Ankle Sprains, Fractures, and Instability: A Q&A with Foot & Ankle Experts at ONS

by Dr. Andrew Pao and Dr. Jordan Pasternack

Drs. Andrew Pao and Jordan Pasternack, foot and ankle surgeons at ONS, provide insights into ankle sprains and fractures. They discuss causes, how to differentiate between a sprain and fracture, ankle instability, treatment options, and what to expect during recovery from surgery.

Ankle Sprains

What is an ankle sprain?
An ankle sprain occurs when the lateral ligaments on the outer portion of the ankle are stretched and/or torn. These are quite common – approximately 1 out of 10,000 people sprain their ankle each day.

How do you know if you’ve sprained your ankle?
A sprained ankle is a common injury that typically occurs as a result of a traumatic event—such as twisting, rolling, or turning the ankle awkwardly. This type of injury often causes sudden pain, swelling, and joint instability, making it difficult to walk or put weight on the foot.

How do you treat ankle sprains?
Most ankle sprains will heal with conservative treatment such as immobilization, bracing, home exercises and physical therapy.

Can sprains lead to ankle instability?
Yes. After ankle sprains, some people develop ankle instability which means that while the sprain itself has healed, it is now stretched out. This results in a loose ankle which can make it easy to roll or sprain – people often feel like their ankle is weak or that it can “give out” at any time. Typically, athletes are more likely to experience ankle instability.

How do you know if you have ankle instability?
A foot and ankle surgeon can diagnose ankle instability by performing a physical exam and taking a detailed medical history. The surgeon will test the strength and motion of your joint to check how loose the ankle is. X-rays may also be helpful to check for ankle arthritis or any changes in bone alignment, while MRIs can help rule out cartilage damage and tendon tears.

Would I need surgery for ankle instability?
Depending on the severity of your symptoms, surgery may be recommended to help relieve pain and restore stability. Ankle ligament reconstructions have a high success rate; the procedure tightens the existing ligaments or uses a graft to reconstruct them. An ankle lateral ligament reconstruction is an outpatient procedure that may include adjunct procedures, such as ankle arthroscopy, to address additional damage or tighten the stretched ligaments.

Ankle Fractures

What’s the difference between a sprain and a fracture?
Sprains and fractures can have the same cause – usually a twisting or rotational injury. You will also likely experience the same symptoms such as pain and swelling and even bruising. While treatment for an ankle sprain is typically conservative (usually immobilization followed by physical therapy), treatment of an ankle fracture can be either conservative or surgical depending on the type and location of fracture.

How do you know if you’ve broken your ankle?
You would typically experience pain and swelling of the ankle and have difficulty walking.

However, some people are still able to walk even on a broken ankle. It is important to get an X-ray for any ankle injury that results in painful walking as only an X-ray can definitively determine a fracture.

How can you break your ankle?
Usually, broken ankles result from a twisting or rotational injury but can also come from a direct blow to the ankle or a crush injury.

How do you treat ankle fractures?
You can treat ankle fractures both non-operatively and operatively. When the ankle joint itself is disrupted or unstable, surgery is typically recommended.

What does recovery look like?
This can involve immobilization for approximately 6 weeks but depends on the treatment option.

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About Dr. Andrew Pao
Dr. Andrew Pao is a board-certified, fellowship-trained orthopedic surgeon specializing in foot and ankle care. He treats a wide range of conditions including arthritis, sports injuries, fractures, deformities, and adolescent foot and ankle issues. He offers minimally invasive surgical options and serves as the foot and ankle consultant for Manhattanville University athletics.

About Dr. Jordan Pasternack
Dr. Jordan Pasternack is a board-certified, fellowship-trained orthopedic surgeon specializing in the comprehensive care of foot and ankle conditions. He treats everything from arthritis, tendon injuries, and fractures to deformities such as bunions and flatfoot. His approach emphasizes personalized care, offering both non-surgical and surgical treatment options tailored to each patient’s goals and lifestyle.