Ankle Sprain
Basics
As opposed to a strain, which is an injury to a muscle or a tendon, an ankle sprain is an injury that stretches or tears the ligaments, or fibrous bands, that support the ankle joint.
The damage to the ligaments causes the joint to become inflamed, leading to swelling, pain, and sometimes bruising. In many cases, the injury also results in a temporary inability to move the ankle or to put weight on it.
Americans experience an estimated 850,000 ankle sprains each year, making it one of the most common injuries in the US.
Causes
Ankle sprains typically occur on uneven walking surfaces--while stepping off a curb, for example, or while strolling across a grassy lawn that has unexpected dips or holes.
Making a misstep during an athletic event or while exercising can also lead to a sprain. An ankle can get sprained while a foot is firmly planted on the ground if the body gets twisted in a way that puts abnormal pressure on the ankle.
A sprained ankle is usually the result of an inward roll (inversion) injury. Figure 01
This injury occurs when the foot is forced to "roll in" (invert), putting abnormal pressure onto the outside edge of the foot. The pressure then stretches or tears one or more of the lateral, or outside, ligaments of the joint.
A much less common cause of a sprained ankle is an outward roll (eversion) injury.
With this injury, the foot is suddenly turned outward, causing the medial, or inner ligaments of the ankle to be stretched or torn.
An eversion injury sometimes results in what is known as a high (syndesmotic) ankle sprain.
This type of sprain occurs just above the ankle joint to the ligaments between the two major lower leg bones (tibia and fibula). High ankle sprains are treated in a similar manner to other sprains, but they tend to be more severe and take longer to heal.
This injury occurs when the foot “rolls in” (inverts), stretching or tearing one or more of the lateral, or outside, ligaments of the joint.
Figure 01. Inversion injury
Symptoms
All ankle sprains produce some level of pain at the time of the injury.
The joint will also feel tender and begin to swell. If the sprain is mild, you may experience very little loss of joint function and may not fall when the injury occurs. You may also be able to walk on the injured ankle without much discomfort. The joint will probably lose some of its stability, however, and feel loose.
Other symptoms of a sprained ankle include:
With a more serious sprain, you will likely fall at the time of injury.
You will also find it difficult, if not impossible, to move or put weight on the injured ankle. Bruising will also appear, and swelling may spread from the ankle to the foot and perhaps to the lower calf.
Risk Factors
Participating in certain sports--those in which you are likely to jump and accidentally land on the side of your foot--increases your risk of spraining your ankle.
These sports include basketball, tennis, skiing, soccer, volleyball, and distance and high jumping.
Running or walking on rough, uneven surfaces also increases your risk; especially if you are wearing shoes with insufficient support to protect your ankle should you accidentally twist it.
If you have high-arched or flat feet, you are more susceptible to ankle sprains.
In addition, your risk of spraining your ankle increases if you have had earlier sprains or other ankle injuries that may have weakened the joint.
Diagnosis
As opposed to a strain, which is an injury to a muscle or a tendon, an ankle sprain is an injury that stretches or tears the ligaments, or fibrous bands, that support the ankle joint.
The damage to the ligaments causes the joint to become inflamed, leading to swelling, pain, and sometimes bruising. In many cases, the injury also results in a temporary inability to move the ankle or to put weight on it.
Americans experience an estimated 850,000 ankle sprains each year, making it one of the most common injuries in the US.
Ankle sprains typically occur on uneven walking surfaces--while stepping off a curb, for example, or while strolling across a grassy lawn that has unexpected dips or holes.
Making a misstep during an athletic event or while exercising can also lead to a sprain. An ankle can get sprained while a foot is firmly planted on the ground if the body gets twisted in a way that puts abnormal pressure on the ankle.
A sprained ankle is usually the result of an inward roll (inversion) injury. Figure 01
This injury occurs when the foot is forced to "roll in" (invert), putting abnormal pressure onto the outside edge of the foot. The pressure then stretches or tears one or more of the lateral, or outside, ligaments of the joint.
A much less common cause of a sprained ankle is an outward roll (eversion) injury.
With this injury, the foot is suddenly turned outward, causing the medial, or inner ligaments of the ankle to be stretched or torn.
An eversion injury sometimes results in what is known as a high (syndesmotic) ankle sprain.
This type of sprain occurs just above the ankle joint to the ligaments between the two major lower leg bones (tibia and fibula). High ankle sprains are treated in a similar manner to other sprains, but they tend to be more severe and take longer to heal.
This injury occurs when the foot “rolls in” (inverts), stretching or tearing one or more of the lateral, or outside, ligaments of the joint.Figure 01. Inversion injury
All ankle sprains produce some level of pain at the time of the injury.
The joint will also feel tender and begin to swell. If the sprain is mild, you may experience very little loss of joint function and may not fall when the injury occurs. You may also be able to walk on the injured ankle without much discomfort. The joint will probably lose some of its stability, however, and feel loose.
Other symptoms of a sprained ankle include:
With a more serious sprain, you will likely fall at the time of injury.
You will also find it difficult, if not impossible, to move or put weight on the injured ankle. Bruising will also appear, and swelling may spread from the ankle to the foot and perhaps to the lower calf.
Participating in certain sports--those in which you are likely to jump and accidentally land on the side of your foot--increases your risk of spraining your ankle.
These sports include basketball, tennis, skiing, soccer, volleyball, and distance and high jumping.
