Synonyms and Keywords“>
Ankle injury, ankle ligament injury, anterior talofibular ligament, fibula, medial malleolus, rolled ankle, talus, tibia, sprained ankle, turned ankle, twisted ankle.
What is an Ankle Sprain?
An ankle sprain is a common medical condition that occurs when one or more ligaments in the ankle are partially or completely torn — usually on the outside since there are three ligaments, versus five on the inside. Ligaments are elastic, rubber band-like tissues connecting one bone to another and bind the joints together; in the ankle joint, ligaments keep the foot and ankle stable by limiting side-to-side movement. However, when you plant a foot awkwardly or when an unusual amount of pressure is applied to the joint, whether because of uneven ground or an unnatural twisting motion, the sudden, forceful extension stretches the ligaments beyond their normal range, causing them to rip partially or even completely.
According to the American Academy of Family Practice, an estimated 1 million people in the U.S. visit a doctor about an ankle injury each year. Ankle sprains are common sports injuries, but they can occur in simple everyday activities as well, such as walking or even getting out of bed. The anterior talofibular ligament, which connects the talus (the bone just below the ankle joint) and fibula (the small outer bone in the foreleg), accounts for 90% of all ankle sprains.
Ankle sprains are caused by trauma, and therefore not the same as strains, which is the over-stretching or pulling of the muscle or tendon. Nor are they a break, which is a complete fracture or splinter of the bone itself from excessive force.
Despite how often it happens, most people improve significantly in the first two week. Some, though, especially those prone to recurring ankle sprains, might still have problems with pain and instability after one year. Re-injury is also common, so you can still suffer an ankle sprain no matter how many times you’ve had it, particularly if your activity of choice involved frequent running, jumping, and change of direction like soccer, football, and basketball.
What Causes an Ankle Sprain?
Sprained ankles often result from a fall or a sudden twist that forces the ankle joint out of its normal position, as well as planting a foot onto an uneven surface. Any of these incidents can roll or turn the ankle ligaments in a foot beyond their normal range in an abnormal position. For example, when a basketball player comes down from a jump and lands on another player’s foot, both the downward force and weight cause his foot to roll over inward and abruptly stretch and tear the ligaments. When the force to the ankle’s soft tissue structures is excessive enough, you may even hear a “pop”. Even routine daily activities such as stepping off a curb and accidents like slipping on ice can sprain an ankle.
Other reasons for ankle injuries include:
- Wearing inappropriate shoes
- Lack of conditioning; the ankle is just not durable enough to take the pounding and remain straight
- Inadequate warm-up and stretching prior to the activity
- A prior history of ankle sprains, which would weaken the ankles and in turn make them more susceptible to the condition
- The person is born with weak ankles
Who Gets an Ankle Sprain?
About 25,000 people experience it each day, so it’s a very common injury. It can happen to athletes and non-athletes, children and adults. It can happen when you participate in sports and physical fitness activities, as well as when you simply step on an uneven surface or step down at an angle. All it takes is one misstep to turn the foot the wrong way.
Are There Different Types of an Ankle Sprain?
There are two major types of ankle sprain:
1. Inversion Ankle Sprains. This is the most common type of ankle sprain. It happens when the foot is inverted, falling inward to stretch the outer (or lateral) ligaments too far. About 90% of ankle sprains are inversion injures. The pain is always on the outside of the ankle, with usually no pain on the inside of the ankle joint.
2. Eversion Ankle Sprains. This is when the foot is twisted outward, stretching the inner ligament (called the deltoid ligament) too far, causing pain on the inner side of the ankle. It is also referred to as a high ankle sprain, and the ligaments above the joint — the syndesmosis ligaments — can also be injured, thus necessitating a longer course of recovery.
What are the Symptoms of an Ankle Sprain?
Depending on the severity of the sprain, the symptoms can vary in intensity. Pain and swelling, common sign of the injury, is sometimes missing in those with previous ankle sprains; instead, they may only feel the ankle is wobbly and unsteady when they walk.
The amount of force placed on the ankle at the time of injury determines the grade of the sprain: Grade 1 is a mild sprain, Grade 2 is a moderate sprain, and Grade 3 is a severe sprain. The symptoms, of course, get correspondingly worse.
For a Grade 1 sprain, there’s slight stretching and some damage to the fibers of the ligament on microscopic level, causing minimal tenderness and swelling in addition to pain, but usually nothing more. Most patients can walk without crutches, but probably not able to jog or jump.
