Ankle Sprains

The ankle is a large hinge joint consisting of three bones: the tibia - commonly referred to as the shin bone, the fibula - the thin bone located next to the shin bone, and the talus - a bone in the foot that sits above the heel bone. The noticeable bony bumps around ankle joint are parts of the base of the tibia (medial or posterior malleolus, located on the inside and back of the ankle respectively) or the fibula (lateral malleolus, located on the outside of the ankle). The primary function of the ankle joint is to enable up-and-down movement of the foot, while the subtalar joint which is located below the ankle joint, allows for side-to-side motion. A strong network of ligaments surrounds the joints and binds the bones together.

Overview

An ankle sprain is an injury to a ligament in the ankle. Ligaments are tough bands of tissues that help hold your ankle bones together and stabilize the joints by preventing excessive movement. Ankle sprains are one of the most common musculoskeletal injuries as they account for nearly 50% of all sports injuries. Over 80% of all ankle sprains are a result of inversion, or inward rolling of the ankle due to rapid shifting movement with the foot planted or landing on an uneven surface. When this happens, the ligaments on the lateral aspect (outside) of the ankle get torn or stretched out and sprained.

Ankle sprain most commonly occur in athletes that participate in "cutting sports" or active individual who go running on uneven terrain. Additionally, people who have inward sloping heels or high-arches are at risk of an ankle sprain as well. Ankle sprains reduce a person's stability, boosting the risk of a repeat injury. An untreated ankle sprain has an every greater likelihood of re-injury.

Symptoms

Individuals who are experiencing an ankle sprain have the following signs and symptoms:

  • Hearing or feeling a "pop" at the time of injury
  • Pain and difficulty while walking immediately after the injury
  • Swelling and tenderness of the area around the ankle
  • Bruising and discoloration of the area around the ankle

Even though ankle sprains are common, seeing a physician is highly recommended if symptoms persist for more than a couple of week. A visit to the physician is critical if there is a potential for a ruptured ligament or broken bone, there is loss of circulation in the foot, or the leg/joint looks deformed and doesn't seem to function properly or feels unstable.

Diagnosis

Ankle sprains are generally diagnosed during a physical examination where the physician will look for the symptoms mentioned above in addition to checking for points of tenderness. The physician may move the joint in multiple directions to check for range of motion and to identify if a particular position or movement cause more pain than others. In some cases, if the injury is severe, your physician may order imaging such as X-rays, MRI scans, or CT scans in order to better assess the extent of the damage and to rule out a broken bone.

Ankle sprains are typically classified in the following three ways:

Grade 1: Mild Ankle Sprain - This involves partial tearing of the anterior talofibular ligament which is torn and/or stretched out, but is still intact. Mild ankle sprains generally take four to seven days to recover.

Grade 2: Moderate Ankle Sprain - This involves significant tearing of the anterior talofibular ligament and partial tearing of the calcaneofibular ligament, however, the ligaments are still intact. Moderate ankle sprains generally take seven to 12 days to recover.

Grade 3: Severe Ankle Sprain - This involves complete disruption of the all the ligaments on the lateral aspect of the ankle, anterior talofibular ligament, the calcaneofibular ligament, as well as the posterior talofibular ligament. Severe ankle sprain is a major injury and may take upwards of four to six weeks to recover. Furthermore, this type of sprain could be associated with an osteochondral injury.

Treatment

Prevention is the best form of treatment for ankle sprains. The key to prevention is improving proprioception (balance) and strengthening of the leg muscles. The stronger the muscles are, the less likely an individual is to sprain his/her ankle and the more the brain is trained to fire those muscles correctly, the less sprain-prone the individual will be. Here are a few ways to prevent an ankle sprain:

  • Balance Training - balancing on one leg is a great way to train the brain. Once that becomes easy, closing the eyes, using a BOSU ball or pillow to balance can further aide in improving proprioception.
  • Ankle Strengthening - Using a resistance band or towel around the ankles, move the foot up, down, in and out.
  • Stretching - Warming up and stretching muscles both before and after exercising or playing a sport is extremely important and can prove to a be a great preventative method.

If prevention fails, and an ankle sprain occurs, self-care methods, such as the RICE approach is advised:

  • Rest- Walking will be painful, so it's best to avoid putting pressure on the injured ankle and limiting activity during the healing process. Time is the best treatment for a typical ankle sprain as the body takes time to heal injured tissue.
  • Ice - Ice should be applied for the first 48 to 72 hours or until the swelling subsides for 10 to 20 minutes no more than once per hour. Use of a barrier, such as a towel, is strongly advised to protect the skin. Heat should be avoided while inflammation is developing; once the swelling goes down, heat can help soothe the pain.
  • Compression- Using a compressing wrap can help significantly decrease swelling. Ensure that the wrap is snug; however, if there is numbness, tingling, or swelling below the wrap, it's probably on too tight and needs to be loosed.
  • Elevation - Raising the ankle above the heart level for a few hours a day can aide tremendously in decreasing swelling and bruising.

Recovery

Recovery time depends on the classification of the ankle sprain as mentioned above. It is best to avoid sports and other vigorous exercises involving the ankle for at least three to four weeks after spraining an ankle even if all the pain and symptoms subside. If there is a need or desire to return or sports or activity sooner, check with a physician to ensure no further damage of the ankle.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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