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Healthy Tahoe: Overcoming ankle instability

Paul Ryan, MD

Winter sports are here, and whether it’s on the basketball court, the slopes, or the ice rink, ankle sprains may happen. An ankle sprain is the most common sports-related injury, accounting for 40% of all sport injuries. The good news is, most recoveries can get you back in the game in six to eight weeks.

Dr. Paul Ryan

We put our ankles under quite a bit of stress during athletics. When we run, our ankles support up to five times our body weight. Much of our stability is maintained by the boney architecture, in addition to ligaments and tendons which help control our ankle. Two ligaments primarily stabilize our ankles, and when you sprain your ankle, you have injured at least one of these ligaments.

Typically, it results in immediate pain and you may even hear or feel a ‘pop.’ The ankle may swell and occasionally bruise. If you are able to ‘walk it off,’ you generally don’t need an x-ray. If you can’t walk on it or have significant pain over the boney portions of the ankle, consult your medical provider, as an x-ray may be needed to ensure it’s a sprain and not a broken bone.



Initial treatment for an ankle sprain includes rest, ice, compression, and elevation, or ‘RICE.’ Immobilization with a brace, boot, secure taping, or wrapping should be utilized for the first three weeks. Immobilization is important to ensure the ligaments heal in the correct position. A sprain can just be a slight stretch on the ligament, but it can also be a tear.

Ankle sprains are graded I-III; a stretch, a partial tear, and a complete tear, respectively. The initial treatment for all three injuries is the same: RICE, followed by a brace for three weeks. After three weeks, if you feel ready to return to sport, you generally can (typical for a grade I sprain).



If you still feel apprehensive or are having pain, physical therapy is recommended to “retrain” the ankle. When a ligament is torn, the nerves that supply the ligament are also injured, contributing to apprehensiveness. Therapy will focus on balance and proprioception (an awareness of where your foot is in space). Once you regain your proprioception, your therapist or trainer will work on range of motion, strength, and return to activity.

If your ankle doesn’t recover after this treatment, an orthopedic surgeon will check the stability of your ankle to evaluate the length of the ligaments. Occasionally, the ligaments heal elongated, or stretched.

Some patients can be treated with continued bracing or taping, other patients may require surgery to return to sport. While recovery can take some time, most athletes (both professional and recreational) are able to return to sport within six months after surgery.

Dr. Paul Ryan is a board-certified orthopedic surgeon with Tahoe Orthopedics and Sports Medicine. He is a foot and ankle specialist treating patients in Carson City, Zephyr Cove, and at the Barton Center for Orthopedics & Wellness in South Lake Tahoe, CA. Dr. Ryan will host a free Wellness Webinar at 5 p.m. Thursday, Dec. 9. Register in advance, or view previously recorded webinars at BartonHealth.org/Lecture. To learn more about foot and ankle services, call 530-543-5554 or visit BartonOrthopedicsAndWellness.com.


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