Ankle Sprain

A sprained ankle is an injury that happens when you twist or turn your ankle in an awkward way. An ankle sprain can stretch or tear the ligaments that help to hold the ankle bones together.

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Ankle ligaments

Generally, ligaments help stabilize joints, preventing excessive movement in various parts of the body. An ankle becomes sprained when those stabilization ligaments are forced out of their normal range of motion. Many ankle sprains injury the ligaments on the outer side of the ankle.

Causes of ankle sprain

When the ankle is forced out of its normal position, causing one or more of the ankle’s ligaments to stretch, or tear completely, is an ankle sprain. The Mayo Clinic lays out risks associated with ankle sprain.

The common causes and factors that increase your risk of a sprained ankle include:

Sports participation. Ankle sprains are a common sports injury, particularly in sports that require jumping, cutting action, or rolling or twisting of the foot such as basketball, tennis, football, soccer, and trail running.
Uneven surfaces. Walking or running on uneven surfaces or poor field conditions may increase the risk of an ankle sprain.
Prior ankle injury. Once you’ve sprained your ankle or had another type of ankle injury, you’re more likely to sprain it again.
Poor physical condition. Poor strength or flexibility in the ankles may increase the risk of a sprain when participating in sports.
Improper shoes. Shoes that don’t fit properly or aren’t appropriate for an activity, as well as high-heeled shoes in general, make ankles more vulnerable to injury.

Symptoms of ankle sprain

The symptoms of a sprained ankle will vary depending on the person and the severity of the injury. Common symptoms may include:

Pain
Tenderness
Swelling of the ankle
Range of motion restriction
Ankle instability
Bruising
A popping sound at the time of injury

Diagnosis of ankle sprain

Your physician will diagnose your ankle sprain after a careful examination of your foot and ankle. FYI The exam may be painful because they will test the following:

Palpate. Your doctor will press around the ankle to determine which ligaments are injured and also to rule out a break.
Range of motion. The doctor will also move your ankle in different directions. This is the part that hurts like hell because, a stiff, swollen ankle won’t move much.

If there is no broken bone, your doctor may be able to tell the severity of your ankle sprain based solely on swelling, pain, bruising, and how loud you scream during the exam.

Grades of Ankle Sprains

According to the American Academy of Orthopaedic Surgeons, there are classes or grades of ankle sprains depending on their severity. After the examination, your doctor may determine the grade of your sprain in order to develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments.

Grade 1 Ankle Sprain (Mild)

Slight stretching and microscopic tearing of the ligament fibers
Mild tenderness and swelling around the ankle

Grade 2 Sprain (Moderate)

Partial tearing of the ligament
Moderate tenderness and swelling around the ankle
If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint

Grade 3 Sprained Ankle (Severe)

Complete tear of the ligament
Significant tenderness and swelling around the ankle
If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs

Additional tests for ankle sprains

If the ankle sprain is really bad, your doctor may recommend one or more imaging scans to rule out a broken bone or to detail the extent of ligament damage:

X-ray. This test is great for ruling out bone fractures.
Magnetic resonance imaging (MRI). MRIs produce a detailed cross-section or 3D images of soft internal structures of the ankle, including ligaments.
CT scan. These can reveal more details about the bones of the joint. (CT scans take X-rays from many different angles and combine them to make cross-sectional or 3D images.)
Ultrasound. This uses sound waves to produce real-time images that may help your doctor judge the condition of a ligament or tendon when the foot is in different positions.

Sprained ankle treatment

The treatment for an ankle sprain depends on the injury severity. The goal of effective treatments should:

Reduce pain and swelling
Promote ligament health
Restore functionality of the ankle

For more severe injuries, you may need to see a musculoskeletal specialist, like an orthopedic surgeon specializing in physical medicine and rehabilitation.

Self-care

Here’s what you can do on your own for an ankle sprain, use the following approach for the first 2-3 days following the injury:

Rest. Stop doing things that cause pain or discomfort.
Ice. Use an ice pack immediately for 15 – 20 minutes, repeat every 2 – 3 hours.
Compression. To minimize swelling, compress the ankle with an elastic bandage until the swelling stops.
Elevation. Another way to reduce swelling is to elevate your ankle above the level of your heart, especially at night. (It’s a little-known fact that gravity helps reduce swelling by draining excess fluid.)

Medications for ankle sprain

Many over-the-counter pain relievers have enough punch to manage the pain:

Ibuprofen (Advil)
Naproxen sodium (Aleve)
Acetaminophen (Tylenol)

Other treatments

Walking on a sprained ankle hurts like crap, so you may want to use crutches when the pain and swelling subsides.

Depending on the ankle sprain severity, your doctor may recommend:

Elastic bandage
Sports tape
Ankle support brace to stabilize the ankle

In the case of a really severe sprain, these may be needed to immobilize the ankle as it heals:

Cast
Walking boot

Physical therapy

When the swelling and pain go down enough to resume activity, your doctor will ask you to begin a series of exercises to restore your ankle’s range of motion, stability, flexibility, and strength.

Stability training is really important in order to retrain the ankle muscles to work together to support the joint as a way to prevent additional injury.

Surgery

In the extremest situations, when the injury doesn’t heal or remains unstable, surgery may be the next option. This is done to repair ligaments or reconstruct ligaments with other tissue.