Ankle sprains are among the most common injuries of the lower leg. Ankle sprains occur when one or more ligaments surrounding the three ankle joints become damaged. Ligament damage can be mild, which could be a stretched ligament; moderate, which could be a partial tear; or severe, where the ligament is severed. Ankle sprains can often completely heal and allow the patient to resume normal activity, but when misdiagnosis, unsuitable treatment, premature return to activity and/or excessive damage has occurred, long-term negative effects frequently develop.
Chronic Pain
Chronic pain is the most common long-term negative effect of an ankle sprain. Even severe sprains should be painless and completely healed within 10 weeks. If pain and inflammation persist after this length of time, there is a likelihood of a missed hairline fracture, ruptured tendon or torn cartilage. Chronic pain without inflammation is usually a consequence of either a partially unresolved dislocation or nerve damage. Chronic ankle pain can alter a person's gait, which can then negatively affect joints of the low back, hips and knees. Chronic pain can also lead to reliance on or addiction to painkillers, which greatly increases the chances of stomach ulceration and liver disease.
Chronic Swelling
Chronic swelling is another common long-term effect of ankle sprains and is usually caused by an unrepaired torn ligament; a nonunion fracture, which is a fracture that does not heal in the normal amount of time; infection; or damaged and leaking blood vessels. Chronic swelling is sometimes caused by synovitis, which is an inflammation of the inner lining of the ankle joint. Chronic swelling of the ankle joints over time can change the texture and color of the skin around the ankle to leathery and tanned.
Reduced Movement
Reduced movement is another long-term effect of ankle sprains and usually a consequence of excessive swelling or inflammation and stiffness. Dorsiflexion--moving the foot up so the toes come closer to the shin--and eversion--or pointing the foot away from the leg--are the movements most affected, especially if the ankle was in a walking cast too long or recommended rehabilitation exercises were ignored.
Osteoarthritis
Over many months, reduced range of motion and joint dislocation can lead to osteoarthritis, which is evidenced by bone spurs and reduced joint space on X-ray. The main symptoms of osteoarthritis are aching pain in the morning and grinding or cracking with movement.
Instability
Ankle instability occurs when an injured ligament fails to regain its anatomical elasticity, causing the ankle joints to become hypermobile and move in unnatural ways. Instability creates a "giving-way" sensation and may be accompanied by chronic low-grade swelling and pain. Ankle instability usually involves long-term weakening of the joints and greatly increases the frequency of future ankle sprains.
Nerve Damage
Nerve damage occurs when there is either excessive twisting during an ankle sprain or long-term swelling leading to compression of the nerves surrounding the ankle. Long-term effects include burning pain, electric-sensation pain, tingling, numbness, muscle weakness, muscle twitches and reduced nerve reflexes. Abnormal self-perception of body orientation may also result, which affects balance and stability of the foot and ankle. If nerve damage and muscle weakness is severe enough, a condition called drop foot can develop, which is the inability to flex the ankle correctly and affects the ability to walk normally.
References
- South Florida Institute of Sports Medicine: Complications of Ankle Sprains
- "The Unstable Ankle"; Meir Nyska et al., 2002
- "The Foot and Ankle in Sport"; Donald E. Baxter, 1995
