Ankles

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 unnatural twisting motion, the sudden, forceful extension stretches the ligaments beyond their normal range, causing them to rip partially or even completely.

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

• 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.

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 the 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.

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 on 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.

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 a 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 angle 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.

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.

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