Running or walking on rough, uneven surfaces also increases your risk; especially if you are wearing shoes with insufficient support to protect your ankle should you accidentally twist it.
If you have high-arched or flat feet, you are more susceptible to ankle sprains.
In addition, your risk of spraining your ankle increases if you have had earlier sprains or other ankle injuries that may have weakened the joint.
Your doctor will ask you questions about your injury and your symptoms. You’ll be also be asked if you have injured your ankle in the past.
Your doctor will examine your ankle to determine the extent of the sprain and to make sure that you haven’t fractured a bone.
He or she will touch various points of your ankle and foot, and perform several tests to determine the extent of damage to your ligaments. For one of these tests, known as the anterior drawer test, your doctor will cup the heel of your injured leg in one hand and then gently pull the heel forward while holding firmly with his or her other hand to your lower shin. For another test, known as the taler tilt test, your doctor will carefully rotate your ankle outward. You’ll also be asked to put weight on your injured ankle. If you experience pain when a bony area is touched or when attempting to stand or walk, you may have a fracture.
Children need to be examined especially carefully to make sure that their symptoms are not a result of injury to a pediatric growth plate—which can mimic symptoms of a sprained ankle.
The doctor will apply pressure to the growth plate areas; if the child feels pain, the plate may be broken.
Doctors grade sprains according to the severity of the injury.
If your doctor suspects a fracture, he or she may order an x-ray of your ankle.
To determine if a ligament has been completely ruptured, your doctor may also order special “stress” x-rays. These are standard x-rays that are taken while someone rotates or stresses the ligaments in the injured joint.
In some cases--high ankle sprains, for example--doctors order computed tomographic (CT) scanning or magnetic resonance imaging (MRI).
Both of these tests produce more detailed images than standard x-rays. A CT scan uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of the body. MRI uses a combination of large magnets, radio frequencies, and a computer to produce its images.
You can do many things to lower your risk of spraining your ankle.
Prevention and Screening
You can do many things to lower your risk of spraining your ankle.
Treatment
There are many cases in which you should seek medical care for an ankle sprain.
Treatment for ankle sprains begin with self care. Rest, ice, compression, and elevation (RICE) are recommended.
Take measures to reduce swelling during the first 24 hours after the injury.
To reduce swelling, avoid the following things in the first 24 hours:
Your doctor is the best source of information on the drug treatment choices available to you.
Your doctor may recommend that you wear a brace or a cast to limit motion in your ankle while it is healing.
You may also be provided with crutches so you can avoid putting weight on the injured ankle.
When the pain and swelling has significantly lessened, your doctor will prescribe rehabilitation exercises, perhaps under the guidance of a physical therapist.
The exercises are designed to reduce swelling, prevent stiffness, increase strength and flexibility, and restore normal, pain-free range of motion in your ankle. It is very important that you do these exercises. Studies have shown that lack of rehabilitation after an ankle sprain can delay the healing process and a return to normal activities.
Rehabilitation exercises for ankle sprains fall into the following categories:
Your doctor or therapist may also recommend more advanced rehabilitation exercises; particularly if you regularly engage in sports and want to resume your previous level of activity.
These exercises will not be started, however, until you can walk comfortably and without a limp. Advanced rehabilitation may include doing stair climbing, hopping, and running in figure eights. You’ll also be advised on how to return gradually to your sport.
Your doctor may recommend that you continue to wear an ankle brace when you return to a strenuous sport or activity.
You can return to your sport when:
Figure 02. Range of motion exercise
Figure 03. Muscle strengthening exercise
Figure 04. Balance exercise
If all efforts at treatment fail and/or you continually sprain your ankle, your doctor may recommend surgery to reconstruct or repair the damaged ligament.
This surgery may involve sewing the torn ends of the ligament together or using a graft from a tendon from the ankle joint to reconstruct the ruptured ligament. The surgery is usually done on an outpatient basis, but you will need to rest for at least 48 hours afterwards with your leg elevated. During this period, you will also need to apply ice to your ankle every hour for about 20 minutes.
After the swelling from the surgery has subsided, your doctor will place your ankle in a cast, which you will need to wear for about six weeks.
Once the cast is removed, you will then need to begin a physical therapy program to regain full use of the ankle.
Alternative therapies should be used only to complement conventional medical treatments.
Always consult your physician before taking supplements, as supplements and herbs can interfere with other medications you may be taking.
People with diabetes and other conditions that can numb the nerves in the feet--such as AIDS or a traumatic injury— may not be able to feel the pain from a sprained ankle.
If you have one of these conditions, be sure to seek medical care when you fall on or twist your ankle, even if you are feeling no discomfort.
Most ankle sprains heal without complications.
People with grade I ankle sprains are usually able to return to their normal activities within one to two weeks of the injury. Those with grade II sprains can do the same within two to four weeks. Grade III sprains require a much longer healing time--usually 12 to 16 weeks. High ankle sprains often take the longest to heal.
Once you have sprained an ankle, you are more likely to injure it again.
Some people develop a condition known as chronic lateral ankle instability, which is characterized by persistent ankle pain, stiffness, or swelling. The ankle may even “give way,” or suddenly fail to support the body, when standing or walking. Chronic lateral ankle instability may require surgery.
You need follow-up care for an ankle sprain only if the ankle is not healing well.
This may indicate that you have a previously undetected fracture or that you have completely torn a ligament.
Call your doctor if: