The ankle is held together by both ligaments and tendons. The ligaments on both sides of the ankle are tightly attached to the bones. On the outside (lateral) aspect of the ankle there are 3 major ligaments. They help to restrict the motion of the ankle joint. Sprains are caused by an injury to the ankle from normal walking events to sports injuries, to falls from a height. Most sprains are of the inversion type. When a patient twists the ankle this usually occurs with the bottom of the foot turning towards the other foot, leading the outside of the foot and ankle to roll to the ground.
When there is an injury to the ligaments they can be stretched out or torn, leading to a sprain of the ligament, weakening them. There can also be damage done to the cartilage of the ankle joint leading to a defect of the cartilage (osteochondral defect) and ankle arthritis. In cases that are left untreated, or in cases after many sprains in a short period of time, there will weakening of the ligaments leading to instability of the ankle. This is called lateral ankle instability.
Most of the time initial treatments are conservative therapy. Conservative therapy include: icing, ankle bracing, immobilization, injections, physical therapy and range of motion exercise.
If surgery is indicated, surgical correction depends on the severity of the injury to the ligaments. In some cases the stretched out ligaments can be tightened through arthroscopy. In most cases the ankle joint will need to be opened over the area of the ligaments and be repaired by placing them back onto the bone in their anatomic position. This repair will tighten and strengthen the ligaments again.