1. What is an ankle sprain?
Ankle sprains are one of the most common musculoskeletal injuries, experienced by about 25,000 people each day. An ankle sprain usually happens during physical activities, but it can occur simply when you step unexpectedly on an uneven surface. An ankle sprain is a tear of one of the ligaments stabilizing the ankle joint. There are ligaments on the medial side (towards the other ankle) and on the lateral side (away from the other ankle). The lateral ankle ligaments are more commonly sprained. The typical mechanism is foot inversion (turning the sole of the foot toward the other foot). You can imagine how this would stretch and tear the lateral ankle ligaments.
There are also high ankle sprains, which are injuries to the syndesmotic ligaments holding the two leg bones (tibia and fibula) together. The syndesmosis is found just above the skin crease that is created when you dorsiflex your ankle, as when you step off the gas pedal. These take longer to heal.
2. How are ankle sprains graded?
Sprains range from Grade 1 to 3, depending on the amount of force causing the sprain. A Grade 1 involves microscopic tearing of the ligament and causes minimal swelling and tenderness. There is no instability. A Grade 3 sprain involves a complete tear of the ligament, causing significant swelling, tenderness and instability. Most ankle sprains are either Grade 1 or 2.
3. How are ankle sprains diagnosed?
Your doctor may ask you about your foot position at the time of injury, and whether or not you heard a pop. The doctor may move the ankle in various directions to determine which ligament has been injured, and how severely. X-rays may be taken to ensure that no bones have been broken, since the symptoms can be very similar. An MRI may be ordered if there is a question of a complete ligament tear, injury to the cartilage or bone chips in the joint.
4. How do I treat an ankle sprain?
Most ankle sprains do not need surgery and need only protection and time to heal. Even a complete ligament tear can sometimes heal without surgery, if it is immobilized properly. This usually takes about 4 to 6 weeks, but it can take months for high ankle sprains to heal.
Remember R.I.C.E. (rest, ice, compression and elevation). Rest as much as possible, using crutches if necessary. Ice the ankle to reduce swelling. Use compression with ACE wrap, air splint or a walking boot. Elevate the ankle above the knee when you are not walking. This also reduces swelling.
You can also take anti-inflammatory medications. After a week or so, you can begin restoring your range of motion, strength and flexibility. Physical therapy can be helpful in regaining function.
Only rarely do ankle sprains need surgery. In cases where nonsurgical treatment and months of rehabilitation are ineffective, surgical options to consider would be 1) arthroscopy to remove a loose fragment of bone, cartilage or ligament caught in the joint, or 2) reconstructive surgery to repair the torn ligament.
5. How do I prevent ankle sprains?
You can prevent ankle sprains by maintaining good strength, muscle balance and flexibility. Remember to warm up before activities or exercise, be aware of the surfaces you are on, wear good shoes and don’t push your body when you feel pain or fatigue.
