Ankle injuries are common; usually they are minor and heal quickly. But too often they lead to chronically unstable ankles that give out repeatedly and ruin a season. This consequence is avoidable if specific treatments are started immediately after the injury.

Ankle Injuries Slideshow Presentation
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Ankle soft-tissue injuries are divided into three Grades.

Grade I: Describes a stretching of the ankle ligaments without tearing of the collagen fibers that provide the bulk of the structure.
Grade II: Describes a partial tearing of the fibers without a complete rupture.
Grade III: Is a complete rupture.

A careful physical exam of the ankle joint by an experienced examiner can accurately grade the injury. X-rays can determine if a bone fracture has occurred with the ligament rupture. The initial treatment of most ankle injuries, independent of their grade, is the same and is described below. Fortunately, surgery is rarely required initially because if specific treatments are instituted early, the results of nonoperative treatment can often match the operative treatment; conversely, the results of late surgical treatment of unstable ankles can be excellent in experienced hands.

When an ankle is injured from twisting in towards the other foot, an inversion injury, most commonly the anterior talofibular ligament is stretched or torn. If the two other primary ligaments on the outside of the ankle (the posterior talofibular ligament and the calcaneofibular ligament) are also injured, the primary bone of the ankle, the talus, can be displaced from beneath the tibia and the ankle "shucks" out of joint. A physician or trainer examining the ankle soon after injury can compare the amount of "shuck" to the opposite ankle and develop a grade for the amount of injury suffered. Usually, if the injury is limited to one ligament, the instability is less. If all three ligaments are involved, the ankle is more unstable. The nerve supply to injured ligaments can also be compromised. The nerves provide "proprioception" or position sense, in effect telling the brain where the foot is in space. In the healing process, it is critical to re-train the healing ligaments to regain the neural connections required for a stable ankle. Specific exercises can effectively do this.

In the past, ankle injuries were often treated with cast immobilization for six weeks or longer. We have found this to be detrimental to the healing tissues. When injured collagen tissues are immobilized, the collagen heals in a disorganized fashion, producing scar tissue. The tissues are weakened by the lack of normal motion and stress required for tissue nutrition and organization. The injured nerve fibers have difficulty re-establishing the proprioceptive sense for the ankle. The result is a higher incidence of chronic instability.