This is one of the most common soft tissue injuries.In fact, it is the most common sports injury treated in outpatient clinics.
However, it is important to note that it is by no means associated only with sports activity. For example, in colder climates, many people suffer ankle sprains walking on icy or snowy surfaces or while clearing snow from their homes.
Sprains can involve either the inner or outer ligaments. A medial sprain involves damage to the ligaments on the inside of the joint (nearer to the centre of the body). This is normally the result of the ankle rolling outwards – an event known as eversion.
Most sprains involve ligaments on the outside of the joint (lateral sprains). These occur when the ankle is rolled inwards – an event known as inversion. This can happen when the patient stumbles and the supporting foot is twisted and, usually, inverted. Examples for this occurrence include a woman slipping in high-heeled shoes or a cross-country runner twisting his ankle when putting his foot on rutted ground. See the diagram above for an illustration of ankle inversion.
A special subcategory of sprains includes those involving ligaments above the ankle itself. This is normally the result of a combination of the foot being turned out and everted at the same time. This type of sprain is known as a high ankle sprain and typically occurs among athletes, especially those in contact sports like hockey.
In many cases, high ankle sprains are accompanied by a broken bone in the joint.
As with most soft tissue injuries, ankle sprains can also be classified according to their severity:
A sprained ankle is always swollen. If the affected ligament is partially torn, then the bruising is slight and usually appears 1-2 days after the injury. Only a limited degree of passive inversion of the ankle is possible. With a completely torn ligament, the bruising is severe and appears at the time of the injury. Further, excessive passive inversion of the ankle is possible
Typical events that can give rise to an ankle sprain include:
In some cases, an individual who has suffered a sprain in the past is more likely to experience one again. So, the above situations are even more likely to cause a sprain for such an individual. Wearing shoes that don’t provide proper support or that make it more likely to “roll” the ankle will also predispose someone to an ankle sprain.
An injury of this type should be handled carefully to ensure that the patient recovers fully before restarting regular activities. Otherwise, the ankle ligaments could be permanently weakened, leading to long term ankle instability or even ankle arthritis.
Typical symptoms of this injury include:
Individuals experiencing some or all of these symptoms should seek medical advice, preferably from someone with a sports medicine background.
In most cases, an ankle sprain can be treated at home using conservative R.I.C.E. procedures, as follows:
The use of painkillers like NSAIDs (Ibuprofen or Naproxen) and Paracetamol may be necessary.
Surgery for an ankle sprain is only rarely required. It may be performed when the damage to the ligaments is severe (as is the case with a grade III sprain) and there is evidence of instability, or the injury fails to respond to non-surgical treatment.
Mild sprains take a week to 10 days to heal, while more severe sprains may require several weeks. As the ankle heals, the doctor may order enrolment in a physical therapy program. This will include ankle strengthening exercises designed to prepare the patient for a return to normal activity.
To reduce the risk of suffering an ankle sprain, individuals can take the following precautions:
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