Sprained ankle

Anatomy

The ankle has ligaments on two sides:

• Lateral side (outside)
• Medial side (inside)

The lateral side of the foot, if looking down, is the side facing out (or the right side of your right foot and the left side of your left foot). It is home to the lateral ligaments, some of the most susceptible to tears. Most ankle sprains occur on this side.

The medial side of the foot, if looking down, is the side facing in (or left side of your right foot and right side of your left foot). It is home to the medial ligaments. Tears can occur on this side, but it is far less likely.

Ligaments are strong, fibrous tissues that connect your bones to other bones. The ligaments in your ankle do this so that the bones are held in place, and the joints are stabilized.

If there is an injury sustained to either side’s ligaments, it could create an un-stabilization of the ankle that could lead to long-term issues.

About

When there is a sprain in your ankle, you technically are not “spraining” anything at all. A sprain is a tear in the ligament that can range from tiny to completely torn depending on severity.

It is not uncommon for your foot to twist unexpectedly in normal day-to-day activity. A twisting motion due to walking, engaging in sports, or falling can cause pressure on the ligaments that might create a tear.

Ankle sprains can occur in all ages and, if they happen consistently, can weaken your ability to perform activities at your body’s full potential.

Symptoms

Those who experience a sprained ankle normally feel pain varying from mild to severe depending upon how intensely the ligament has been torn.

The most common symptoms of a sprained ankle are:

• Swelling
• Bruising
• Tenderness to touch
• Instability of the ankle (In severe cases, this instability could mean there has been a full tear of the ligament or complete dislocation of the joint)

If there has been a full-intensity tear, you might also hear or feel a “pop” when the sprain occurs. This is only in the most severe cases, but if this “pop” does occur, it is advised to seek immediate medical evaluation. Symptoms of this type of severe ankle sprain are like those of a broken bone.

Diagnosis

During a physical examination, your Florida Orthopaedic Institute physician will ask about your symptoms and medical history. They will perform a careful examination of your foot and ankle (which may be painful depending on the severity of the sprain).

Your physician will palpate the ankle, which means they will gently press all around it to determine which ligaments are affected. They will also test for the range of motion by moving your ankle in different directions. In most cases, a sprained and swollen ankle will not have much range of motion.

If there is no broken bone, your physician will likely be able to tell the severity of the sprain due to the swelling, pain and bruising it exhibits. If this is not the case, your physician may order x-rays to ensure that a bone has not been broken as well.

Besides standard x-rays, your physician may order the following:

• Stress x-rays – Scans taken while the ankle is being moved around. They help show if the movements are abnormal.
• Magnetic resonance imaging (MRI) scans – In the most severe cases, an MRI may be ordered if your physician believes that there could be deeper damage to the ligaments and bones, or if there was a bone chip.
• Ultrasound – Scans that allow for your physician to view the stability of the affected ligaments.

After the examination, your physician will determine the grade of your ankle sprain. The grade of the sprain is determined by how much damage has been done to the ligaments.

• Grade 1 sprain – A mild, common sprain. There may be a slight stretching and tiny tears to the ligaments along with swelling.
• Grade 2 sprain – A moderate sprain that is accompanied by a partial tear of the ligament. There may be significant swelling and tenderness.
• Grade 3 sprain – The most severe sprain, due to the ligament completely tearing. This is the most intense sprain, usually accompanied by intense swelling and pain.

Treatment for ankle sprains

The good news is that almost all ankle sprains are treatable at home and without surgery. Even the most severe tears in the ligaments can be healed without any surgical repair if the ankle does not have unneeded pressure on it.

A three-phase program can help recover all ankle sprains:

• Phase 1 – Resting and protecting the ankle
• Phase 2 – Restoring range of motion and strength
• Phase 3 – Slowly returning to activities that do not require turning or twisting of the ankle

Nonsurgical treatment

The Florida Orthopaedic Institute’s philosophy is to try all appropriate nonsurgical methods first to increase mobility and function. Since most sprains of the ankle can be healed right at home, there are many nonsurgical treatment options available.

Following the RICE protocol is a good rule of thumb to heal as quickly and safely as possible:

• Rest your ankle
• Ice the affected area to reduce swelling
• Compression bandages will support your ankle
• Elevate your ankle above the level of your heart as much as possible for the first 48 hours

Medication may also be prescribed in the form of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve). These assist with swelling and pain while you recover.

Depending on severity, walking may be initially difficult. Your Florida Orthopaedic Institute physician will determine if crutches may be necessary to assist with healing. In some cases, immobilization and physical therapy may be recommended. Strength exercises and balance training can help with improved range of motion.

Surgical treatment

Most nonsurgical treatment options will help heal a sprained ankle within a few weeks. If nonsurgical treatments do not do the trick, surgical options may include:

• Arthroscopy – A small camera is used through a tiny incision in the ankle joint to direct the surgeon where loose fragments of bone or cartilage need to be removed.
• Reconstruction – The torn ligament is repaired with stitches or sutures, and the damage is replaced with tissue obtained from other ligaments and tendons found in the foot or ankle.

Most surgical procedures of the ankle require immobilization and rehabilitation of some form. The length of recovery time varies depending on injury severity and the amount of surgery done. Most rehabilitation will take anywhere from a few weeks to a few months.

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