Winter in Vancouver = Ankle Sprains

Along with the usual rains that occur in Vancouver in the fall and winter comes an increase in lower extremity injuries. Whatever your passion rain equates to slippery terrain, be it the ultimate field, soccer pitch, the Grouse Grind or Upper Oilcan on Mt. Fromme. In the clinic we usually see a jump in ankle sprains in the fall/winter as us ‘Adventurous Vancouverites’ don’t let a little rain and sloppy conditions stop us playing outside.

The most common ankle sprain occurs when you ‘roll over’ onto the outside of your pointed foot (inversion sprain) due to the relative instability of the lateral joint in this position. The Anterior talo-fibular ligament is usually the first ligament to sprain and is likely the most commonly sprained ligament in the body. Involvement of the Calcaneo-fibular and/or posterior talo-fibular ligament depends on the severity of injury.

Sprains are classified as Grade 1, 2 or 3. Grade 1 indicates a mild sprain with little swelling and joint stiffness involving a minor stretch or microscopic tearing of the ligament and no joint laxity. You can usually return to activity within a few days with minimum loss of function.

Grade 2 sprains are more severe associated with moderate to severe pain along with swelling and joint stiffness. Partial tearing of the stabilizing ligaments has occurred so laxity will be present and moderate loss of function is expected. Two – three months may be required to regain stability and strength.

Grade 3 sprains are most damaging involving complete ligament rupture with severe laxity. Pain may be severe initially, followed by little or no pain due to total disruption of the nerve fibers. Swelling may be profuse and the joint becomes stiff. You may require some form of immobilization and experience complete loss of function. These injuries are commonly managed conservatively with rehabilitation, but a small percentage may require surgery.

It is important to rule out other injuries including fracture, dislocation, tendon injuries and other ligament sprains. Prolonged excessive swelling and tenderness, deformity or increasing pain and swelling with weight bearing can indicate a more complex problem that may require further investigation.