Severe ankle sprains

Understanding this condition

A severe sprain corresponds to a complete rupture of one or more lateral ankle ligaments. The mechanism is the same as for a minor sprain (varus twist) but the trauma is more violent.

A severe sprain may be accompanied by other lesions: an associated fracture, tendon injury, or osteochondral lesion of the talar dome.

Symptoms

Very acute pain, significant and immediate swelling, extensive bruising. Often a snapping sensation at the time of injury. Weight-bearing is often impossible or very limited.

A precise clinical examination (sometimes delayed due to pain) and imaging (X-rays, sometimes MRI) are necessary.

How can it progress?

Without appropriate management, a severe sprain leaves severe chronic instability, repeated sprains, and predisposes to early ankle osteoarthritis. Insufficient rehabilitation is the main cause of poor outcomes.

Treatment options

For the majority of severe sprains: immobilisation with a boot or splint for 4 to 6 weeks, followed by prolonged and thorough rehabilitation. Non-surgical treatment gives good results in most cases.

Surgery is reserved for cases of residual instability after well-conducted rehabilitation, or for associated lesions (fracture, cartilage damage). An initial consultation and a follow-up assessment allow appropriate management decisions.