Ultrasound-Guided Cortisone Injections for Chronic Ankle Sprain

 

Introduction

A chronic ankle sprain occurs when an ankle injury fails to heal properly, leading to persistent pain, swelling, instability, and recurrent sprains. This condition often arises from incomplete ligament healing, residual inflammation, or biomechanical imbalances following an acute ankle sprain. It can significantly impact mobility, making daily activities and physical exercise difficult.

At Alton Pain Clinic, ultrasound-guided cortisone injections may be considered as a targeted treatment option for managing persistent inflammation and discomfort in chronic ankle sprains. This blog provides a comprehensive overview of chronic ankle sprains, including anatomy, pathology, causes, symptoms, diagnosis, and treatment options, with a focus on how cortisone injections work and their mechanism of action.

Chronic Ankle Sprain

Anatomy of the Ankle Joint

The ankle joint is a hinge joint that connects the lower leg bones (tibia and fibula) to the talus (ankle bone). It allows movements such as:

✔ Plantarflexion (pointing the foot downward)
✔ Dorsiflexion (lifting the foot upward)
✔ Inversion (turning the foot inward)
✔ Eversion (turning the foot outward)

The ankle joint is stabilised by ligaments, which provide support and restrict excessive movement. Key ligaments involved in ankle stability include:

✔ Lateral Ligaments (most commonly injured)

  • Anterior talofibular ligament (ATFL) — Prevents excessive forward movement of the talus.
  • Calcaneofibular ligament (CFL) — Provides lateral ankle stability.
  • Posterior talofibular ligament (PTFL) — Supports the back of the ankle.

✔ Medial Ligaments (Deltoid Ligament Complex)

  • Stabilises the inner side of the ankle.

✔ Syndesmotic Ligaments

  • Connect the tibia and fibula, preventing excessive widening of the joint.

When these ligaments are overstretched or torn, it can lead to ankle instability, pain, and recurrent injuries.

Pathology of Chronic Ankle Sprain

A chronic ankle sprain develops when an acute sprain does not fully heal or when repetitive injuries cause long-term ligament damage. Key pathological changes include:

✔ Ligament Laxity — Weak or overstretched ligaments fail to provide proper joint support, increasing the risk of further sprains.
✔ Synovial Inflammation — Persistent swelling and irritation within the joint.
✔ Tendon Dysfunction — Surrounding tendons, such as the peroneal tendons, may become irritated or inflamed.
✔ Chronic Joint Instability — Weak ligaments contribute to recurrent ankle rolling, increasing injury risk.
✔ Cartilage Damage — Prolonged instability may lead to wear and tear of joint cartilage, contributing to early arthritis.

Causes of Chronic Ankle Sprain

1. Incomplete Healing of a Previous Sprain

  • If ligaments are not given adequate time to heal, they remain weakened and prone to re-injury.

2. Repetitive Sprains

  • Individuals who frequently roll or twist their ankles develop ongoing ligament damage.

3. Muscle Weakness or Imbalance

  • Weak peroneal, tibial, and calf muscles can fail to stabilise the ankle, increasing the risk of instability.

4. Improper Rehabilitation

  • Lack of physiotherapy or rehabilitation exercises can lead to long-term weakness.

5. Poor Foot Biomechanics

  • Flat feet, high arches, or poor ankle alignment can contribute to chronic instability.

6. High-Impact Activities

  • Sports involving jumping, pivoting, or quick changes in direction (e.g. football, basketball, running) increase the risk.

Symptoms of Chronic Ankle Sprain

✔ Persistent pain — Usually on the outer side of the ankle.
✔ Swelling — Mild to moderate swelling, especially after activity.
✔ Recurrent ankle rolling — Weak ligaments make it easier to twist the ankle.
✔ Joint instability — Feeling like the ankle may “give way” when walking or running.
✔ Limited range of motion — Stiffness or discomfort when moving the ankle.

If left untreated, chronic ankle sprains can lead to degenerative changes in the joint, contributing to early-onset arthritis.

Diagnosis of Chronic Ankle Sprain

Clinical Assessment at Alton Pain Clinic

A clinician will perform a detailed examination, including:
✔ Medical history — Assessing previous injuries, symptoms, and activity level.
✔ Physical examination — Checking ligament stability, range of motion, swelling, and tenderness.

Imaging Studies

  1. X-ray — Rules out fractures or bone abnormalities.
  2. Ultrasound Scan — Assesses ligament integrity, swelling, and tendon involvement.
  3. MRI Scan — Used in cases of suspected severe ligament damage or cartilage injury.

Treatment Options for Chronic Ankle Sprain

Conservative Management

✔ Footwear Modifications — Supportive shoes help prevent excessive movement.
✔ Pain Relief Strategies — Includes NSAIDs, ice therapy, and activity modifications.

Ultrasound-Guided Cortisone Injections for Chronic Ankle Sprain

For persistent pain and inflammation, ultrasound-guided cortisone injections may be considered.

Mechanism of Action of Cortisone Injections

Cortisone injections contain corticosteroids, which:
✔ Reduce inflammation — Inhibiting inflammatory mediators within the joint and soft tissues.
✔ Suppress synovial swelling — Reducing joint fluid accumulation.
✔ Provide temporary symptom relief — Allowing for rehabilitation and improved function.

Why Use Ultrasound Guidance?

At Alton Pain Clinic, ultrasound guidance ensures:
✔ Precise delivery of medication to the affected ligaments or joint.
✔ Minimisation of complications by avoiding nearby structures.
✔ Optimised treatment effectiveness.

Procedure Overview

  1. Preparation — The ankle is cleaned, and a local anaesthetic is applied.
  2. Ultrasound Imaging — The affected ligament or joint is visualised for precise targeting.
  3. Injection — Corticosteroid medication is delivered to the inflamed area.
  4. Post-Injection Care — Patients are advised to limit high-impact activities for 24–48 hours.

Why Choose Alton Pain Clinic for Chronic Ankle Sprain Treatment?

✔ Expert clinicians specialising in musculoskeletal conditions.
✔ Advanced ultrasound-guided injection techniques.
✔ Comprehensive, patient-centred care tailored to individual needs.

Conclusion

Chronic ankle sprains can cause persistent pain and instability, impacting daily activities and physical performance. While physiotherapy and conservative management are key, ultrasound-guided cortisone injections may provide targeted relief for persistent inflammation and discomfort.

At Alton Pain Clinic, we offer expert musculoskeletal care, ensuring precise and effective treatment to help patients achieve better mobility and quality of life.


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