The ligament is partially torn in a Grade 2 sprain, accompanied by moderate swelling and bruising caused by bleeding under the skin. Your range of motion is decreased, and if the ankle joint is moved in certain ways, you can feel an unusual looseness. It’s usually painful to walk, but you can still take a few steps.
A Grade 3 sprain involves the complete tear or rupture of ligaments. The swelling is quite significant, from the size of a golf ball to as big as a tennis ball. It is also very painful, sufficient to discourage you from walking or putting any weight on the foot. Patients may complain of instability due to the severe tenderness, or a giving-way sensation in the ankle joint.
Other general signs of an ankle sprain include hurtful joint throbs; the pain worsens when the sore area is pressed or the foot moves in certain directions and while walking or standing; redness and warmth, caused by increased blood flow to the area.
Normally, an ankle sprain does not require a trip to the doctor. The problem is telling a sprain from a more serious injury, such as a fracture (break). See a doctor if any of the following occur:
- The ankle does not improve within five to seven days.
- You’re unable to walk more than a few steps, even with a limp, without severe pain.
- Persistent, uncontrollable pain despite the use of medications, elevation, and ice.
- You cannot move the injured ankle.
- You feel excoriating pain when pressing over the bony bumps on each side of the ankle.
- You experience loss of feeling in the foot or toes.
- The foot or ankle is misshapen beyond normal swelling.
- You have pain and swelling in the back of the ankle (heel pain), over the Achilles tendon, or are unable to push the toes forward and down (like pressing a gas pedal).
- You have pain or swelling into the upper part of the lower leg just below the knee, or swelling of the calf muscle.
- You see redness or red streaks spreading out from the injury.
How do You Diagnose an Ankle Sprain?
Some ankle sprains are much worse than others. The severity depends on whether the ligament is stretched, partially torn, or completely torn, in addition to how many ligaments are affected. If you have sprained your ankle in the past, you may continue to sprain it if the ligaments did not have time to heal completely. Also, should you get ankle sprain regularly and pain lasts for more than four to six weeks, you may have a chronic ankle sprain.
Because a broken bone can have similar symptoms of pain and swelling, your doctor may order X-rays to make sure that is not the case, and an MRI (magnetic resonance imaging) scan after the swelling and bruising subside if he/she suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip, or other problems. Regardless, the physical exam can be painful, since the doctor may need to move your ankle in various ways to see which ligament has been hurt or torn, and to determine the grade of the ankle sprain.
How do You Treat an Ankle Sprain?
Most ankle sprains heal without complications or difficulty. Recovery time depends upon the severity of the sprain and possible accompanying injuries. Normally, the healing process takes about four to six weeks. The doctor may tell you to include some motion exercise early in the recuperation to prevent stiffness.
If walking is difficult because of the swelling and pain, you may need to use crutches. Depending upon the grade of the sprain, the doctor may tell you to use removable plastic devices such as cast boots or air splints. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately.
In any case, the rehabilitation of a sprained ankle has to begin right away. Any delay can cause improper healing.
Self-Care at Home
Home care for an ankle sprain relies primarily on R.I.C.E: Rest, Ice, Compression, and Elevation.
1. Rest: Rest your ankle by not walking on it. The first 24-48 hours after the injury is critical for treatment and you must curtail physical activities. Gradually put as much weight on the affected ankle as tolerated, and don’t use crutch if/when you can walk with minimal to no pain or limp.
2. Ice: Cover the area with ice or apply cold compresses, preferably within a half minute after the injury. This keeps the swelling down by counteracting the increased blood flow into the injured ankle. For the first 48 hours after the injury, do this to an elevated ankle for about 20 minutes, three or four times a day. The ice pack can be a bag of frozen vegetables (peas or corn) so you can re-use it. Another popular method is to fill paper cups with water and freeze the cup, then use the frozen cube like an ice cream cone, peeling away the paper as the ice melts. However, do NOT ice an ankle sprain for more than 20 minutes at a time, as it will not help heal the sprain any faster and the cold can do damage to the tissues! Also, if you’re elderly or have poor circulation, remove the ice pack from the injured part for 30 seconds or so every five minutes.
3. Compression: Use dressings, bandages, or ace-wraps to immobilize and support the injured ankle when elevating the sprain in early treatment. Wrap the ankle from toes all the way up to the top of the calf muscle, overlapping the elastic wrap by one-half of the wrap’s width. The wrap should be snug, but not cutting off circulation to the foot and ankle. So, if your foot becomes cold, blue, or numb, re-wrap!
