Question
I play a lot of netball and sprained my left ankle quite badly back in March.

I had previously sprained the same ankle 10 years earlier and was aware that it was weaker.

The sprain in March was quite bad and I was unable to weight bear for 3 days.  I had two x-rays which showed no breaks but I was told I had pulled both the ligaments in my ankle and the tendons in my foot. This eventually healed after resting it for 6 weeks.

Then in September 2012, I went over on my right ankle playing netball. Again I rested it for 6 weeks and I am just starting to introduce exercise again.

Both ankles have clicked for years and I have never thought anything of it. However, I have noticed that my right ankle now clicks constantly when I walk.

I have also noticed that I am getting an occasional shooting pain on the instep of my right foot and the occasional pain down the outside of my left foot when running.

Can you give me any advice as to what is causing the clicking and whether there is anything I can do to strengthen my ankles as I don't want to give up playing netball.

Thanks

Answer
Rachel, with that many sprains I would be suspicious of a talar dome osteochondral lesion.  Multiple ankle sprains not only injures the ankle ligaments, but also over time can damage the ankle joint.  The talar dome is the bottom part of the ankle joint that can hit against the top of the ankle joint in ankle sprains.  Although no "break" is seen on xray, you actually damage the bottom bone of the ankle joint.  If you have several repeated ankle sprains that piece of the talar dome that is damaged can actually break off the bone and cause "clicking" in the ankle joint.  Usually an xray is difficult to detect talar osteochondral defects (OCD lesions) and a CT scan is needed to find it.  Treatment for these lesions usually require arthroscopic surgery if there are painful enough.  Physical therapy can help to strengthen the ankle ligaments to a degree but if you've sprained your ankle that many times, the ligaments specifically the ATFL (anterior talofibular ligament) and the CFL (calcaneofibular ligament) can be partially or completely torn which limits your success rate with PT.  An ankle brace such as the lace up w/ figure eight velcro strap (aka ASO brace) would probably the most supportive for you and help support the ankle rather than depending on your ankle ligaments.  Please let me know if there is any other questions you have.

Sincerely,
Dr. Leslie Johnston, DPM
Tampa, FL
Advanced Podiatry

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