Sprained ankle

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 5, 2016
StartDiseasesSprained ankle

A sprained ankle is a common injury that can be as minor as a lightly twisted ankle or as severe as a collection of torn ligaments. Typically, sprained ankles do not need invasive surgery and will heal on their own with RICE (rest, ice, compression, elevation). If the ankle injury is more severe, wearing a brace and undergoing physical therapy are key components of rehabilitation. Sprained ankles can typically be prevented by wearing supportive footwear, strengthening ankle muscles, and improving one's stability. 

Contents

Definition & Facts

Ankle sprains include damage to one or multiple ligaments. The ligaments could over-extend partially or completely tear. Ligaments stabilize the ankle on either side of the ankle bone, and sprains occur when muscles supporting those ligaments “give out” and allow the ankle to stretch unnaturally to either side.

An inversion sprain, in which the ankle rolls inward and affects the ligaments on the outside of the ankle, is the most common type of ankle sprain. Eversion sprain, in which the ankle rolls outward and affects the ligaments and tendons on the inside of the ankle, is rarer.

Symptoms & Complaints

Symptoms of a sprained ankle include a broad range of pain from mild to severe, soreness, swelling, or bruising around the affected area. Symptoms also include decreased range of motion that may result in limping, instability, or joint stiffness.

In minor sprains, patients may feel only mild versions of these symptoms, but even mild sprains could lead to more severe sprains in the future due to the weakened ankle. In more severe cases, patients may not be able to put any pressure on their foot, and in the case of a torn ligament, the foot may feel almost as though it is detached from the ankle. 

Causes

Ankle sprains are very common and can happen virtually anywhere to anyone, regardless of one's physical fitness. The sprain may occur while playing sports, walking up or down stairs, walking or running on uneven terrain, wearing shoes that don't fit properly, or even by a simple footing misstep while walking anywhere. When the foot lands at an unexpected angle, a weak ankle rolls to either side, which stretches or tears the ligaments. It is easier for this sprain to occur when one has poor balance and weak ankles. 

People who have had previous ankle sprains, especially if they were mild but had gone untreated, are at a higher risk of recurrent sprained ankles. Wearing high heels can often lead to sprained ankles, as well as wearing any other kinds of shoes that do not provide ample ankle support. 

Diagnosis & Tests

Immediately after the injury, if the above symptoms present themselves, a primary doctor or orthopedic specialist should be consulted. The doctor will physically examine the injury and test for such signs as tenderness, range of motion, and the patient’s ability to put weight on the foot. Next steps should always include taking X-rays to identify if any bone fractures occurred in the accident.

In more severe cases, imaging tests such as MRIs or ultrasounds may be recommended in order to evaluate the full extent of the injury. In those cases, the doctor will then be able to determine if surgery will be needed, or if non-invasive treatment will suffice. 

Treatment & Therapy

The proper amount of rest, care, and strengthening are integral to ankle sprain recovery. Following a doctor’s visit and diagnostic tests, the first steps to take should always be RICE: rest, ice, compress, and elevate. Rest by limiting activities as much as possible. If the injury is too severe to put any pressure on the ankle, crutches may be recommended for any necessary transportation.

Ice the injured area within 48 hours of the accident every few hours, for no more than 20 minutes at a time. Compress the injured area with a brace or elastic wrap (such as an ACE® bandage) for the prescribed time period. Elevate the injured ankle at a level above the heart whenever lying down to assist with blood flow away from the swelled area.  Taking the doctor’s recommended dosage of anti-inflammatory medications, such as naproxen or ibuprofen, will help to relieve the ankle swelling and pain.

Depending upon the severity of the sprain, physical therapy is often the next step and a key factor in recovery. Visiting a sports or physical therapist once or twice per week will help to strengthen, stretch, and stabilize the injured ankle. Physical therapy helps to increase the range of motion soon after the injury, and it helps to increase endurance once the injury has been healed. Treatment may also include therapeutic ultrasound or massage techniques to promote healing the damaged tissue and to increase range of motion in the ankle joints. 

Typically, low-grade ankle sprains will heal within 4 to 6 weeks with the proper care. However, more severe ankle sprains may take 3 months to heal, and sometimes it may take 6 to 9 months for the individual to be completely relieved of pain and discomfort when partaking in physical activity. If any sprain is not treated properly, further complications may occur, including tendinitis or chronic pain and instability.  If the ankle sprain does not appear to be healing on schedule, reconstructive surgery may be necessary in rare cases, but a doctor should always be consulted about all possible scenarios. 

Prevention & Prophylaxis

Accidents may happen, but one can reduce the risk of a sprained ankle by performing exercises that improve one's balance and ankle muscle strength. Being mindful of warming up and stretching properly before and after exercise will help to protect ankles.

Applying heating pads or taking a hot bath before stretching and exercise can help to loosen and ready muscles for activity. Practicing balance and strengthening exercises improves ankle reflexes, which improves the chance that ankles will protect themselves regardless of uneven terrain. 

Footwear that fits properly is also key to ankle sprain prevention. Choosing a shoe or boot that offers good support and rises above the ankle can help prevent sideways ankle motion. High heels above two inches and other unsupportive footwear, such as flip-flops, should be avoided on uneven ground or with weak ankles.