5 min read
Almost everyone has rolled an ankle. You step off a curb wrong, land badly under the basket, or catch a root on a trail, and for a week or two the ankle is swollen and sore. Then it mostly settles, and life goes on. "Mostly" is the word worth looking at. A sprain is the injury people are most likely to walk off, and it is also one of the more common reasons an ankle is still causing trouble a year later.
What a sprain actually is
A sprain is an injury to a ligament, the tough band of tissue that holds one bone to another. In the ankle it is usually the ligaments on the outer side, which are stretched or torn when the foot rolls inward. A sprain can be a mild overstretch, a partial tear, or a complete tear, and from the outside those can look surprisingly alike in the first few days.
Ligaments do more than hold the joint together. They also carry the nerve endings that tell your brain where the ankle is in space, which is a large part of how you balance on uneven ground without thinking about it. When a ligament is injured, that sense is affected as well as the strength of the joint.
Sprained or broken: why it is hard to tell at home
A sprain and a fracture can both swell, bruise, and hurt to stand on, and being able to walk does not rule out a break. People walk on small ankle and foot fractures regularly. Clinicians look at a few specific things when deciding whether an X-ray is warranted:
- Whether you could put weight on the foot right after the injury, and whether you can take several steps now.
- Whether the pain is over bone, particularly the bony knobs on either side of the ankle or the outer edge of the midfoot, rather than in the soft tissue just below them.
- Whether the ankle or foot looks out of its normal shape.
- Whether there is numbness, or the foot is cold or changing colour.
The part people skip
Here is the quiet problem with a sprain. The pain and swelling usually improve on their own, so it feels finished. But a ligament that healed in a lengthened position, or an ankle that never got its balance sense back, may not be finished at all. It can simply be waiting for the next uneven step.
When an ankle keeps rolling, that pattern has a name: chronic ankle instability. Foot and ankle surgeons describe it as a repeated giving way of the outer side of the ankle, and it most often follows a sprain that did not heal fully or was never rehabilitated. Each new sprain can stretch the ligaments further, which makes the next one more likely. It is a slow cycle, not a dramatic one, and most people in it have simply learned to describe themselves as having "a bad ankle".
None of this means every sprain ends that way. Most do not. It does mean that an ankle which is still not right after the swelling has gone is telling you something, and that the usual assumption that it will sort itself out is not always correct.
Signs an old sprain is not really over
These are the things people commonly report when an ankle did not recover fully. None of them is a diagnosis, and all of them have other possible causes:
- The ankle gives way or feels like it is about to, especially on grass, gravel, stairs, or a sloped driveway.
- It has been sprained more than once on the same side.
- Swelling or an ache that returns after activity, long after the original injury.
- A feeling of not trusting the ankle, such as avoiding a sport, a trail, or a ladder you used to manage without a thought.
- Pain or stiffness deep in the joint rather than on the outer side where the sprain was.
Where this comes up around Chillicothe
This part of Ohio is not flat, and that is part of the appeal. The trails at Great Seal and Scioto Trail State Parks, and the sandstone country around Lake Katharine near Jackson, are exactly the kind of rooted, uneven ground where ankles get rolled, and where an ankle that already gives way gets rolled again.
The other steady source is sport. School seasons in Ross, Pike, Pickaway and Jackson counties produce the same injury every fall and winter in basketball, football, soccer and volleyball, and so do adult rec leagues, where a player in their thirties or forties is often carrying an old sprain from their own school years. An ankle that was "just a sprain" at seventeen is a common thing to hear about at forty.
What an evaluation involves
An ankle evaluation starts with how the injury happened and what the ankle has done since. The examination checks where it is tender, how it moves, and how much give there is in the ligaments compared with the other side. Imaging may be part of it when the history or examination points that way.
The purpose is to answer the question that cannot be answered at home: what was actually injured, and has it healed. What follows depends entirely on that answer, and for many people it is reassurance and a plan for getting strength and balance back.
Coming to us from outside Chillicothe
Bends Foot and Ankle has one office, at 37 N Plaza Blvd in Chillicothe, Ohio. Patients from the surrounding towns are seen there, and each of these pages covers the drive in:
- Jackson, Ohio: about 35 to 40 minutes · about 33 miles · US-35 west
- Frankfort, Ohio: about 15 minutes · about 14 miles · US-35 east
- Waverly, Ohio: about 25 minutes · about 20 miles · US-23 north
- Circleville, Ohio: about 25 minutes · about 18 miles · US-23 south
If your ankle was sprained and has not felt the same since, or it has gone over more than once, it is reasonable to have it examined rather than wait for the next time. Dr. Storts sees ankle injuries, new and old, at our office in Chillicothe.
This article is general information about a common foot and ankle condition. It is not medical advice and it is not a diagnosis of your own symptoms. If something is wrong with your foot, have it examined.
Care at Bends Foot and Ankle is provided by Eric Storts, DPM, FACFAS, board certified podiatric foot and ankle surgeon.