are experiencing ankle pain, you should immediately consult an orthopedic foot and ankle physician or a sports medicine physician to diagnose your condition and recommend the best steps for your treatment and recovery.
For a proper diagnosis, your doctor will perform a careful examination of your foot and ankle. This typically includes:
- Range of motion. He or she may also move your ankle in different directions. A stiff, swollen ankle will probably not move much.
- Your doctor will gently press the ankle to determine which ligaments are injured.
If there is no obvious broken bone, your doctor may be able to tell the grade of your ankle sprain based upon your swelling, pain and bruising. However, he or she may need more information and will order an imaging test, such as an X-ray, stress X-ray, MRI or ultrasound.
X-rays. These provide a closer look at your bones and determine if a broken bone is causing the pain and swelling.
Stress X-rays. This scan is taken while the ankle is being pushed in different directions and can show whether the ankle is moving abnormally because of injured ligaments.
Magnetic resonance imaging (MRI). An MRI is necessary if your doctor suspects a severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip or another problem. In some cases, an MRI won’t be ordered until after the period of swelling and bruising resolves.
Ultrasound. This test allows your doctor to see the ligament directly while a technician moves your ankle. This can help the doctor determine how much stability the ligament is providing.
In general, for most minor ankle injuries, a physician will first recommend conservative treatment, such as “R.I.C.E.” (Rest, Ice, Compression and Elevation) and physical therapy.
Most ankle injuries do not require surgery, but if they do, your doctor will refer you to an experienced foot and ankle surgeon who will explain exactly what technique he or she recommends, the post-surgery rehabilitation required and expected downtime.
Recommended treatments for some of the most common ankle injuries:
Achilles Tendonitis – For most patients with Achilles Tendonitis, a physician will recommend conservative, non-surgical treatment. This usually includes physical therapy to strengthen the tendon and a compression bandage or brace around the ankle/lower leg. He or she may also recommend over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain, rest and a break from activities involving the the affected ankle.
In some cases, after conservative methods have been exhausted, a doctor may suggest surgery to repair the tendon.
Achilles Tear/Rupture – Treatment for an Achilles tear or rupture should be administered as soon as possible. Usually, for young athletic patients, surgery is recommended. During surgery, an incision is made to allow the doctor to see the extent of the torn or ruptured tendon and then repair it with small sutures. If there is significant damage to the tendon, the repair may be reinforced with other tendons taken from the patient’s ankle or lower leg.
Post- surgery, the patient is typically put in a boot to immobilize the affected ankle for approximately six to 12 weeks. Physical therapy may start soon after the surgery, even while the patient is still in the boot or cast. Full recovery and return to sports can take up to six months.
In some cases, surgery is not recommended and non-surgical treatment options are available. These include a cast or a boot with wedges to elevate the heels, allowing for the tendon to repair itself. However, the likelihood of a re-rupture is more common with non-surgical treatment methods, and subsequent re-ruptures may be harder to repair.
Ankle Sprain – Because ankle sprains are divided into three grades depending on the severity of ligament damage, treatment for ankle sprains can vary.
-For the least severe Grade I ankle sprains, doctors recommend following the Rest, Ice, Compression, and Elevation (R.I.C. E.) protocol at home, as well as non-steroidal anti-inflammatory drugs (NSAIDs). Recovery time is usually two to four weeks.
– For Grade II sprains and some less-severe Grade III sprains, patients may be placed in an immobilizing boot and given crutches to assist with walking on the unaffected foot/ankle. Additionally, a course of physical therapy is typically recommended to prevent stiffness in the ankle and to aid in rehabilitation. Athletes are typically able to get back to their sports after six to eight weeks of recovery
-For severe Grade III sprains, surgery may be necessary if non-surgical options have failed. Two options are available: arthroscopic and reconstruction surgery. During arthroscopic surgery, a small incision is made, a camera is inserted and the surgeon repairs the tendon with miniature instruments. During reconstruction surgery, the surgeon will replace torn ligaments with a graft of other ligaments or tendons found elsewhere in the foot or ankle. In both cases, a cast will be administered after surgery to immobilize the ankle. A course of physical therapy is prescribed after the cast is removed. Recovery time is typically up to six months.
Ankle Fracture – To treat ankle fractures, a physician may recommend either a surgical or non-surgical treatment. Depending on the severity of the fracture, patients may be able to put pressure on the affected ankle right away, or they might have to wait to walk with the affected ankle/foot for up to six weeks.
If the patient’s ankle is fairly stable and just slightly out of place, the doctor may suggest a cast or an immobilizing boot and crutches.
If the fracture causes the ankle to become unstable, a physician may perform surgery to reposition the broken/fractured bone fragments. These fragments will be held in place with screws, metal plates or rods. After surgery, rehabilitation typically includes physical therapy to strengthen the ankle. It can take up to three months for athletes to return to their sport after ankle fracture surgery.
Os Trigonum Syndrome – Os Trigonum Syndrome, common in ballet dancers, can sometimes be treated non-surgically using conservative techniques, such as modifying activities and using the Rest, Ice, Compression and Elevation (R.I.C.E.) protocol at home. If non-surgical treatment doesn’t provide pain relief, a foot and ankle specialist may recommend surgery to remove the os trigonum bone, followed by physical therapy to strengthen the ankle. Typically, patients can get back to normal activities between eight to 12 weeks.
Ankle Impingement – To treat both posterior (back of the ankle) and anterior (front of the ankle) ankle impingement, a foot and ankle doctor will first recommend the Rest, Ice, Compression and Elevation (R.I.C.E.) protocol, sometimes followed by steroid injections to control pain. He or she may also recommend physical therapy to restore muscle strength and re-gain full range of motion in the joint.
In rare cases, a doctor may recommend surgery to remove the bone spur caused by the impingement. If the Os Trigonum bone is causing a patient’s posterior impingement, a surgeon may recommend that this bony structure be removed surgically.
Recovery for both anterior and posterior ankle impingement can take up to 12 weeks.