It's certainly a situation that many people face! For most people who are involved in sports, ankle sprains are one of the most common injuries.
Most of the time, symptoms resolve without too much of an issue, but for some, there can be ongoing instability and pain symptoms.
Reading through your MRI scan, it's certainly not unexpected if you have a physically active job and take part in sport.
As Dr Sean mentions, conservative options do include physiotherapy and perhaps a brace to help with stability, but generally I do not recommend prolonged use of a brace as it can lead to dependancy on this.
There are, however, a number of other options. Firstly, if pain is this overriding issue, you could consider a cortisone injection into the ankle joint.
While there seems to be a certain taboo about steroid injections, they are pretty effective in controlling pain symptoms and can help with your rehabilitation objectives.
Some people are warned against them and are concerned that they can cause lots of side effects, however, if used with care and if injections are done under ultrasound guidance, they can be safe and effective.
Another option for you might be a prolotherapy injection to the ligaments. This can help improve the stiffness of the ligaments and hence improve your symptoms. After these injections there is a period of offloading and rehabilitation, but patients that have undergone this procedure seem to do quite well.
As I said before, you are not alone - many people with have injuries to ligaments and certainly if we scanned a hundred active people with past ankle sprains, there would be a high proportion who do not have all their ligaments intact. Certainly we do not need to operate on all of them and conservative management with physiotherapy or perhaps the injections may be all that is required.
Best of luck with your ankle symptoms.
BW
Dr Dinesh
