The Orthopaedic Clinic

Ankle Sprain


Overview Diagnosis
  Treatment Options

Overview

A sprain involves damage to a ligament. In a mild injury, the ligament may only be stretched, resulting in microscopic injury to the ligament. In a more severe sprain, the ligament may actually tear or rupture.

The ankle is a hinge joint formed by the junction of the tibia and fibula, two long leg bones, with the talus. The lateral (outside) complex of the ankle also comprises three major ligaments:

  • the anterior (near the front) talofibular (ATF)
  • calcaneofibular (CFL)
  • posterior (near the back) talofibular ligaments

    The medial (inside) complex of the ankle includes the large deltoid ligament. The weaker lateral ligaments are involved in the majority of ankle sprains.

    Ankle sprains may be caused by:
  • falling
  • sudden twisting of the ankle, such as stepping on an uneven surface or in a hole
  • inversion of the foot when playing sports or exercising, which causes your ankle to "roll over"

    Risk factors that increase your chances of spraining your ankle include:
  • playing sports
  • poor coordination
  • poor balance
  • loose joints


    Diagnosis

    An ankle sprain may not require a visit to the doctor. However, you should call your doctor if:

  • you can't move your ankle
  • you can't put any weight on that foot
  • pain is over a bony part of your foot or ankle
  • pain interferes significantly with walking
  • pain is not relieved by ice, pain relief medication and elevation
  • you feel numbness in the leg, foot or ankle
  • pain does not improve within 5-7 days
  • you are not certain about the severity of the injury
  • you don't know how to care for this injury

    The doctor will ask about your symptoms and how the injury occurred. He will also examine your ankle to assess the stability of the joint and the severity of the injury. Tests may include:

  • x-rays to make sure that no bones are broken
  • magnetic resonance imaging (MRI) scan to see if a ligament has torn completely (rarely needed)
    Ankle sprains are graded according to the damage to the ligaments. In addition, the more ligaments involved the more severe the injury.

    Grade1
  • some microtearing of ligament tissue

    Grade 2
  • partial tearing of ligament tissue
  • mild instability of the joint
  • usually involves damage to two or three ankle ligaments

    Grade 3
  • severe or complete tearing of ligament tissue
  • significant instability of the joint

    Injuries can occur either in the ligament's midsubstance or at the point of attachment to the bone. Of the three lateral complex ligaments, the most frequently injured is the ATF, the weakest of the ankle ligaments.

    The injury can occur in isolation or can be combined with injury to other ankle ligaments. The mechanism of injury is usually a sudden twist (the foot most often inverts or turns inward). Performing movements that require agility puts an athlete at risk for ankle sprains.

    Symptoms of an ankle sprain include:
  • pain, swelling, and bruising around the ankle
  • worsening of pain when walking, standing, pressing on the sore area, or moving the ankle inward
  • inability to move the ankle joint without pain
  • popping or tearing sound at the time of the injury (possibly)


    Treatment Options

    Treatment includes:

  • rest
    Avoid putting any pressure on your ankle by not walking on it.

  • ice
    Apply ice or a cold pack to the ankle for 15-20 minutes, 4 times a day for at least 2 to 3 days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

  • compression
    Wrap your ankle in an elastic compression bandage (e.g., Ace bandage). This will limit swelling of your ankle.

  • elevation
    Keep your ankle raised above the level of your heart for 48 hours. This will help drain fluid and reduce swelling.

  • medication
    Take one of the following drugs to help reduce inflammation and pain:
              - ibuprofen (Motrin, Advil)
              - naproxen (Aleve, Naprosyn)
              - acetaminophen (Tylenol)
              - aspirin

  • brace
    You may need to wear a brace to immobilize your ankle. If you play sports, you may need to wear an ankle brace or tape your ankle when you return to play.

  • leg cast
    If you have a severe sprain, your doctor may recommend a short leg cast for two to three weeks, but this is very rare.

  • rehabilitation exercises
    Begin exercises to restore flexibility, range of motion, and strength of the muscles around your ankle as recommended by your health care professional.

  • surgery
    Surgery is rarely needed to repair an ankle sprain. However, it may be needed to repair a ligament that is torn completely.

    Prevention
    Many ankle sprains cannot be prevented. To reduce your risk of spraining an ankle:

  • Take a break from sports or exercise when you feel tired.
  • Do exercises that strengthen leg and foot muscles.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments, and tendons, including those around your ankle.

    How Athletes Can Prevent Ankle Sprains
    Many ankle sprains cannot be prevented. To reduce your risk of spraining an ankle:

  • Take a break from sports or exercise when you feel tired.
  • Do exercises that strengthen leg and foot muscles.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments, and tendons, including those around your ankle.

    Improving Sports Performance
    The key to improving sports performance after an ankle sprain is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone.

    The most important aspects of improving performance after a sprain are:
  • Strengthen the leg and foot muscles regularly with exercise.
  • Stretch the muscles around the ankle.
  • Know when you've had enough, and take a break when you feel tired.
  • Use proper technique.
  • Tape the ankle or use a brace for support if you are prone to sprains.

    Rehabilitation for ankle sprains
    Ankle sprains are one of the most common sports injuries. As an athlete, you may already know that one of the most common and best ways to begin rehabilitating a sprain is RICE:

  • Rest
    Avoid putting any pressure on your ankle by not walking on it.

  • Ice
    Apply ice or a cold pack to the ankle for 15-20 minutes, 4 times a day for at least 2 to 3 days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

  • Compression
    Wrap your ankle in an elastic compression bandage (e.g., Ace bandage). This will limit swelling of your ankle.

  • Elevation
    Keep your ankle raised above the level of your heart for 48 hours. This will help drain fluid and reduce swelling.
    You can begin exercise rehabilitation when the swelling subsides, which is usually a few days after the injury. Because warmed tissue is more flexible and less prone to injury, you may want to warm the ankle before doing rehabilitation exercises. Use ice when finished to minimize any irritation to the tissue caused by the exercise.
    To get you back in the game as quickly as possible, there are three main goals in rehabilitating the ankle:

  • Restoring motion and flexibility
    Gently move the ankle up and down. After 5 to 7 days, try restoring motion to the hind foot by turning the heel in and out. To restore flexibility in your calf muscle, try facing a wall with one foot in front of the other and lean forward with your hands on the wall. Bend the front leg while keeping the back leg straight and both heels on the floor. Lean forward until you feel a gentle stretch, and hold for ten seconds. Switch legs and repeat.

  • Restoring strength
    Once motion is restored, you can begin strengthening exercises using a rubber tube for resistance. Fix one end of the tube to an immovable object like a table leg, and loop the other end around the forefoot. Sit with your knees bent and heels on the floor. Pull your foot inward against the tubing, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.

    You can also sit on the floor with your knees bent and the tube looped around both feet. Slowly pull outward against the tube, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.

  • Restoring balance
    As your ankle gets stronger, the next task is restoring balance. Try standing on the injured leg, with your hands out to your sides, and hold position for 30 seconds. Repeat this exercise until balance is achieved.

    When can I return to my sport or activity?
  • When you have full range of motion in all directions (up and down, side to side, and in and out).
  • Your strength is restored in all muscles around the ankle, including the calf.
  • Your balance is restored.
  • You have no pain or swelling with exercise or activity.

    How long will the effects of the injury last?
    With proper rehabilitation, an ankle sprain usually lasts two weeks. If the injury has recurred several times, full recovery may take as long as six weeks.


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