Ankle Sprain

What Is an Ankle Sprain?

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Causes

Sprained ankles often result from a fall, a sudden twist or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes or walking or running on an uneven surface.

Sometimes ankle sprains occur because a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.

Symptoms

The symptoms of ankle sprains may include:

• Pain or soreness
• Swelling
• Bruising
• Difficulty walking
• Stiffness in the joint

Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Diagnosis

In evaluating your injury, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. X-rays or other advanced imaging studies may be ordered to help determine the severity of the injury.

Nonsurgical Treatment

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:

• Rest. Stay off the injured ankle. Walking may cause further injury.
• Ice. Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Compression. An elastic wrap may be recommended to control swelling.
• Elevation. The ankle should be raised slightly above the level of your heart to reduce swelling.
• Early physical therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.

When Is Surgery Needed?

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored

Ankle Instability

Ankle instability is caused by injury to the lateral [outside] ankle ligaments. This usually causes strain or stretch, and in more severe forms, causes a sprain or tear in the ligaments. This can lead to a sense of instability (giving out) in the ankle and predispose the patient to get frequent ankle sprains even with minor trauma or twist. Often, patients with ankle instability can be treated without surgery by strengthening the muscles that control the ankle joint, avoiding high-risk activities and using a supportive brace or shoe to decrease the risk of recurrent ankle sprains. In some patients, non-operative treatment is not successful and surgery is required to either tighten up the ligaments supporting the outside of the ankle, or to reconstruct these ligaments using a tendon graft.

Treatment

A history of multiple ankle sprains is one of the most common presentations of ankle instability. If the patient has recently had an ankle sprain, it should be treated as any normal ankle sprain would be.

Non-Operative Treatment

For chronic ankle instability, a combination of the following treatments is often successful at relieving symptoms and minimizing the risk of recurrent ankle sprains:

Therapy to strengthen the muscles surrounding the ankle joint: These include exercises to strengthen the muscles that evert and invert the ankle, particularly the everting muscles that allow the ankle to resist inversion, including the peroneus longus and peroneus brevis.

Therapy to improve ankle proprioception. or brain ankle coordination: Aggressive therapy to improve proprioception should also be performed. Exercises such as standing on one foot with the eyes closed and later on a soft surface with the eyes closed can be very helpful in improving proprioception

Evaluation and treatment by a physical therapist: The patient may benefit from strengthening and proprioception training under the guidance of a trained physical therapist.

Prophylactic splinting of the ankle: Prophylactic ankle splinting with the use of an ankle stirrup, ankle lacer, or ankle taping, can be very helpful in patients who are participating in high-risk activities.

With appropriate rehabilitation, including strengthening and proprioception training as well as splinting or bracing as required, most patients with ankle instability can be treated non-operatively.