Ankle Sprain

Ankle Sprains are a common injury that occurs from over stretching or tearing of the ligaments that support the ankle. In fact, it has been estimated that 25,000 ankle sprains occur each day in the US. The ankle is composed of bones forming a joint and ligaments are the elastic structures which are responsible for holding these bones in their proper place. Ligaments and other soft tissues function to prevent abnormal movement such as twisting, turning, and rolling of the foot beyond the normal range. Sprains occur when the strong bands of tissue that hold our joints together, called ligaments, stretch or tear. This happens when we twist or roll our ankle suddenly and exceed a ligament’s normal length. In the ankle, this typically involves the ligaments on the outside of our ankle.

What Causes a Sprained Ankle?

Ankle sprains occur due to sudden inward or inverted movement of the foot during sports activities, or while walking and running on uneven surfaces. An ankle sprain can occur from falling, or sudden force on the ankle which twists the joint beyond its normal range, resulting in damage to the ligament. Ankle sprains can occur at any age and although commonly seen as a sports injury, ankle sprains can occur to non-athletes as well.

If you have rolled your ankle inward, which is a motion the ankle typically does with ease, instead you did it too quickly. Normally this is a result of a misstep while walking or stepping on someone else’s foot while playing sports. The sudden inward motion injures the ligaments on the outside of the ankle. Initially, there is swelling as blood flows to the site of the injury. Discoloration may occur within hours and may last days or even weeks.

What are the Symptoms of a Sprained Ankle?

Ankle sprains result in pain, swelling, bruising, and stiffness of the ankle region. Mobility, range of motion and weight bearing are adversely affected. The severity of the ankle sprain depends on the condition of the torn ligament. Swelling may be subtle if it is a mild injury and typically involves the outside of the ankle, or it could be dramatic if it is a higher energy injury and may involve the entire ankle. You may be able to walk on a mild sprain, but you will likely limp. If you cannot walk on the ankle then you should seek medical attention immediately.

Grades of ankle sprain

Based on the severity of the ligament’s condition, ankle sprains are categorized as grade 1,2, or 3.

• Grade 1: a mild sprain with some damage to the ligament fibers.
• Grade 2: a moderate sprain with partial tearing of the ligament.
• Grade 3: a severe sprain with complete tearing of the ligament.

How is an Ankle Sprain Diagnosed?

The diagnosis of ankle sprain starts with the physical examination, which is painful as the ankle is bent in various directions to assess which ligament is injured. Your physician will examine your ankle for swelling, bruising, and deformity. There is typically tenderness when pressing on the ligaments around the ankle, but if there is tenderness on the bony prominences, then you should have an X-ray of your ankle. X-rays are taken to confirm whether any fracture is present, as the symptoms of a sprain are similar. The doctor grades the ankle sprain by looking at the amount of swelling and bruising of the ankle. The physician will check the range of motion of your ankle which will likely be less than normal both because of the swelling and pain. The amount of swelling, pain, and the location of the injury will determine the treatment. In complex cases, an MRI scan is ordered for analyzing the injured ligament.

How is an Ankle Sprain Treated?

If you think you have sprained your ankle the first thing to do is remove yourself from any activity that may create further injury. Elevate the ankle and apply ice and a compressive wrap – like an ace bandage or an ankle brace that can be picked up in many pharmacies. For less severe sprains, it is best to start moving as soon as possible and place weight on the ankle with a light wrap or brace. More severe sprains may require a period of immobilization and potential use of crutches. It may take days, weeks or even months to return to normal. Throughout this time, even if the pain is improved, the ankle may continue to swell with activities, but should improve over night. If you seem to stop improving, make sure you see an orthopedic surgeon for further evaluation. Treatment and healing time of an ankle sprain will depend on the grade of the sprain. All sprains will be treated with the R.I.C.E. method: Rest, Ice, Compression, and Elevation. You may return to activities without restrictions once you have regained full, pain free range of motion, have no pain with activities and demonstrate normal strength.

Your physician may also order the following treatment measures if the sprain is a grade 2 or 3.

• Immobilization: A splint, short leg cast, or boot may be used to immobilize the ankle and allow healing to take place with a grade 2 or 3 sprain.
• Medications: Medications such as aspirin and NSAID’s, non-steroidal anti-inflammatory drugs, can be prescribed for your comfort and to minimize swelling.
• Physical Therapy: Strengthening and range of motion exercises may be prescribed by a therapist to regain normal function of the ankle and prevent chronic ankle problems. Your therapist may utilize ultrasound and electrical stimulation to decrease pain and swelling and instruct you on taping the ankle for support while it heals.

Surgery for ankle sprains is rarely needed but may be necessary if the sprain is a grade 3 with complete tearing of the ligament and the patient does not improve with conservative treatment measures and months of adequate healing time.

Your surgeon will perform Ankle Arthroscopy surgery to evaluate and repair the torn ligament.

Arthroscopy is a surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.

The benefits of arthroscopy compared to the alternative, open ankle surgery, include:

• Smaller incisions
• Minimal soft tissue trauma
• Less pain
• Faster healing time
• Lower infection rate
• Less scarring
• Earlier mobilization
• Usually performed as outpatient day surgery

Your surgeon will look for any loose fragments of bone or ligament inside the joint with the help of an arthroscope through a small incision.

The torn ligament is repaired by stitching it back together with sutures or by using the surrounding ligaments or tendons to repair the damaged ligament.

How Can I Prevent an Ankle Sprain?

If you participate in activities that put you at risk of ankle sprains, like ball sports, then it is important to keep your ankles strong and treat even mild injuries with rest until they have healed. Playing on an injured ankle may put you at further risk of injury of the ankle or elsewhere. Some studies have shown that people with recurrent sprains may benefit from using a brace or having their ankles taped during activities. Finally, if you continue to sprain your ankle despite using these precautions, you should see an orthopedic surgeon to determine if your ankle will require a focused rehabilitation program or surgery.

Conclusion

Ankle sprain is a common and painful condition in which ligaments supporting the ankle joint are torn or damaged. Sprains are most often treated conservatively by resting the injured joint, applying ice to the injury, using a compression bandage, and elevation of the foot. In severe cases, surgery may be necessary.

Further Reading

Ice vs Heat For Injuries

Top of Foot: Treatment Tips for Fracture, Sprain or Strain