Repeated Ankle Sprains: If Left Untreated, Can Lead to Arthritis Where Only Inner Cartilage Wears Down

If an ankle sprain is not managed properly after the first occurrence, it can lead to 'chronic instability,' a feeling that the ankle continues to wobble. According to a video from Uihak Channel Biondwi, repeated ankle injuries require caution as they can cause characteristic arthritis where the inner ankle cartilage is intensively worn down, going beyond simple pain.

Stages of Ankle Sprains and Initial Response: 'PRICE'

The condition medically described as having 'sprained an ankle' is called an 'ankle sprain.' This refers to a state where the ligaments connecting bone to bone are damaged due to trauma. Ankle sprains, which account for the largest portion of sports injuries, mainly occur when the foot moves downward and the ankle twists inward; during this process, the anterior talofibular ligament, calcaneofibular ligament, and the lateral ligament complex on the outside of the ankle can be damaged.

The degree of ligament damage is largely divided into three stages. Stage 1 is a minor injury with slight swelling; Stage 2 is a state where the ligament is partially torn, making walking difficult; and Stage 3 refers to a state where the ligament is completely torn, resulting in severe ankle instability. Usually, from Stage 2 or 3, the pain is severe and walking is often very difficult.

Immediately after the injury, initial response through the 'PRICE Protocol' is important. The video emphasizes the following principles:

• Protection: Additional trauma must be prevented through bandages, braces, or casts. Typically, immobilization treatment is carried out for 2 to 4 weeks depending on the degree of injury.
• Rest and Ice: Take sufficient rest and use ice packs to reduce swelling and inflammation.
• Compression: Apply compression so that the swelling does not worsen.
• Elevation: When resting, raise the foot higher than the heart to help the swelling subside.

For diagnosis, an X-ray examination is fundamentally performed. While X-rays are useful for checking for fractures, they have limitations in confirming the ligament damage itself. Therefore, when swelling is severe or when the specific degree of ligament damage needs to be identified, an ultrasound examination is conducted to check for partial or complete ligament tears. If surgical consideration is necessary or if a comprehensive assessment of the cartilage and other conditions is required, an MRI examination may be performed.

Characteristic Patterns of Arthritis Caused by Chronic Instability

'Chronic instability,' where the ankle repeatedly twists, is caused by ligaments healing in a stretched state, structural abnormalities (varus foot), decreased proprioceptive nerve function, or congenitally flexible joints. If left untreated, it not only results in chronic inflammatory pain lasting more than a month but also carries a high risk of progressing to ankle arthritis after middle age.

In particular, arthritis caused by chronic instability shows unique characteristics different from general traumatic, degenerative, or rheumatoid arthritis. According to the video, X-rays of patients with chronic instability show that rather than the entire joint being destroyed, the outer joint remains relatively healthy, while the inner bones meet and the cartilage wears down, causing the overall alignment to shift. In other words, it takes a form where the outside widens and the inside curves.

This phenomenon can be confirmed through a 'load test.' In an unstable state where ligaments are stretched, the outer joint widens when external force is applied. At this time, instead of the widened outer side, the inner bones meet and collide with each other, causing only the inner joint cartilage to be intensively worn down. This results in a characteristic pattern where only the inner joint cartilage is lost.

Surgical Treatment Methods Based on Symptoms: From Joint Replacement to Osteotomy

If symptoms do not improve despite non-surgical treatments (injections, physical therapy, rehabilitation, etc.), or if the ligament tear is severe enough to make walking impossible, surgery can be considered. Surgical methods are largely divided into three types depending on the patient's condition.

The first is Total Ankle Replacement. This is a method of creating a new joint by removing the damaged joint and inserting a new artificial joint.

The second is Arthrodesis (Joint Fusion). If the pain is severe, this method eliminates the joint entirely and fixes the upper and lower bones together. This method is effective in alleviating pain by fixing the joint.

The third is Supramalleolar Osteotomy, which is mainly considered for arthritis patients caused by chronic instability. This is a surgery that corrects the shape by cutting the bone above the malleolus (ankle bone). It is characterized by correcting the ankle alignment to widen the narrowed joint space, thereby creating an environment where existing cartilage can be preserved and even regenerated. It can be particularly useful for patients in their 40s to 60s, and the state of cartilage regeneration can be checked through an endoscope.

Experts advise that if you frequently twist your ankle, the key to preventing arthritis is to receive appropriate immobilization treatment in the early stages and then prevent recurrence through rehabilitation treatment that strengthens the surrounding muscles. If pain and swelling persist, you should visit a hospital to receive an accurate diagnosis of the ligament condition and whether arthritis has progressed.