Sprained Ankle

A sprained ankle is a soft tissue injury involving trauma to the ligaments of the ankle. The severity of this injury can range from a grade 1 strain (consisting of mild overstretching of the structure or microscopic tearing) to a grade 3 strain (consisting of a complete rupture and usually accompanied by joint instability). In the most severe cases (e.g. inability to put any weight on the ankle), a sprain may be accompanied by a fracture. Typical symptoms of a sprained ankle are pain, swelling and tenderness. In most cases, a sprained ankle can be treated at home, using R.I.C.E. procedures and pain relief medication (see below). However, in a few cases, the severity of the injury may prompt a doctor to suggest more invasive procedures.

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.

Types Of Ankle Sprain

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.

High Ankle Sprains

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.

Degrees Of Ankle Sprain

As with most soft tissue injuries, ankle sprains can also be classified according to their severity:

• A grade I, or mild sprain involves only overstretching of the ankle ligaments, with no actual tearing;
• Grade II sprains involve a partial, but not total, ligament tear;
• Grade III sprains involve a complete rupture of a ligament. This type of sprain usually requires surgical intervention for its proper treatment.

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

Causes

Typical events that can give rise to an ankle sprain include:

• Falling awkwardly in a way that causes the ankle to twist while you are off balance;
• Landing awkwardly after a jump and twisting the ankle while trying to recover your balance;
• Walking, running or exercising on a rocky or unstable surface. In these circumstances, the ankle can be twisted when the patient inadvertently steps on the side of a rock while walking or running (for example).

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.

Ankle Sprain Symptoms

Typical symptoms of this injury include:

• Pain and swelling over the lateral side of the ankle (for an inversion sprain);
• For an eversion sprain, the pain and swelling tends to occur at the anterior (front) side of the ankle;
• In some cases, the patient may also experience contusions (leading to bruising and discoloration) over the painful area;
• Difficulty bearing weight on the injured ankle, resulting in the patient being forced to limp;
• Ankle instability, or “wobbliness of the ankle” when the patient tries to put weight on it;
• Stiffness and decreased range of motion of the ankle.

Individuals experiencing some or all of these symptoms should seek medical advice, preferably from someone with a sports medicine background.

Treatment & Prevention

Treatment Of Ankle Sprains

In most cases, an ankle sprain can be treated at home using conservative R.I.C.E. procedures, as follows:

• Rest – keep the weight off the ankle as much as possible. If the patient needs to move around, he or she should consider using crutches or a wheelchair. A brace can also be used to support the ankle;
• Apply Ice to the ankle every 15 to 20 minutes for the first day or two after suffering the injury. After this, ice can be applied every three to four hours for the next two days;
• Apply Compression to the injury using an elastic bandage. If this causes numbness or a loss of feeling anywhere (including away from the ankle), the bandage may be interfering with circulation. If so, the bandage should be removed immediately and a doctor consulted;
• Whenever possible, keep the ankle Elevated (for example by using pillows) above heart level to reduce swelling.

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.

How To Prevent Or Reduce The Risk Of A Sprain

To reduce the risk of suffering an ankle sprain, individuals can take the following precautions:

• Warm up and stretch properly before commencing any athletic activity. The warmer your joints are, the more supple your ligaments will be. As a result, the less likely these ligaments are to be torn or overstretched if something happens.
• Avoid exercising or playing on uneven surfaces as much as possible;
• If you have previously suffered an ankle sprain, use an ankle brace, an elastic bandage or athletic tape to give the joint additional support;
• If you play a sport in which falls are common, you can get coaching in falling or running when off balance. This will reduce the risk of incurring an ankle sprain when you are doing these things;
• Performing exercises to strengthen the muscles used during the physical activity in question.