Ankle Sprains

What is an Ankle Sprain?

An ankle sprain is an injury to one or more ligaments typically on the outside of the ankle.  Ankle sprains remain the most common musculoskeletal injury.  Only a small fraction of patients with ankle sprains develop chronic ankle instability, however this disorder presents unique treatment challenges.  Ligaments are elastic bands of tissue that connect bones together and bind joints together.  Ligaments provide stability to the ankle joint by limiting side to side movement such as twisting or rolling.  Ligaments become injured when they are abnormally stretched such as during twisting, turning or rolling.   The severity of an ankle sprain depends on the number of ligaments involved.  There are 3 main supporting ligaments on the outside of the ankle.  The severity of an ankle sprain also depends on whether the ligament is stretched, partially torn, or completely torn.  Multiple ankle sprains can lead to ankle instability and chronic pain, which often requires surgical repair.

What causes an Ankle Sprain?

Sprained ankles result from a sudden twist, fall or a blow that forces the ankle joint out of its normal position.  Ankle sprains occur while playing sports, wearing inappropriate shoes such as high-heeled shoes or walking and running on an uneven terrain.  Genetics plays a factor if one is born with extremely lax or weak ankles.  Also if a patient has a high arched foot they have a higher incidence of ankle sprains because they tend to walk on the outer aspect of the foot. 

Symptoms of Ankle Sprains

Symptoms of an ankle sprain include pain, swelling, bruising, difficulty walking and stiffness in the joint.  The patient may hear a pop as the ligament tears.  The intensity of the symptoms depends on the severity of the sprain.  Patients may feel unsteady when they walk and feel like their ankle is always giving out on them.   

Diagnosis of an Ankle Sprain

Diagnosis is achieved by clinical examination and manual testing is fundamental for the diagnosis of mechanical ankle instability.  Digital x-rays will be taken to check for any fractures or dislocations.  An MRI may be needed to evaluate the extent of ligament damage as well as other tissues such as the cartilage of the ankle joint. 

Treatment of an Ankle Sprain

  • Conservative Treatment

Prompt medical attention after an ankle sprain is very important because an untreated ankle sprain can lead to chronic ankle instability, which causes discomfort and a constant feeling that the ankle is giving way.  Along with an ankle sprain, a bone fracture could have occurred and if left untreated complications can result.  Rehabilitation needs to begin immediately or the ankle may not heal properly and in a timely manner.  Immediately after the injury the patient must begin to stay off the injured ankle, apply ice, elevate and apply compression.  Depending on the severity of the sprain a multi-compression wrap can be applied in the office and a walking boot or cast may be needed.  Bracing and taping have both been shown to be effective in reducing the incidence of recurrent ankle sprains.  Physical therapy will be started to promote healing and increase range of motion.  Nonsteroidal anti-inflammatory drugs will be recommended to reduce pain and inflammation.  Ankle sprains do not heal quickly and if not treated in a timely manner and activity is started too soon chronic ankle instability can develop.