Ankle Sprains

What is an ankle sprain? 

An ankle sprain is when an injury occurs to one or more of the ligaments of the ankle.  The ankle joint is comprised of three bones - the tibia, fibula, and talus.  The tibia is the largest bone of these.  All of these bones are connected by a complex arrangement of ligaments which provide inherent stability and allow this joint to function normally.  An ankle sprain can range from a simple overload of the ligament that heals within several days to the complete rupture of multiple ligaments and subsequent dislocation or subluxation of the ankle.

                                       

The severity of an ankle sprain is dependent upon whether the ligament is stretched, partially torn, or  completely torn, as well as the number and location of the ligaments that are affected. 
The most common ligaments ruptured are the anterior talofibular ligament (ATF) and calcaneofibular ligament (CF).


Etiology:

An ankle sprain is generally the result of a twisting type of motion to the ankle joint, or a direct blow that forces the ankle out of its normal anatomic alignment.  Ankle sprains can occur while doing virtually any activity although they are most common while playing sports or while wearing inappropriate shoes. 


Symptoms of an ankle sprain:
Symptoms usually include pain, swelling, and bruising.  Often times the ankle joint will become stiff from all the swelling and inflammation (the body's attempt to immobilize itself).  Also, pain deep within the ankle joint may present.  Walking may be difficult or impossible depending upon the severity of the sprain. 

Pain and swelling may be absent in people who have had previous ankle sprains.  The ankle may feel unstable and "floppy" when walking.  An ankle sprain always requires treatment.  If left untreated, the ankle may develop chronic ankle instability - a condition with persistent discomfort and a continual "giving way" of the ankle.  Additionally, a sprain may be accompanied by a more severe ankle injury such as an ankle fracture, or an osteochondral defect (damage to the cartilage within the ankle joint.) 

Treatment and Rehabilitation:
Immobilization is generally recommended until pain has subsided enough to begin physical therapy.  Therapy is started as soon as possible to promote healing and increase your range of motion.  Anti-inflammatory medications such as ibuprofen or naproxen are generally recommended initially.  Ice and compression are also used in the initial inflammatory stages of rehabilitation. 

Ankle sprain grading and treatment
Grade 1 - stretched ligament = lace up ankle brace
Grade 2 - partially torn ligament= aircast, transition to lace up ankle brace
Grade 3 - complete tear of ligament = CAM Walker until pain subsides, then aircast with PT, Lace up brace once back to activity. 

Lace up Ankle Brace



Aircast Ankle Brace


CAM Walker

Once you return to your sport or full activity it may still be recommended to utilize an ankle brace for stability, and to minimize chances for recurrence. This is generally recommended for 3 months with a complete tear doing normal day to day activities to prevent recurrence.  With sports, the lace up brace should be utilized for 6 months to prevent recurrence. 

Occasionally surgery is indicated.  Usually this is for the person who experiences subjective chronic instability of the ankle from multiple sprains or for sprains that did not heal as expected.  Additionally, cartilage damage within the ankle joint (an osteochondral defect) may need surgery.   

 

Initial Treatment:
This injury should be stabilized as soon as possible either by the emergency room or by a foot and ankle specialist.  Until you are able to be examined by a doctor, the “R.I.C.E.” method should be followed. This involves: 

• Rest. It is crucial to stay off the injured foot, since walking can cause further damage. Non-weightbearing with crutches or a walker is ideal. Generally, an ankle brace will be recommended to stabilize the ligaments initially (regardless of if you are able to bear weight), and then to be used while performing physical therapy. 
• Ice. To reduce swelling and pain, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
• Compression. Wrap the ankle in an elastic bandage or wear a compression stocking to prevent further swelling. An ACE bandage is often recommended as initial treatment.
• Elevation. Keep the foot elevated to reduce the swelling. It should be even with or slightly above the hip level.