An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle
Ligaments are tough bands of fibrous tissue that connect bones together. They keep your joints stable and prevent excessive movement.
A sprained ankle occurs when the ligaments are forced beyond their normal range of motion or stretched too far, resulting in them tearing, either completely or partially.
How does an ankle sprain occur?
A sprained ankle occurs following a sudden sideways or twisting movement of the foot. An ankle sprain can occur whilst exercising or during everyday activities. All it takes is an awkward step or an uneven surface to cause an ankle sprain – this is why sprained ankles are among the most common orthopaedic injuries.
Symptoms
Signs and symptoms of a sprained ankle include:
- Pain, especially when you bear weight on it
- Swelling and, sometimes, bruising
- Restricted range of motion
- Some people hear or feel a “pop” at the time of injury.
When to see your doctor
Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.
Causes
A sprain occurs when your ankle is forced to move out of its normal position, which forces one or more of the ligaments that surround and stabilise the bones out of its usual range of motion, causing the ligament to stretch or tear.
Examples of situations that can result in an ankle sprain include:
- A fall that causes your ankle to twist
- Landing awkwardly on your foot after jumping or pivoting
- Walking or exercising on an uneven surface
Risk Factors
Factors that increase your risk of a sprained ankle include:
- Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
- Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.
Investigations
If the injury is severe, your doctor may recommend imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage.
- X-ray
- During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for bones but is less effective at visualising soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
- Bone scan
- For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
- Computerised tomography (CT)
- CT scans are useful because they can reveal more detail about the joint and the soft tissues that surround it. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
- Magnetic resonance imaging (MRI)
- MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualising soft tissue injuries.
Complications
If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:
- Chronic pain
- Chronic joint instability
- Early-onset arthritis in that joint
Treatment
Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home. For immediate self-care of an ankle sprain, try the P.R.I.C.E. approach:
- Protection.
- Immobilize your ankle with an elastic wrap or splint to protect it from further injury. If your sprain is severe, your doctor may place a cast or brace around your ankle to protect it and instruct you on how to use a cane or crutches.
- Rest.
- Avoid activities that cause pain, swelling or discomfort – but don’t avoid all physical activity. Instead, avoid high stress activites but continue.
- With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest. That way you still exercise three limbs and keep up your cardiovascular conditioning.
- Ice.
- Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake, for the first 48 to 72 hours.
- Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately as this could indicate cold injury.
- NB If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
- Compression.
- To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, if the area becomes numb or if swelling occurs below the wrapped area.
- Elevation.
- To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.
Medications
In most cases, over-the-counter anti-inflammatories like ibuprofen are enough to relieve the pain caused by a sprained ankle.
Physical Therapy
After the swelling and pain has gone down, you can start performing exercises to restore your ankle’s range of motion, strength, flexibility and balance.
Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.
If you sprained your ankle while exercising or participating in a sport, talk to your physiotherapist or doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.
Surgery
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilise your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Many people don’t seek medical attention for mild ankle sprains. If your sprain is severe, however, your family doctor may refer you to a doctor who specialises in sports medicine or orthopaedic surgery.
What you can do
You may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you’ve had, especially past ankle injuries
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.
Prevention
Take the following steps to help prevent a sprained ankle:
- Warm up before you exercise or play sports.
- Be careful when walking, running or working on an uneven surface.
- Wear shoes that fit well and are made for your activity.
- Don’t wear high-heeled shoes.
- Don’t play sports or participate in activities for which you are not conditioned.
- Maintain good muscle strength and flexibility.
- Practice stability training, including balance exercises.