A sprained ankle – more serious than you think?

More than one million people present at A&E with ankle sprains every year. But if that sounds like an awful lot of twists and falls, be warned; it’s just a fraction of the numbers who simply hobble on, without checking in. So, says renowned foot and ankle orthopaedic surgeon, Mr Andrew Goldberg.

As Mr Goldberg points out, at some point in our lives, many of us will suffer the pain and indignity of an ankle sprain. And winter is a prime season for slippery surfaces. So, whether it’s from sliding on an icy pavement, rolling over on a wet football pitch, or tumbling off your high heels on New Year’s Eve, the opportunities for ankle injury are everywhere at this time of year.

In his clinics at The Wellington Hospital in St John’s Wood, Elstree Outpatients in Hertfordshire, and HCA UK at The Shard in London Bridge, all part of HCA UK, Mr Goldberg has seen all these injuries and more, from everyone from teenagers to professional athletes, and even grandmothers. And what’s most important, he says, is not to brush it off and try to get back on your feet too quickly.

"It’s easy to ignore the severity of a twisted ankle and try to get straight back to work or your daily exercise regime," he says. "The trouble is, even if you are young and fit, if you don’t allow yourself enough time to rest and recover, not only can it slow down recovery now, but it may well make you more vulnerable to future injuries."

Grades of injury

Mr Goldberg, who is Director of the London Ankle & Arthritis Centre, is helping to advance pioneering treatments such as stem cell cartilage repair, explains that the ankle is one of the most stable, but complex joints in the body. "The ankle is held together by very strong ligaments, designed to restrict movement and when you injure those ligaments the ankle can become unstable."

Mr Goldberg explains that ankle sprains are graded from 1 to 3, with grade one being mild and grade three being severe. In Grade 1 injuries, only part of the ligament is stretched and these typically heal with a couple of days’ rest. Grade 3 injuries are where there is a complete tear of all the fibres of the ligaments. These can be very swollen and bruised and take six weeks or longer to calm down. "If you try and move a serious ankle injury too early," he warns, "the ligaments can heal stretched or maybe never heal at all. This can cause long term problems and may even require surgery."

What to do if you’ve rolled your ankle

No matter what grade of injury, Mr Goldberg explains the best initial treatment is to take the weight off your feet and apply the ‘RICE’ protocol straight away. "Rest, Ice, Compression and Elevation really are the best first response for most ankle injuries," he says. "In a Grade 3 injury which is very swollen and bruised, you must limit movement, so the ligaments have a chance to heal in the right place".

"Most people go to A&E and are told its not broken, and they feel relieved," he says. "I actually think a severe ankle sprain is worse than a broken bone, as these injuries are often much more problematic than the bones themselves and are in the main neglected". He continued, "in cases where I am concerned about a Grade 3 injury, I recommend a supportive ankle brace immediately and then I arrange an MRI scan to see the extent of any soft tissue damage. An MRI also frequently shows broken bones not seen on X-rays".

Once the swelling is reduced, probably after a few days for a mild injury, Mr Goldberg recommends some simple movements and weight-bearing exercises. More serious injuries may take a lot longer for the swelling to subside. This is where physiotherapy is helpful to work on the ‘dynamic stabilisers’, encouraging muscles and tendons to take over from damaged ligaments and restore function. If initial treatment was swift, most patients can make a full recovery.

"The problem comes when a Grade 3 ankle injury is missed, as these patients can go on having recurrent injuries over the years and eventually may even wear away the joint cartilage, with early-onset arthritis".

When surgery is the best option

Mr Goldberg is fortunate to work with the network of HCA UK’s walk-in Urgent Care Centres. "Our multidisciplinary team all work together to scan and diagnose these patients as quickly as possible, so we can assess whether ankle braces or crutches are needed or even whether or not the patients may benefit from surgery".

"Surgery is rarely the first-line treatment for most cases" says Mr Goldberg. He continues, "the cases I tend to operate on early are either the really severe Grade 3 injuries in an athlete and those who plays sports regularly where rapid restoration of full function is essential, or those who had poor initial treatment and where recurrent sprains are now affecting their quality of life".

He reiterates that early diagnosis is key. "In a badly treated Grade 3 injury, the ligaments have healed stretched or not at all, and these patients can often run for miles in a straight line without issue, but if they try and cut or thrust at speed, they find their ankle unreliable. I would tend to recommend surgery in those cases".

Mr Goldberg performs different surgical interventions depending on the extent of damage, including:

• Keyhole surgery (arthroscopy) – an exploratory operation to check the condition of your ankle, and deal with scar tissue and damaged cartilage 
• A ligament reconstruction, sometimes called a Brostrom-Gould operation, to repair and reconstruct overstretched or torn ligaments and restore full function
• his pioneering and specialised technique to restore function in severe ankle sprains even after failed surgery elsewhere.

"With ankle injuries, early diagnosis and treatment are essential to prevent long term problems", Mr Goldberg says, "Providing the right treatment is given, most cases make a full recovery".

Find out more about our orthopaedics services for acute injuries or to book an appointment, contact us on 020 3733 5966.