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What are non-surgical alternatives for a torn ankle ligament that is causing ankle pain? (photo)

Orthopaedic Surgery

Hi doctors, I have a torn ankle ligament that is causing pain for the last 9 months. The pain and swelling comes on whenever I walk for about 5 - 10 mins continuously, and also during fast movements like jumping up to catch a basketball. Also, my job requires me to be in boots for 12 hrs per day, and to climb 4 - 5 levels of stairs every few hours, which is tough for me. What are viable alternatives to surgery for a torn ankle ligament that is causing ankle pain? Thanks.

What are non-surgical alternatives for a torn ankle ligament that is causing ankle pain? (photo)
DOCTOR’S ANSWER (2)

Looking at your MRI, and hearing about your symptoms, I think there are a few things to consider. 

People with ankle ligament injuries, if left untreated, invariably complain of either persistent/ chronic pain, or instability. And if it’s pain, it can be due to the torn ligaments, or sometimes other pathology within the ankle joint.

If u read your MRI, you will notice it says subarticular sclerosis - that is a sign of possible arthritis. And one of the complications of an untreated ligament tear in the ankle is early post-traumatic arthritis, which can cause symptoms like what you’re experiencing. A lot of times there is chronic inflammation within the ankle joint that is causing pain as well. You may want to consider a repeat MRI if the symptoms are persistent.

Nonetheless, if non-surgical treatment is what you’re considering, it would really only be just medication and physiotherapy.

Wearing a good ankle brace may also provide some relief. If the symptoms get better with the above treatment, then we can watch the ankle. However, if symptoms persist and get worse, and in view of your activity level etc, there may be a role for surgical treatment as well. Hope this answers your question,

Kind regards

Dr Sean Ng 

1105 views 31 May 2018

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

1061 views 2 Jun 2018
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