4. Elevate: Keep your sprained ankle higher than your heart as often as possible for 48 hours. Sit in a reclining chair or prop your legs up with pillows. Elevate at night by placing books under the foot of your mattresses — just make sure you stand up slowly in the morning.
In addition, massage the injured ankle three times a day. For ten minutes, using your index and middle fingers, stroke the area above the swelling and then the section below it. Stroke toward the heart to help move the fluids away from the injury and back into circulation. Then, working from the injury outward, gently massage the tenderest spots.
The simple exercises below can help maintain ankle motion and stretch the injured ligaments in the ankle joint back in place:
- Achilles Stretches. You can start this soon after sustaining an ankle sprain. While seated or lying down, take a towel and loop it around your toes. Pull the ends of the towel to pull your toes upward, and feel the stretch in the back of the ankle. Do this 3-4 times a day for several minutes.
- Alphabet Writing. While seated or lying down, write the alphabet in the air with your toes. Make the letters as big as possible.
The next step in recovery from ankle sprains is strengthening the muscles surrounding the ankle joint, so they can help support it and prevent further injury. Some of the exercises you can do include:
- Heel and Toe Walking. Walk on your toes for one minute, then on your heels for one minute. Alternate walking on your heels and toes, building up the time until you can do it for a total of 10 minutes. Repeat these 4 times daily.
- Toe Raises. Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times for each foot, 4 times a day.
After an ankle sprain, the joint’s ability to provide feedback to the brain (proprioception) can be damaged. The best way to re-stimulate it is with a “wobble board”, or balance board, available commercially and specifically for exercising the ankle for $12 and up.
Start exercising to maintain flexibility and strength when the swelling has resolved and you can walk without pain. This may be as simple as walking or jogging, or more intense for athletes who participate in a competitive sport. No matter the level, the key is to progress slowly. Work your way gradually up from very low intensity and very low duration — never have a sudden jump in either aspect. Once the exercises can be done at full speed with no pain, you can resume the sport. Your coach or trainer can give you more specific exercises if necessary.
Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.
Professional treatment will be similar to home care, especially using ice to reduce the inflammation. The doctor may choose to apply a brace or cast to reduce motion of the ankle. Crutches are often provided so you don’t have to bear weight on the injured ankle. The most common medication used for ankle sprains are nonsteroidal anti-inflammatory medications such as ibuprofen (Motrin IB and Advil) and naproxen (Aleve or Naprosyn) to reduce pain and help control inflammation. If you cannot tolerate these drugs, acetaminophen (Tylenol) or narcotics are common alternatives. Ultrasound and electrical stimulation may also be used as needed to help with pain and swelling.
Rehabilitating exercises assigned by the doctor may involve active range of motion or controlled movements of the ankle joint without resistance. Water exercises may be used if land-based exercises, such as toe-raising, are too painful. Lower extremity and endurance exercises are added as your tolerance increases. Once you’re pain-free, other exercises may be added, such as agility drills, to recover the full range of motion.
You need follow-up only if the ankle is not healing well after two weeks. This could indicate a previously undetected fracture or torn ligament. Consult an orthopedic or podiatric specialist if initial treatment fails.
It’s rare for an ankle sprain to require surgery. Surgical procedure is reserved for injuries that fail to respond to nonsurgical treatment and for persistent condition after months of rehabilitation and non-surgical treatment.
Surgical options include:
- Arthroscopy. The surgeon looks inside the joint for any loose fragments of bone or cartilage, or parts of the ligament caught in the joint.
- Reconstruction. The surgeon repairs the torn ligament with stitches or suture, or uses other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.
The length of time you can expect to spend recovering and rehabilitating after a surgery depends upon the extent of injury and the amount of surgery done. It may take from weeks to months.
How to Prevent an Ankle Sprain?
The best way to prevent ankle sprains is to maintain good strength, muscle balance, and flexibility by:
- Warming up before doing exercises and vigorous activities.
- Paying attention to walking, running or working surfaces. Make sure the field or environment is clear of any holes or obstacles.
- Wearing the right shoes — those that give your proper ankle support, such as high-top basketball shoes.
- Heeding your body’s warning signs to slow down when you feel pain or fatigue.
- Considering having a weak ankle taped to offer extra support when participating in a sport.
If you’re prone to or have repeated sprains, wearing an ankle brace may help.
You can use the exercises listed in Self-Care at Home to prevent sprains or re-injury, not just for rehabilitation, and add to them the ankle circles: stretching the legs in front of the body and sliding the ankles up and down, side to side, or rotating the joint in a circle. Flexing and pointing the toes repeatedly as well as massages with oil are also effective.