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Ankle sprains and arthritis

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Ankle sprains and arthritis

People don’t generally tend to associate ankle sprains with ankle arthritis due to its seemingly innocuous presentation in comparison to ankle fractures or dislocations, however recurrent ankle sprains can result in serious trauma to the ankle. Post traumatic arthritis secondary to recurrent ankle sprains is actually one of the most common cause s of the ankle joint surfaces (cartilage) wearing out prematurely (ankle arthritis).

Did you know that around 50% more energy per step is produced within the ankle joint than other joints such as the knees and hips? That’s a lot of energy! It does however explain why even an ankle sprain, and resulting alteration in biomechanics, can produce such a devastating, long-term affect on your ankle.

The ankle is made up of the shinbone (tibia) and ankle (talus) with ligaments surrounding these bones. Ligaments are made up of soft tissue that mainly consist of collagen. Sprains to the ankle usually occur on the outside (lateral) ligaments of the ankle following an inversion injury. Sprains can occur in different ways from minute tears in the fibres that make up the ligaments, to complete transverse tears of the ligament itself.

The reason that ankle arthritis can occur following recurrent ankle sprains is due to the  alternation in biomechanics of the ankle joint. Over time, the cartilage of the ankle wears away, resulting in ankle arthritis. These mechanical changes can result in instability of the ankle and mal-alignment (secondary to advanced arthritis) if appropriate steps are not taken initially to manage the injured ankle following ligamentous injuries.

The best way to avoid ‘post traumatic’ ankle arthritis following ankle sprains is to avoid  the ankle sprain in the first place, however  this is not always possible. There are various degrees of ankle ‘sprains’ raging from a simple sprain to one of the lateral (outer) ligaments of the ankle, to severe disruption of ligamentous tissue on both sides of the ankle joint. A thorough examination is warranted, and if the original injury resulted in significant swelling and an inability to weight bear, then typically my preference is to suggest a formal assessment +/- an MRI scan. Regardless of whether your ankle injury requires a surgical procedure, all ankle ligamentous injuries should be managed ‘actively’ with the aim of reducing any ongoing instability episodes during activities. This often involves an intense strength and conditioning program during the rehabilitation phase.

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