Everything You Need to Know About Ankle Sprains

Everything You Need To Know About Ankle Sprains

An ankle sprain is one of the most common injuries out there. But how many of you actually know what it is? In this article, I’ll highlight everything you need to know about ankle sprains, including grading, diagnosing, treating, and rehabbing.

What is an ankle sprain?

An ankle sprain is an injury to one of your body’s ligaments. Ligaments are rope-like structures that are located all over the body. Their job is to serve as a bridge connecting two separate bones. The bone-ligament-bone structure forms a joint which allows your body to move. The ankle is an example of a joint.

Let’s go over some of the ankle’s anatomy. The ankle joint is made of several bones. The lower leg has 2 parallel bones that start at the knee and end at the ankle – the tibia and fibula bones. These bones connect via ligaments to the foot bones below – called the talus and the calcaneus.

The ankle has several ligaments but the most commonly injured are those on the outside of the foot. This area has 3 main ligaments which connect the lower leg bones to the foot bones. There is one larger ligament on the inside of the foot and another on the top. If you turn your ankle hard enough to cause some compromise to these ligaments, you have sprained your ankle.

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Grading ankle sprains

There are 3 grades to an ankle sprain:

  • A grade I sprain (mild sprain) – Causes inflammation in the ligament and possibly a microscopic tear. These have the least pain and swelling, but can still be uncomfortable for a few days.
  • A grade II sprain (moderate sprain) – Involves larger partial tears of the ligament. There is more pain with walking and more swelling.
  • A grade III sprain (complete tear of the ligament) – The ankle may feel unstable and walking will be difficult and painful with a feeling that the ankle may give out.

Diagnosing an ankle sprain

The most common mechanism of an ankle sprain is twisting of the ankle or foot. There are several ways that this can happen, ranging from stepping in a hole, a wrong step off a curb, and even jumping from a high ledge.

In an ankle sprain, pain with walking or inability to walk is one of the most common initial complaints. There will also likely be swelling and possibly some bruising too. Remember, an ankle sprain usually involves tearing a ligament. If a ligament is torn, blood vessels in the region will likely be too – hence the bruising.

If this happens, it is a good idea to see your doctor. X-rays are helpful to evaluate for broken bones – especially because there are so many in the ankle. Sometimes, the bones around the ligaments can crack too, depending on the angle that the ankle twists at. If a bone is broken, treatment will be different than if the injury only affects the ligaments.

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Treating an ankle sprain

The most effective initial treatment for an ankle sprain is RICE: Rest, Ice, Compression, and Elevation. Below are more details about each treatment option.

Rest

Rest is quite straightforward – the more you can stay off your injured ankle, the better it will heal. For some, this will be easy. If walking is too painful, you will want to stay off the ankle. Even if you can tolerate walking to some extent, rest in the early stages after an injury can expedite healing.

Ice

Ice is also helpful to reduce swelling and pain. Apply ice for 15 minutes every couple hours for the first 48-72 hours.

Compression

Compression is important for two reasons. One, it provides extra stability to an ankle that may be unstable. This allows for easier and less painful mobility. Two, it reduces swelling by pushing the fluid away from the ankle which lessens pain.

There are several types of compression. A standard ACE wrap may be good for the first few days and can be easily taken on and off. However, there are two other types of wraps that can be prescribed by a doctor, depending on the severity of the sprain.

A cam walker boot is a full orthopedic boot that goes up to just below the knee. This completely immobilizes the ankle and is useful for severe sprains including those where it is otherwise too painful to walk as well as injuries that involve minor fractures. A cam walker boot generally allows even major ankle sprains to walk pain-free while immobilizing the ankle to allow the ligaments to heal in the right spot. Depending on the severity of the sprain, this may need to be worn continuously or only with ambulation. It may be required for a month or more or only for a week. Again, this depends on the severity of the injury. Note that more major fractures may even necessitate surgery and different special appliances under the care of an orthopedic surgeon.

A lace-up ankle brace is a less bulky brace that is helpful for a grade I sprain and some grade II sprain. If you are able to walk with a normal gait and only mild pain, a lace-up ankle brace adds extra stability and compression. It can help with walking longer distances, especially as time goes on. A lace-up brace can also be used as a step-down brace from the cam walker boot.

Elevation

Elevation in the initial days following the injury is very important. This can be done by resting the ankle on a pillow while lying down or sitting. Doing so can also help the swelling and pain dissipate more quickly.

Medication

Lastly, medication can also help with symptom management. Tylenol works well for pain but does not reduce inflammation. Advil and Aleve can work well to reduce both pain and inflammation. However, too much Advil or Aleve can irritate the stomach so use with caution. If there are any broken bones, it is best to stick to Tylenol since anti-inflammatories can interfere with bone healing.

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Rehabbing an ankle sprain

Physical therapy is an important part of the treatment of ankle sprains. After the initial period of RICE and medication, rehab is generally recommended to return to activities in the best way possible.

After an ankle sprain, the ligaments often heal improperly, becoming lax and stretched out. This leads to a weaker ankle. In addition, following several weeks of reduced activity and possibly bracing, the muscles surrounding the ankle joint become weak. A full return to activity without proper rehab can predispose someone to chronic discomfort and re-injury.

Physical therapy for the ankle includes several different components. Manual therapy aims to loosen up the ankle tissues. Modalities such as heat, ice, ultrasound, and electric stimulation aim to decrease pain and swelling. Range of motion and stretching exercises are very important as the ankle often become stiff after sprains, especially if immobilization was needed for treatment. Finally, strengthening and balance exercises can help return the ankle to its baseline state prior to the injury or perhaps, even stronger!

Conclusion

With the above combination of treatments, ankle sprains generally heal very well and rarely require surgery.  Always remember to consult your personal physician to inquire on which treatments best fit your particular sprain.

Have you had an ankle sprain before? Share your story below!

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Matthew Bassan, DO
Dr. Matthew Bassan is a sports medicine and family medicine physician with a special interest in wellness and prevention. He received a Bachelor of Science in Kinesiology, the study of human movement, from the University of Maryland. After medical school at Nova Southeastern University in Florida, he did his residency in family medicine in Long Island, NY. During residency, he worked with patients that had many of the illnesses and chronic diseases that he hopes to prevent in his career through the advocacy of physical activity and exercise. He then completed a sports medicine fellowship in New York. He trained at a practice in Manhattan seeing patients from Broadway dancers and weekend warriors to those wishing to become more active. His career interests are to promote proper nutrition, physical activity, and a healthy lifestyle in order to optimize wellness, achieve personal fitness goals, and prevent illness. He aims to help patients through obstacles and injuries to get them back to what they enjoy. After fellowship, he spent a year with an orthopedic practice and is now a sports medicine and weight management specialist for a private practice in New Jersey.

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