Painful ankle after sport: What are the treatment options?

Sports injuries of the ankle are very common, and can be seriously painful if not treated promptly. In his latest online article, leading consultant orthopaedic surgeon and expert in foot, ankle and limb reconstruction Mr Hisham Shalaby delves into some of the most frequently asked questions regarding these injuries.

What are the common causes of ankle pain following a sports injury?

Sports injuries are very common, and pain after an injury is also very common, making it one of the most frequent presentations in our clinic. One of the most common causes of injuries or forms of injuries is ankle ligament injuries. Here, the patient usually rolls over their ankle, damaging ligaments on the outer aspect of the ankle.

They could sometimes damage other ligaments, which can lead to ankle instability and longer-term problems. Another cause of pain can be fractures, whether patients have been tackled or whether they go over their ankle.

Common fractures are fractures around the ankle itself, but sometimes other forms can also present, like fractures of the metatarsals, fractures of the calcaneum, or the heel bone. Any bone in the foot can fracture during sports.

Another form of presentation is injuries that result in damage to the joint surface. These are called osteochondral lesions. These are lesions that involve "osteo" (bone) and "chondral" (cartilage), resulting in a combined injury to the cartilage and the underlying bone. This usually has a specific presentation, involving a deep, dull ache that keeps occurring whenever patients engage in sports or physical activities.

Another form of injury that is very common in the foot and ankle are injuries to the Achilles tendon, including Achilles tendon ruptures, partial injuries, complete injuries, muscle tears, and so on. These are very common sports injuries.

How can I differentiate between a sprained ankle and a more serious injury?

The key factor to differentiate is the severity and significance of the resulting pain. In cases of a trivial ankle sprain, the pain should be moderate, and patients should still be able to put weight on it and walk. However, if you experience severe pain, it should always raise the possibility of a more significant injury. It's also important to relate this to the nature of the injury.

An injury resulting from a simple trip and fall is different from a heavy tackle during a football match where someone steps on a foot and causes a significant amount of deviation of the foot. Such events are more likely to result in much more severe injuries.

The ability to put weight on the injured ankle is another key indicator. If somebody can walk, that's a good sign. If somebody finds it very difficult to walk, it's an indication that something more severe has occurred. Furthermore, the more severe the injury, the more swelling and bruising the patient will present with. A simple fall shouldn't result in a black-and-blue pattern of bruising all over the foot. This indicates that something more serious has happened.

Finally, it's about recovery and improvement. A simple sprain should show significant improvement within a couple of days, with a maximum recovery time of a week. If you experience ongoing pain, swelling, and insecurity in the ankle for more than a week, there's likely something more serious going on.

What are the recommended first aid measures for a painful ankle after sport?

Immediately after an injury, the treatment we recommend is the acronym RICE: rest, ice, compression, and elevation. The key thing is to rest the affected part and keep it elevated, as elevation significantly reduces swelling. Cold compresses or icing of the ankle prevent a large hematoma from forming, and applying compression, like a compression bandage, further reduces initial swelling.

However, if the injury is severe or the subsequent pain is significant, it's advisable to seek medical attention at the A&E department or a minor injuries clinic. Here, patients are usually examined and, importantly, receive an x-ray to rule out fractures, which is the main concern.

One crucial aspect of recovery is the initial immobilisation, which is often overlooked. Many patients attending A&E are sent home with minimal support. However, immobilisation, especially in the form of a boot, can prevent the calf muscles from becoming excessively tight, facilitating faster recovery. In summary, remember RICE, attend A&E for x-rays if the pain is significant, and consider a period of immobilisation, which can be short or long depending on the severity of the injury.

When should I seek medical attention for persistent ankle pain post-sports injury?

This is another important question because initially, patients often attribute their sports injury to a sprain that will resolve on its own. So, when should they seek medical advice? In general, any ankle that is still sore and hasn't fully recovered should be properly examined and assessed.

Here are some patterns of pain that warrant attention after sports injuries:

1. Pain over the outer aspect of the ankle: This may indicate torn ligaments, with patients compensating using the peroneal tendons. If this pain persists for four or five weeks, it's likely there's some form of ligament damage.
2. Pain related to damaged joint surfaces: Patients with osteochondral lesions may experience a deep, dull ache within the joint, particularly during exercise. This suggests the need for examination, an MRI scan, and appropriate treatment.
3. Abnormal movement or locking of the joint: If you feel like the joint is catching or locking, it may indicate cartilage lesions causing problems.
4. Weakness: Ankle weakness, such as difficulty standing on tiptoes or pushing up, may indicate damage to the Achilles tendon.

Any ankle that experiences a trivial sprain should significantly improve within a few weeks. If you find yourself needing to strap your ankle to play or exercise, it could indicate underlying instability. Leaving an ankle unstable can lead to   in the long term, so these issues should be assessed to prevent long-term problems.

What are the available treatment options to relieve and recover from a painful ankle after sport?

The choice of treatment depends on the specific problem. Let's discuss two common scenarios:

1. Ankle instability: For patients with ongoing soreness, particularly over the outer aspect of the ankle, due to ligament damage, the initial treatment should involve physiotherapy to strengthen the ankle muscles and improve proprioception. If, after an appropriate course of physiotherapy, the ankle remains symptomatic, surgery may be necessary. This is especially true for young, active athletes who need quick recovery and want to avoid long-term joint damage that can lead to arthritis. This surgery offers very successful results to athletes.

2. Osteochondral Lesions (Focal cartilage damage): For patients with deep, dull joint pain during exercise, indicating osteochondral lesions, conservative treatments have limited effectiveness. The treatment approach depends on factors like the size and location of the lesion, stability, the patient's age, and any underlying medical conditions. This requires a thorough assessment by a surgeon. Treatment options include keyhole surgery to stimulate healing through drilling, or reconstruction for larger lesions. A technique involving bone grafting and a collagen membrane to cover the lesion is often used to restore the joint surface, providing excellent results, especially for young and healthy patients active in sports.

Mr Hisham Shalaby is a renowned consultant orthopaedic surgeon based in Edinburgh. If you would like to book a consultation with Mr Shalaby, you can do so today via his Top Doctors profile.