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Will a torn ligament heal? Why does it still hurt for up to three months after an ankle sprain?

An ankle sprain (also called an ankle sprain) is one of the most common repetitive injuries in the lower limbs. Up to 40% of ankle sprains develop into chronic symptoms, including pain, swelling, instability and recurrence, and these symptoms can last for at least 12 months. Repetitive ankle sprains often directly affect athletic performance and cause psychological effects, and the symptoms may persist for many years, making it difficult to engage in leisure activities as usual, reducing the quality of life.

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Common Causes of Ankle Sprains

  • Stepping on an uneven surface or twisting: Usually occurs when running, jumping or landing, where the ankle unexpectedly twists or overextends, causing the ligaments to stretch or tear.
  • Stepping into a hole: When walking or exercising on uneven surfaces, the ankle may suddenly twist, causing a sprain.
  • Sudden stops or turns: When running at high speeds, if you have to suddenly decelerate or change directions sharply, the ankle will experience tremendous twisting force and is prone to sprains.
  • Improper landing: In jumping sports such as basketball and volleyball, if the landing posture is poor, the ankle may experience excessive impact force during landing, which can also lead to sprains.
  • Insufficient muscle strength: Lack of muscle strength in the knees, calves or around the ankle joint can lead to instability of the joint during exercise, increasing the risk of sprains.
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Tissues Prone to Injury After an Ankle Sprain

Peroneus longus, peroneus brevis, and peroneus tertius muscles: When the ankle rolls inward, if the muscles contract in time, they can transfer the force to the muscles, reducing the risk of injury to the lateral ligaments and joints.

Calf muscles: When the ankle rolls outward, if the muscles contract in time, they can transfer the force to the muscles, reducing the risk of injury to the medial ligaments and joints.

Lateral ankle ligaments: When the ankle rolls inward, if the muscles cannot protect against excessive twisting force, the lateral ligaments may be traumatized and torn.

Medial ankle ligaments: When the ankle rolls outward, if the muscles cannot protect against excessive twisting force, the medial ligaments may be traumatized and torn.

Displacement of the talus, navicular, cuneiform, and cuboid bones: Due to excessive twisting force on the ankle, the bones of the ankle may become displaced.

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What is a talus subluxation?

Under excessive twisting force on the ankle joint, the talus may sublux and shift forward and inward. At the same time, the medial and lateral ligaments connected to the talus will also be stretched.

In minor sprains without bone displacement, the torn ligaments generally recover within two to three weeks. However, in cases of bone displacement, even if the ligament tear is minor, pain may persist for up to six months to a year.

How to treat a talus subluxation?

  • Relax the tense soft tissues: Reduce excessive tension in nearby muscles and fasciae, such as the peroneal muscles, calf muscles, and plantar fascia, to create enough space for the next step.
  • Reposition: With the fasciae relaxed, gently press the talus back into its correct position, and then rock the sole of the foot.

Acute and Subacute Management After An Ankle Sprain

Acute phase (0-3 days) of Sports Injuries: PEACE

  • P: Protect against further injury
  • E: Elevation of the injured area
  • A: Avoid anti-inflammatory medication
  • C: Compression
  • E: Education from a professional

Subacute phase (4-14 days) of Sports Injuries: LOVE

  • L: Load the injured tissue with appropriate exercise
  • O: Optimism and positive mindset
  • V: Vascularization through movement
  • E: Exercise to restore range of motion, strength, and proprioception
  • Severe pain and swelling: Even in a minor sprain, if the ankle pain is severe, an X-ray should be taken to rule out the possibility of a fracture. Additionally, if swelling does not subside within 24 hours, it may indicate a need for further evaluation.
  • Joint deformity or abnormal movement: If the ankle joint appears deformed or has limited movement, such as an inability to bear weight or move normally, an X-ray should be taken immediately to check for fractures or severe ligament damage.
  • Inability to walk normally: If you are unable to walk or bear weight normally after a sprain, even if the pain and swelling are not severe, an X-ray should be taken to ensure there is no bone injury.
  • Adequate muscle strength and reaction
    • Strengthen the muscles of the ankle, calf, and thigh to stabilize the joint.
    • Train muscle reaction time to improve response to sudden situations.
  • Good proprioception and balance
    • Train proprioception (the body's awareness of muscle and joint positions).
    • Practice balance exercises like single-leg standing and planks to improve balance control.
  • Proper exercise form
    • Pay attention to landing posture when running, jumping, etc., and avoid excessive inward or outward rolling of the ankle.
    • Choose appropriate athletic shoes that provide adequate support and protection.
    • Be extra careful in areas with obstacles.

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