“An untreated sprain can lead to an ankle replacement at age 45.” The explanations of Dr. Andrei Constantinescu, MedLife, one of the few orthopedists specializing in ankle and foot surgery

Seemingly trivial injuries, especially in winter on icy pavements, can create long-term problems if not treated seriously. Dr. Andrei Constantinescuone of the few Romanian orthopedists specializing in ankle and foot surgery, who also operates in Italy, in Milan, and in Romania, sounds the alarm: the trivial sprain, ignored by many, can lead to arthrosis at the level of the ankle and, finally, to the replacement of the joint with a prosthesis.

Winter inevitably brings a wave of ankle accidents. Icy sidewalks are the main reason why hundreds of patients end up in orthopedics every year. Dr. Andrei Constantinescu, a specialist in ankle and foot surgery at MedLife Orthopedic Hospital, says there are two clear peaks in the seasonality of these injuries: winter, when people slip, and summer, when they start playing sports again. The doctor draws attention to a phenomenon often ignored by the majority of the population: badly treated or untreated sprains can lead to instability of the ankle, and over time an ankle prosthesis is needed.

“7 out of 10 people have had at least one sprain in their life”

Ankle sprains are among the most common musculoskeletal injuries. Dr. Constantinescu estimates that approximately 7-8 out of 10 people have suffered at least one episode in their life. Because not all sprains are severe, many people underestimate them. “People expect it to be over in two weeks. Sometimes it takes six weeks, sometimes 12 weeks for a sprained ankle to fully recover,” says the doctor.

The correct treatment in the first hours and days is known and works: ice applied locally for 15-20 minutes, every 3-4 hours, anti-inflammatory, rest and the leg kept elevated to reduce swelling. The problem is not that people do not know what to do at home, believes Dr. Constantinescu, but that few know when these measures are not enough.

If the symptoms do not decrease by 60%-70% in the first three to four days, this is the signal that a consultation with the orthopedic doctor is needed.

Another red flag is repeated sprains. If after a first sprain the patient suffers others in the same wrist, at shorter and shorter intervals, it may be an ankle instability and requires surgical evaluation.

From repeated sprains to chronic instability

When we suffer a sprain and the ankle ligaments tear – partially or completely, if we don't recover properly, the joint remains vulnerable. For a first uncomplicated sprain, conservative treatment is usually sufficient, supplemented by a physical therapy program. But if sprains recur, it means that the ligaments have not returned to their stabilizing function and the ankle remains at risk.

“Patients who sprain more and more frequently develop ankle instability. And ankle instability leads to premature arthrosis,” explains Dr. Constantinescu. Specifically, a patient who might normally develop ankle arthrosis somewhere between 65 and 70 years of age may end up with the same problem at age 45 if the instability has been ignored for a long time.

The data from the orthopedic surgeon's practice is instructive: approximately 40% of patients who end up needing an ankle prosthesis have untreated or poorly treated chronic instability as their basic problem. So, a trivial, repeated sprain, which was not given due attention, can result in ankle arthrosis around the age of 45.

Another risk is if we don't recover properly from a sprain

There is also a less discussed mechanism by which an untreated sprain can make things worse. Anxious patients, who have a hard time tolerating pain and uncertainty, tend to protect their affected foot by avoiding stepping on it normally. Apparently, it's a protective instinct. In reality, it can trigger a chain of problems.

“When we keep the ankle in plantar flexion, as if standing on tiptoes, to avoid pain, the Achilles tendon progressively shortens,” explains the doctor. This shortening leads to contractures, plantar fasciitis and, over time, forefoot pain. What started as a neglected sprain may end up requiring, in addition to ligament reconstruction, an Achilles tendon lengthening intervention.

The solution for these patients is not to ignore the pain and force walking, but quite the opposite: a structured program of physiotherapy, two to three times a week, through which the patient gradually regains confidence in the joint. “Physiotherapy is, in fact, a training in which the patient rebuilds his proprioception: the sense of balance and joint position. Those who follow the program, no matter how anxious they are, solve the problem”, emphasizes Dr. Constantinescu.

When surgery is needed

For the first sprain, the surgical indication appears only in specific situations: associated cartilage injuries, intense sports activity that requires rapid recovery or the impossibility of following a prolonged recovery program.

But when the instability becomes chronic – repeated sprains, an ankle that “gives” when walking on uneven ground – surgical intervention is clearly indicated. The operation involves the anatomical reconstruction of the ligaments, mainly the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL), using a tendon harvested from the knee.

Autonomous from the first day after the operation

The postoperative recovery is very fast. “The next day, the patient walks with all his weight on his leg, wears an orthosis instead of a cast and starts physical therapy after 4-5 days”, the doctor explains. After three to four weeks, the orthosis is removed and the patient is already mostly functionally recovered. At two months he can run in a straight line, and at five-six months he can fully return to sports, including changes of direction.

This approach—early mobilization without prolonged immobilization—is one of the primary goals of orthopedic surgeons today. “If we immobilize a healthy man in plaster for six weeks, he will lose another two months just to recover the function of walking. I want the patient to come out of the operation and be autonomous from the first day,” says Dr. Constantinescu.

The prosthesis: the modern solution for ankle arthrosis

When ankle arthrosis reaches an advanced stage and the pain becomes disabling, there are two surgical options: arthrodesis, which permanently blocks the joint, and prosthetics, which replaces the damaged joint with an implant and preserves mobility.

Dr. Constantinescu works at a reference center in Milan, where approximately 500 ankle prostheses are implanted per year. The technology has developed considerably compared to the first generations of implants from the 80s and 90s, which had modest results, and the current data 10 years postoperatively are, says the doctor, very good. In Romania, ankle prosthesis is at the beginning, but arthrodesis – the definitive blocking of the joint – tends to become an increasingly less recommended solution.

Ankle and foot surgery, a needed niche

Ankle and foot surgery is a recent and rare subspecialty in Romania. Dr. Constantinescu is one of the few Romanian doctors dedicated exclusively to this niche. Why was such over-specialization needed? “Medicine has evolved so much that you can no longer be at the highest level in ankle surgery, shoulder surgery, and hand surgery. You have to dedicate yourself to one segment in order to be able to offer patients the best and newest solutions in that segment,” he explains.

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This article is supported by MedLife, the largest network of private medical services in Romania, and is part of an extensive information and education effort, dedicated to prevention and a long-term healthy lifestyle.

At MedLife, health is approached with care and responsibility, starting from the real needs of each patient. Medical decisions are based on complex evaluations, supported by multidisciplinary teams of good doctors and state-of-the-art technologies. Through modern diagnostic and treatment solutions and, more recently, genomics expertise and the possibility of early identification of risks for common and lifestyle diseases, MedLife aims to help people take better care of their health.

The objective is clear: active prevention and timely intervention, before health problems affect the balance and quality of life. Because health means more than the absence of disease. It means energy, mobility and balance, at any age. MedLife is constantly investing in solutions that support sustainable health and contribute to a life well lived, not just today, but over the long term.

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