The ankle is a complex joint providing motion primarily in the up and down direction. It is composed of three bones and eleven ligaments that connect these bones together. Covering these bones is a firm white substance called cartilage. Cartilage allows the bones to move freely on each other. The smooth gliding motion of the foot on the leg occurs when the cartilage is uninjured.

Injuries to the ligaments in the ankle occur most commonly while participating in sports. However, walking in a high heeled shoe or tripping off of a step can often cause a twisting to the ankle, causing injury to one or more of the ligaments in the ankle joint.

When injuries occur it is important for these ligaments to heal perfectly so chronic pain and instability do not develop. It is especially important in young teenagers and athletes who want to participate in sports without the ankle constantly giving way.

GRADE I (MILD) – Grade I injuries are consistent with a stretching injury to the ligaments. The most common ligament injury is the ligament on the outside of the ankle. A mild stretching injury to this ligament will cause some pain with ambulation. A mild amount of swelling and discoloration may develop but immediately following the injury the person should be able to weightbear with mild discomfort. Examining the injured area will reveal pinpoint tenderness over the ligament.                                                                                                       TREATMENT: Treatment for this injury may include rest, ice (20 minutes on and 40 minutes off on top of a towel or sock), compression with an ace bandage or ankle brace and elevation. These injuries may take a few days to two weeks before they recover. These injuries usually heal uneventfully without any long-term problem.

GRADE II (MODERATE) – These injuries cause a partial tear to the ligaments. The most common ligaments injured are on the outside of the ankle. These injuries are accompanied by more moderate swelling and discoloration to the ankle joint. There is more difficulty weightbearing as soon as the injury has occurred. Diffuse tenderness is noted around the outer ankle region.                                                 TREATMENT: The patient should be seen for this injury. A partial tear can turn into a complete tear and these injuries are best treated by immobilization in a cast or a leg brace until the injury heals. Rest, ice, compression and elevation are also important with this type of injury. These injuries can take from three to six weeks to improve. If a person continues to participate with sports or activity on a Grade II injury it can convert into a Grade III, which may cause chronic pain and instability to the ankle joint.

GRADE III (SEVERE) – These injuries cause a complete tear to the ligament or ligaments in the ankle joint region. They are accompanied by diffuse swelling both on the inside and outside of the ankle. Discoloration may be on the inner and outer ankle including the heel area and toes. Tenderness is located diffusely to the outer and also inner aspect of the ankle. Difficulty weightbearing as soon as the injury occurs is most common and is a clue to the severity of the injury.        TREATMENT: Treatment of these injuries should be immediate. These injuries should be immobilized in a cast or leg brace. Depending on the number of ligaments injured immobilization may be four to six weeks. Following immobilization prophylactic ankle bracing and aggressive physical therapy will be necessary to prevent chronic pain and instability.

CHRONIC INSTABILITY:When injuries to the ankle ligaments are not treated immediately, chronic instability may develop. When the person walks the ankle will easily twist and roll over. This may occur on a small pebble or wearing a shoe with a small heel. They may also occur while simply walking down a step. Sports may become difficult because of the inability of the person to become stable during activity.                                                                                                              TREATMENT: Treatment for this condition may include aggressive physical therapy to improve strength and balancing. If unresponsive to an aggressive rehabilitation protocol then the ligaments can be repaired and a full return to sports is to be expected. The time necessary to return to sports following a ligament reconstructive procedure is ten to twelve weeks.

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