Why some people are more prone to ankle sprains and how to help your injuries heal faster

It can happen when you’re crossing the road and you underestimate the height of the curb when stepping off. Or you could be pivoting or jumping during sports when your ankle contacts the ground awkwardly and twists to the side. No matter the scenario, you’ll be left limping and wincing in pain.
Ankle sprains are one of the most common musculoskeletal injuries that doctors see. At National University Hospital (NUH), for instance, ankle sprains account for up to 70 per cent of all sports injuries related to the foot, according to Adjunct Assistant Professor Andrew Hong Choon Chiet, the head and consultant with NUH’s Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery.
Over at Mount Elizabeth Hospital, orthopaedic surgeon Dr Nicholas Yeo sees three or four cases per week. “These account for 10 per cent of Accident & Emergency visits and up to 30 per cent of all sports-related injuries,” he said.
But what’s the big deal, you say, as you sit there icing your foot. Everyone has had a sprained ankle before, whether you’re a weekend warrior or just love wearing high heels. And anyway, the swelling and pain will subside with time, right?
For one, a previous sprain may predispose you to future ones if you don’t help it heal properly. Second, if you keep spraining the same ankle, it could lead to something serious such as end-stage arthritis.
So, what can you do if your ankle keeps getting injured? What recourse is there for ankle arthritis? We find out from the experts.
WHAT USUALLY HAPPENS TO THE ANKLE WHEN IT’S SPRAINED?
The most common type of ankle sprain is the lateral ankle sprain when the joint rolls laterally inwards, said Adj Asst Prof Hong.
According to Harvard Health Publishing, this inward-rolling action can damage the ligaments in the outer ankle that form part of the ankle ligament complex. Ligaments are bands of fibrous tissue that connect bone to bone.
Depending on the severity of the damage (from Grade 1 to 3), the injured ligaments could end up over-stretched or torn. And like a worn-out rubber band, they can’t snap back into shape to provide stability to the ankle.
But it’s not all doom and gloom the minute you have a sprain. The vast majority of individuals, who sprain their ankles for the first time, “recover well enough to return to their pre-injury activities”, said Dr Yeo.
The issue comes when you have more than one sprain. “The ankle may become too lax and unstable. Strengthening the surrounding muscles can no longer compensate for the insufficiency of the ankle ligament complex and this predisposes one to future sprains,” said Dr Yeo.
“A lateral ankle sprain can also cause injury to the proprioceptive receptors, resulting in altered neuromuscular activities such as delayed muscle response time, poor balancing and proprioceptive reflex,” said Adj Asst Prof Hong.
WHY ARE SOME PEOPLE MORE PRONE TO ANKLE SPRAINS THAN OTHERS?
High-arched feet can make you more prone to sprains, said Dr Yeo. “This type of foot shape causes the ankle and foot to curve inwards slightly, and makes it more likely to invert or ‘roll’ the ankles inwards,” he said.
Having lax ligaments could be another cause, said Adj Asst Prof Hong. This means your joints are naturally very flexible and have a wider range of motion than most people – good for yoga perhaps, but not so good for minimising ankle sprains.
Biomechanics aside, certain sports, too, can increase your risk, Dr Yeo added, including basketball, soccer, volleyball and racket sports. “Basically, any sports where you have to jump, land and pivot quickly would predispose you to ankle injuries.”
And once you have an ankle sprain, you have a 12 per cent to 47 per cent risk of re-spraining that same ankle again and again, said Adj Asst Prof Hong, which could, in turn, give rise to a condition known as chronic lateral ankle instability. You’ll feel an instability in your ankle, like it’ll give way or collapse when you’re walking or standing.
In fact, almost 74 per cent of 231 patients treated at NUH over a five-year period for recurrent sprains had chronic lateral ankle instability, said Adj Asst Prof Hong.
HOW DO ANKLE SPRAINS LEAD TO ANKLE ARTHRITIS?
