The Problem Ankle

Why Simple Sprains become Problem Ankles, and How To Tackle Them (So to Speak)…

ankle-injuryAnkle Sprains. They are one of the most common musculoskeletal injuries, and affect between 6-11 people per 1000!! Chances are, you have either experienced this annoying injury yourself or know at least one person who has.

 Generally, ankle sprains are caused by rolling over the ankle during some kind of activity…whether it is running, walking, hiking; a game of rugby, tennis, or soccer; or simply taking a stroll on the beach!

Most often the ankle rolls inwards (known as an inversion ankle sprain), due to the relative instability of the lateral (outside) joint and weakness of the lateral ligaments compared to the much stronger ligament on the inside of the ankle.

Over the years, the term “Ankle sprain” has become synonymous with the term “inversion ankle sprain”, implying a rather benign injury to the lateral ligaments.

Unfortunately, this is not always the case. Severe ankle sprains can be associated with ligament and/or tendon rupture or tearing, as well as fractures to the various bony elements which comprise this small but ever so important joint.

Even in the very best scenario when the injury is localized to the lateral ligaments, inadequate rehabilitation can lead to prolonged symptoms, suboptimal sporting performance, and a high risk of re-occurrence. When pain persists and reoccurs in an injured ankle, we call it a Problem Ankle.

Thus we are presented with two essential requirements in preventing the development of a Problem Ankle:


  1. Correct Diagnosis
  2. Adequate and thorough Rehabilitation


It is always a good idea to get your ankle checked after a sprain, everybody responds differently to injury and perceives pain differently. This means that although you may have little pain, there may be a serious injury and vice versa. In order to correctly diagnose an injured ankle, your therapist will take you through an array of orthopedic tests to assess the various structures of your ankle. It is important to note that the sooner you can get assessed, the better! Once the severe swelling and pain set in, it is very difficult to ascertain any valuable information from manual testing.

Depending on the amount of swelling, bruising and pain; and the findings on examination, your physician will then decide whether it is necessary to send you for an X-ray to screen for fractures, or an ultrasound to screen for ligament or tendon damage.

As a rule of thumb, the following signs suggest serious damage to ankle joint integrity:


  1. Immediate swelling
  2. Widespread Bruising
  3. Inability to weight bear directly after the injury
  4. Hearing a pop or snap at the time of injury


Most cases of simple ankles sprain resolve well with a gradual reduction of pain and swelling and improved function over a period of 2-3 weeks. Unfortunately, not all sprains are so lucky! The sheer number of people spraining their ankles explains why there remains a substantial amount of people who do not progress well; and report recurrent instability, pain, swelling and impaired function well after 6 weeks post injury!

The two most common causes of the development of a Problem Ankle are incorrect diagnosis and inadequate rehabilitation.

Sometimes these injuries are misdiagnosed due to poor management, and other times due to unusual locations of trauma that are difficult to view using the various imaging techniques.

In any case, a skilled therapist should have a rough timeline of expected improvement, both structurally and functionally that should be routinely assessed throughout the rehabilitation process to ensure nothing has been missed.

The treatment of simple sprains versus ligament damage and bony fractures differs greatly! It is thus important to determine as early as possible the integrity of the various ankle tissues in order to determine the correct line of treatment.

As far as rehabilitation goes, each and every ankle injury should be rehabilitated. Yes, you heard me…every single one! The aim of rehabilitation is to restore range of motion, muscle strength, and *proprioception; as well as begin functional training specific to each individual. Furthermore, as a Chiropractor, I like to assess the mechanics of the lower limb to determine whether there might be a hidden reason as to why the ankle rolled in the first place!

It is clear to see that these common ankle injuries are often not as simple as they seem, and very often may require a multi-disciplinary approach in complicated cases.

At the end of the day, the take-home message is to look after your ankles! These relatively unstable joints have a tendency to roll and without proper care and rehabilitation, they will probably roll again! Your feet are your ticket to independence and locomotion and are more than worth the effort of keeping them healthy and strong!

Move Well. Live Well.

*Your brains awareness of where your body is in space and how it is able to move.