Ankle sprain or sprained ankle is one of the most common orthopedic injuries, with more than 25,000 people suffering from it every day in the USA alone.
An ankle sprain refers to an injury to the ligaments of the ankle joint causing pain and swelling at the ankle (injury to the bones is referred to as fractured ankle).
Ligaments are thick, stretchable bands that unite one bone to the other in a joint. These ligaments have elastic properties and allow movement of the bones within a specific range. Any exaggerated movement or stress that stretches these ligaments beyond the normal limit results in a sprain.
The ankle joint is the point where the bones of the lower leg tibia and fibula, join with those of the hind foot, i.e. talus (anklebone) and calcaneus (heel bone). These bones are held together with the help of a number of ligaments located both on the outer and inner side of the ankle.
Ankle sprains usually occur due to inversion (rolling outwards) of the foot, which overstretches and damages the ligaments on the outer side of the ankle.
There are three ligaments on the outer side of the ankle joint, which connect the fibula to the anklebone and heel bone. The ligament bearing most of the impact is the one in the front called the anterior talo-fibular ligament (that joins the fibula to the anklebone talus). The other two ligaments are also involved, but to a lesser extent.
Grade I Sprain involves minimum damage; ligaments are only overstretched, with no significant joint instability.
Grade II Sprain involves moderate damage; ligaments are often partially torn, with no significant instability.
Grade III Sprain involves severe damage; ligaments are completely torn, resulting in joint instability.
Ligaments can be damaged due to:
- overstretching, as occurs when the foot is twisted inwards or outwards during running, jumping, walking on an uneven surface, or due to wearing inappropriate shoes.
- Trauma from a direct blow or a fall
Factors increasing the risk of acquiring ankle sprains:
Proper evaluation and treatment is a must, even when there is no significant swelling or pain.
History of the patient regarding how the injury occurred, along with a careful physical examination of the joint help to diagnose a sprain.
An X-ray is usually required to examine the extent of the injury and rule out any fractures in the area.
Treatment depends upon the severity of the sprain and involves controlling pain and swelling, and immobilizing the joint to allow for healing.
- Following the RICE protocol immediately after the injury (in the first 48 hours), not only helps to ease the pain but also reduces the swelling. It includes:
Rest: keeping the weight or any kind of stress off the joint
Ice application: for about 15 -20 minutes, several times a day, in the first 2 or 3 days
Compression: applying pressure through an elastic bandage (the bandage should not be too tight)
Elevation: elevating the injured joint above the heart level helps to reduce swelling.
Other measures that may help include:
- Use of anti-inflammatory painkillers such as ibuprofen, acetaminophen, etc.
- An ankle-brace or cast can be applied to limit movement at the joint. The casts or splints are usually applied for two to six weeks.
- Crutches are also advised to help keep the weight off the affected joint
- Manual and ultrasonic massage therapy also help shorten the recovery period by reducing the stiffness and improving the range of motion at the joint.
Surgical treatment is not often required for an ankle sprain and usually involves repairing the torn ligaments. The surgical procedure depends upon several factors such as the extent of damage to the ligaments and the activity level of the individual. After the surgical repair, a cast needs to be applied for about six weeks to allow for complete healing.
Proper rehabilitation is important in order to restore normal function of the joint. The ligaments often become loose or weaken after the injury, leading to instability at the joint and making the foot more prone to twisting or rolling. A joint that has suffered a sprain is doubly at risk of getting another sprain in the future.
Exercises to strengthen the muscles around the ankle help to improve joint stability.
Additional ankle supports, such as strapping or ankle braces, may also be recommended for use on uneven ground or during sports activities.
Orthotics that will help to treat ankle sprains can be found below.