Prolonged recovery after ankle inversion injuries

Many people have experienced ankle inversion injury, commonly known as ankle sprain, which can lead to medial and lateral ligament sprain. Some people believe that ankle sprains are minor injuries that can heal on their own without the need for medical consultation. However, some people may still experience stiffness and pain in the ankle for a long time after the injury while others feel that their ankle is loose and at risk of spraining again. Many people think that once they have sprained their ankle, they are more prone to recurrent sprains. So, are these common perceptions accurate? Let's find out the correct answers from a professional perspective.

Firstly, let's understand the tissue healing process after an ankle sprain. After the sprain, the tissue goes through four stages: bleeding, inflammation, proliferation, and remodeling. Following an ankle sprain, there is bleeding and inflammation in the tissues. Then, the fibrous tissue undergoes proliferation. However, during this stage, the newly formed tissue is disorganized and forms "scar adhesions". Although the tissue arrangement is irregular during this stage, it generally reshapes during the final remodeling phase, gradually restoring the injured ankle to normal. Generally speaking, mild ankle sprains heal on their own.

However, after a certain period of time, some people may feel a significant stiffness at the injured site, while others may experience a sensation of looseness in the ankle. Why do these two conflicting situations occur?

Some people continue to feel ankle stiffness, especially when squatting or during physical activities, even after their injury has supposedly healed. This lingering discomfort may be attributed to the presence of unresolved "scar adhesions" near the ligaments or deep within the joint. Typically, this arises from inadequate treatment during the inflammatory phase, leading to chronic inflammation and a worsening condition. As these issues occur in the deeper tissues, they are often challenging for individuals to self-identify and address.

On the other hand, some patients feel that the lateral side of the ankle is unstable, and they are constantly worried about spraining it again. In reality, the ligaments may not be genuinely lax but this perception may be due to decreased sense of body perception, leading the body to falsely perceive instability in the lateral ankle. This misconception can lead to ongoing fear of re-injury and avoidance of physical activities. Research by Wikstrom et al. in 2021 showed that a previous lateral ankle sprain indeed increased the risk of recurrence. Without proper treatment, recurrent ankle sprains can occur.

To address both of these situations effectively, seeking the assistance of a professional physiotherapist is crucial. They can develop a tailored treatment plan to resolve deep-seated issues, strengthen the muscles around the ankle, improve balance and proprioception, and reduce the risk of recurrent sprains, allowing you to regain the joy of an active lifestyle!