An ankle sprain is one of the most common injuries that one can experience throughout their lifetime. It is reported that approximately 25,000 people experience it each day, and it can happen to athletes, non-athletes, children and adults. It can happen when one taking part in a sport or physical activity or simply stepping on an uneven surface, or stepping down at an angle.
The ankle is considered to be a very complex joint, held together by set of ligaments called the medial and lateral collateral ligaments. These ligaments secure the ankle joint and protect the joint from abnormal movements, especially twisting, turning and rolling of the joint.
Medial collateral ligaments are located inside of the ankle joint and are considered to be the strongest and protect the ankle from abnormal eversion (rolling-out) of the ankle joint.
Lateral collateral ligaments are located outside of the ankle joint and are considered to be the weakest and protect the ankle from abnormal inversion (rolling-in) of the ankle joint.
Inversion ankle sprain (ankle rolling-in) is the most common type and with an ankle sprain (inversion or eversion) these ligaments can stretch and if severe enough the ligaments can tear leading to pain, swelling and bruising.
The amount of force with which the ankle was twisted along with clinical findings, determines that grade of ankle sprain.
- Grade 1 sprain (Mild): Slight stretching and some damage to the ligaments.
- Grade 2 sprain (Moderate): Partial tearing of the ligaments.
- Grade 3 sprain (Severe): Complete tear of the ligament, which leads to gross instability of the ankle joint on physical exam. A severe ankle sprain can cause damage to the ankle joint surface (cartilage) leading to arthritis and chronic pain.
|Severity||Grade – 1|
|Physical Examination Findings||Minimal tenderness and swelling|
|Typical Treatment*||Weight bearing as toleratedNo splinting/casting Isometric exercises
Full range-of-motion and stretching/ strengthening exercises as tolerated
|Severity||Grade – 2|
|Physical Examination Findings||Moderated tenderness and swellingDecreased range of motion Possible instability|
|Pathophysiology||Complete tears of some but not all collagen fibers in the ligament|
|Typical Treatment*||Immobilization with walking boot for 6 weeksPhysical therapy with range-of-motion and stretching/strengthening exercises|
|Severity||Grade – 3|
|Physical Examination Findings||Significant swelling tenderness andInstability|
|Pathophysiology||Complete tear/rupture of ligament|
|Typical Treatment*||Immobilization for 6 weeks or morePhysical therapy similar to that for grade 2 sprains but over a longer period Possible surgical reconstruction in ankle joint instability noted after conservative treatment|
X-ray: Since an ankle fracture can have similar symptoms of pain, swelling and bruising, an X-ray may be needed to make sure you do not have a ankle or foot fracture.
MRI: In case of severe ankle sprains, your doctor may need to order an MRI (Magnetic Resonance Imaging) to evaluate the extent of damage to the ligaments. Most often, this can be helpful in pre-operative planning.
Symptoms of Ankle Sprain
- Inability to apply pressure on foot or ankle
Conservative Treatments of Ankle Sprain
- Rest (Grade 1,2,3)
- Ice (Grade 1,2,3) (10-15 minute every 1 hour. You can ice over wrapping to decrease discomfort)
- Elevation (Grade 1,2,3)
- Compression (Grade 1,2,3) (wrap with Ace bandage to reduce swelling)
- Immobilization with cam-walker (Grade 2,3) (Allows the ligaments and surrounding tissue to heal themselves)
- Ankle brace (for preventative purposes)
- Taping before Activity
- Physical therapy
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to control pain and inflammation
Surgical Treatment of Ankle Sprain
Surgical treatment for acute ankle sprain is rare and is usually reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.
Ankle Sprain taping
We encourage you to consult with a foot and ankle specialist for a complete assessment of your condition.
Dr. Jones Hormozi at Valley Foot & Ankle Center (VFAC) utilizes state-of-the-art technology, minimally invasive procedures, and advanced techniques to prevent and treat all conditions of the foot and ankle. This allows most patients to walk immediately after most procedures, and they are able to rapidly return to high levels of functioning with excellent outcomes.