“Ankle sprains contribute to up to 22 per cent of all cases of ankle arthritis,” said Dr Yeo. Adj Asst Prof Hong also acknowledged the link. At Ng Teng Fong General Hospital and NUH, up to 25 per cent of end-stage ankle arthritis patients seen over a 10-year period had histories of multiple ankle sprains, he said.
Dr Yeo explained that “recurrent ankle sprains lead to ankle instability and this results in uneven weight distribution over the ankle joint”. “Over time, this can progress to ankle arthritis. In a proportion of ankle sprains, there is an associated injury to the cartilage. This, too, can progress with time to more generalised wearing of the joint surface and eventual arthritis.”
Adj Asst Prof Hong added that “this is why we often advise patients with unstable ankles who still want to continue their active lifestyles to consider surgical stabilisation”.
“We also often recommend patients who are averse to surgery to wear protective braces regularly during sporting or heavy-impact activities to prevent recurrent sprains,” he said.
HOW DO WE HELP A SPRAINED ANKLE TO HEAL PROPERLY?
You’ve heard of RICE, which stands for rest, ice, compress and elevate, when it comes to treating an ankle sprain. And you should carry out those steps immediately following a sprain, said Adj Asst Prof Hong.
If adequate treatment is not instituted early, especially in more severe cases, trauma to the ankle’s surrounding structures such as cartilage, bone, tendons and other ligaments can result. And in the long run, you may end up with sustained pain, swelling, cartilage damage, loose bodies and impingement from bone spurs, said Adj Asst Prof Hong.
Hence, “it’s crucial to apply ice to the injured area within 24 hours of the injury,” said Dr Yeo. “A firm compressive dressing should be applied to help reduce swelling. The foot should be elevated above the heart to reduce swelling and a course of anti-inflammatory medication will aid in this, too.”
“After approximately two weeks, when the swelling has subsided, the key is to restore the ankle’s range of motion, strength and flexibility,” said Dr Yeo. “Working with a physiotherapist to guide you through this phase of recovery is helpful. After about eight to 10 weeks, a gradual return to exercise and sports is possible.”
Oftentimes, according to Dr Yeo, that is enough for the injured ankle to heal on its own through scarring. But “in a proportion of patients, scar tissue can cause pain over the outside of the ankle joint. This is known as impingement. In certain cases, keyhole surgery is required to remove the scar tissue and alleviate the pain.”
If you continue to experience ankle pain and instability three months after a sprain, surgery may be required to reconstruct the ankle ligaments, said Dr Yeo.
WHAT TREATMENT IS AVAILABLE FOR ARTHRITIC ANKLES?
Motion isn’t good news when a joint’s protective cartilage has been worn down over the years and is now the source of joint pain and inflammation, or what is known as arthritis. The same applies to the ankle, especially one that is unstable from recurrent sprains to begin with and has created uneven wearing of the cartilage.  
In such an instance, the gold standard surgery is ankle fusion or arthrodesis, where the ankle joint is fused to eliminate motion, said Adj Asst Prof Hong. “This is a time-proven and effective surgery to relieve pain and improve function.”
The ankle is surgically fixed in a neutral position. While you won’t be able to flex your ankle to point your foot up and down, you’ll still be able to move your heel from side to side, and the middle and front parts of your foot up and down.
Also, “patients will have limitations in certain activities such as squatting, driving, climbing stairs and certain sports. But we have observed that they adapt to these limitations and do well,” said Adj Asst Prof Hong.
The alternative is total ankle replacement surgery or arthroplasty, said Dr Yeo, who claims to be the earliest surgeon in Asia to perform it. Similar to a knee replacement surgery, it involves replacing the worn parts of the ankle with metal implants. The procedure “allows the patient to preserve the range of motion of the ankle joint. This allows for a more natural gait and movement”, he said.
It is more acceptable to patients who don’t wish to lose their range of motion, said Dr Yeo. “Also, an ankle replacement procedure protects the adjacent joints around the ankle as opposed to a fusion procedure, which puts more stress on the surrounding joints.”