07/29/2009 05:12 am ET Updated May 25, 2011

Ankle Sprains Are Notoriously Under-Treated

"Ankle sprains are notoriously under-treated by primary care doctors and emergency rooms, and most importantly by the patients who suffer them", says Dr. Holly Johnson, a foot and ankle specialist from Prosports Orthopedics in Cambridge, MA. Thousands of young men and women, from weekend warriors to professional athletes, suffer ankle sprains daily. They often end up spending more time with lingering pain and swelling than is necessary, and would have been back to sports earlier if only they had rested and then rehabilitated the ankle more aggressively from the start.

After an ankle injury, people often head to an emergency room for where they are evaluated quickly and have x-rays taken of their ankle. The x-rays are typically negative, meaning no obvious fracture, or broken bone, is identified. However, soft tissue injury to the ankle often takes more time to recover from and has more longstanding effects on the ankle than a broken bone might have had.

Usually the ligaments on the outside of the ankle are injured, though the ligaments on the inside can be involved, too. This ligamentous injury - whether the ligament tears completely or partially - often takes weeks to months to heal, and can leave the ankle in a weaker state and prone to further ankle injuries and possibly the development of arthritis later on.

"In about 5 % of ankle sprains, a small area within the joint is damaged, creating a "pothole" in the otherwise smooth ankle cartilage that can cause pain in the ankle and require surgery to repair", says Dr. Josh Dines, a sports medicine orthopedic surgeon at the Joe DiMaggio Sports Foot and Ankle Center at Hospital for Special Surgery in New York City. He further adds that " the "high ankle sprain," as professional athletes Sidney Crosby and Terrell Owens had, is when the ligaments just above the ankle are injured as well. This injury, occurring in about 1% of ankle sprains, takes at least 6-10 weeks to heal".

When you have an ankle sprain that you can't shake off in a few days, you should see a health care professional trained in the evaluation and treatment of such injuries. Your internist is usually not the best person to evaluate these injuries. A sports medicine professional (podiatrist, orthopedic surgeon, physiatrist) is recommended to evaluate these injuries.

"Initial treatment should start with bracing. An ankle support, typically a lace-up type with side panels, or even a walking boot should be used for a few weeks. Bracing allows the ankle ligaments and tendons to rest and recuperate, providing pain relief and protection from further injury", adds Dr. Dines. After adequate rest, physical therapy should be started in most cases, especially if the ankle has been immobilized. Physical therapy is crucial to strengthen the ankle, regain any lost ankle motion, and most importantly, to retrain the ankle's tendons and ligaments to respond appropriately to any new twisting injury. Prescription foot orthotics are also very helpful as they provide increased stability and support to the ankle and provide improved biomechanical function of the foot and ankle as it relates to the knee, hip, and back.

Most people recover fully after proper treatment, and can get back into their typical activities and sports. Dr Dines further comments that " when the injured ankle is painless, back to at least 80% of the strength of the other ankle, and has full range of motion, the patient can safely return to sports and running. About 10% of the time patients will go on to have ankle instability or lingering pain that requires not only further work-up, usually an MRI scan, but sometimes surgery." The two most common surgeries performed after severe or recurrent ankle sprains include ankle arthroscopy and ankle ligament reconstruction.

Bottom line: there is no such thing as a simple ankle sprain. Treat it with respect as it may cause more problems than one could possibly imagine and possibly interfere with your quality of life.