Ligaments hold bones together throughout your body. If you've ever twisted your ankle, you know what it feels like to damage ankle ligaments. These common injuries, known as ankle sprains, most frequently affect the ligaments on the outside of the ankle. They are categorized and treated based on the severity of the ligament injury. Grade 1 sprains involve ligament stretching without obvious tearing. A grade 2 sprain describes a partial ligament tear, and grade 3 sprains involve complete tearing of one or more ankle ligaments. Treatment may include a combination of rest, exercise and rehabilitation. Surgery is sometimes needed for severe grade 3 ankle sprains.
Treatment of ankle ligament tears during the acute phase -- the first few days after the injury -- focuses on reducing pain and inflammation. Ice packs can be applied for up to 20 minutes every 3 to 4 hours, beginning immediately after injury. Cold application helps decrease pain by making your nerves less sensitive and is most effective for the first few days after injury. Nonsteroidal antiinflammatory medication, such as ibuprofen (Advil, Motrin), naproxen (Aleve) or aspirin, may alleviate pain and reduce inflammation during this phase. Elevating your leg as much as possible helps limit and reduce swelling. Your doctor may recommend crutches, a supportive boot, elastic bandage and/or a splint to protect your ankle from further injury.
The subacute phase of healing begins around day 4 and continues until 2 weeks after an ankle ligament injury. During this phase, range-of-motion exercises begin to decrease ankle stiffness caused by swelling. You might receive physical therapy, including ultrasound and electrical stimulation, to help promote healing and exercises to improve your mobility. Exercises might include drawing the alphabet in the air with your toes, ankle circles, gentle stretches and possibly nonweightbearing activities, such as riding a stationary bike. You might begin to put some weight on your foot as you walk. You might also be weaned from your brace and crutches during this phase.
The rehabilitation phase of treatment typically begins once you are able to bear full weight on your ankle and no longer need crutches to walk. This phase may begin 2 to 6 weeks after injury, with more severe ligament tears at the latter end of that time frame. The goal of this phase is to regain movement, strength and function in your ankle. Your physical therapist may stretch your ankle to decrease stiffness and improve movement. Strengthening exercises, such as calf raises, towel toe scrunches and toe marble pick-up, may be performed.
Six weeks after injury and beyond, treatment for ankle ligament tears focuses on returning to full function. Range-of-motion exercises continue with added resistance from an elastic band. Balance training activities, such as standing on an uneven surface and standing only on your injured leg, are also included in treatment. Functional activities might also include sports and recreational activities, jumping and running.
Severe grade 3 sprains may require surgery, particularly if you have ongoing pain or consistently feel like your ankle is going to give out. In these situations, your torn ankle ligaments may be reattached with screws. You may have to wear a cast and use crutches for 6 to 8 weeks while the ligament heals. Once the cast is removed, treatment begins at the subacute phase and progresses through the rehab and functional phases.
Warnings and Precautions
Seek medical attention if you sprain your ankle, even if you think it's just a minor injury. Early treatment can prevent long-term issues with loss of motion and chronic weakness that can develop after this injury.
- Brigham and Women's Hospital: Standard of Care: Ankle Sprain
- Orthopedic Reviews: Diagnosis and Treatment of Acute Ankle Injuries: Development of an Evidence-Based Algorithm
- Nicholas Rizzo, MD: When to Use Heat and Cold for Athletic Injuries
- American Academy of Orthopaedic Surgeons: Foot and Ankle Conditioning Program
- The Podiatry Institute: Surgical Versus Conservative Treatment of Acute Lateral Ankle Sprains in Athletes