Ankle Sprain
Almost every person has suffered from a sprained ankle at some stage. A sprain is a tear of the ligaments around a joint. Of course, most heal quite well! However recent evidence has shown that as many as 20 - 40 % have some residual problems in the long term. This may include a feeling of persistent instability or secondary arthritis causing ankle pain. In an acutely sprained ankle, "RICE" (Rest, Ice, Compression bandage, Elevation) is usually the initial first aid treatment.
If a severe sprain is suspected (marked swelling, bruising, feeling of instability), it is wise to get a specialist to look at it. A special orthotic boot may be prescribed to provide some support. Sometimes X rays may be required to exclude a fracture. Surgery is not recommended in the acute stage; it should only be considered after 6 weeks to 3 months. Instability or pain after 3 months may indicate another problem, for example, a cartilage lesion in the ankle joint itself, or a loose body floating in the joint.
For this reason, I would often perform an ankle arthroscopy to look inside the joint with a camera, to diagnose and treat these associated conditions. The ligaments most commonly involved lie on the outside (lateral aspect) of the joint, of which there are three ligaments.
If there is persistent instability after a period of immobilisation, I would consider surgery to repair/reconstruct the affected ligaments. Further investigations may be required before this, including special "stress" Xrays or ultrasound scans. Clinical evaluation by an expert can itself provide most of the information required. The results of ligament reconstruction are good, but a period of rehabilitation is required, so a good physiotherapist is an invaluable asset in managing sprains.