Ankle sprains seem to boost the risk of developing painful osteoarthritis in the I joint, new research suggests.

This finding indicates that intensive rehabilitation is needed after chronic ankle instability or injury to help ward off the degenerative joint disease, say researchers.

For years, experts have known that arthritis in the ankle often occurs after a fracture in that joint, but there's been debate whether recurrent ankle sprains or instability--without a fracture can lead to arthritis. The new research says that it can, although not everyone agrees.

The Study

Swiss researchers evaluated 268 patients who had ankle arthritis. Of these, 83% had experienced a fracture in the past and 18% had chronic ankle instability with recurrent sprains but no fractures. In patients who experienced fractures, it took an average of 21 years from the time of injury to develop arthritis: among those with ankle injuries without a fracture, arthritis developed 22 years later.

This study is not the first to suggest the sprain-and-arthritis link, says lead researcher Dr. Victor Valderrabano of the orthopedic department of the University of Basel.

Valderrabano says arthritis may develop after an ankle sprain because the weight from walking and other movements continues to stress the vulnerable joint.

Up to 40% of patients who have ankle injuries experience chronic instability in the joint, the authors say, and up to 80% of those people eventually will develop arthritis in the ankle.

However, not everyone agrees that the link between ankle sprains and arthritis is so clear-cut. "People have looked at this many times in the past and it has not held up to scientific scrutiny," says Dr. Stuart Miller, an orthopedic surgeon at Union Memorial Hospital in Baltimore. Experts suspect a connection but have no definitive proof, he adds.

Miller and the Swiss researchers agree on one point—anyone who experiences recurrent ankle sprains needs an intensive rehabilitation program of physical therapy to strengthen muscles to become more immune to injury.

Osteoarthritis is characterized by the breakdown of the joint's cartilage. This loss of cartilage causes bones to rub against each other, causing pain and loss of movement, according to the Arthritis Foundation.

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