Sometimes it’s not just about the ligament. It could be a cartilage injury—it could be the cartilage within the talus bone that’s injured. This is something that cannot be picked up by X-ray or CT scan. The only way that we identify that is an MRI scan. If there is a cartilage injury and it’s picked up early enough, it is very possible to treat it. But if left too long, it may not be.
If the sprain is really bad, the joint may have partially popped out and popped back in. At that point it is highly likely that you would have an articular injury, which is the cartilage injury. With a high-grade ankle sprain, we often get a scan for that specific reason. You may feel your ankle click and basically you'll feel like there’s a little pebble in your joint. It’s not a great feeling.