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Ankle Sprain 

​ ankle sprain ankle sprain

1 Diagnosis and Condition

n ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.

Most sprains are minor injuries that heal with home treatments like rest and applying ice. However, if your ankle is very swollen and painful to walk on — or if you are having trouble putting weight on your ankle at all, be sure to see your doctor .

Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle—making it more likely that you will injure it again. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and ongoing instability.

 

Ankle sprains occur when the strong ligaments supporting the ankle are stretched or torn beyond their limits. It is a common injury that occurs in all age groups. It ranges from mild to severe, depending on the degree of ligament damage.

 

Most sprains are mild injuries that can be treated with rest and ice. However, if your ankle is very swollen and painful when walking, or if you have any difficulty putting weight on your foot, be sure to see your doctor.

 


Without proper treatment and rehabilitation, more severe sprains weaken the ankle and increase the chances of reinjury. Repeated ankle sprains can lead to long-term problems such as chronic ankle pain, arthritis and persistent instability.

2 Description

Ligaments are strong, fibrous tissues that connect bones to other bones.

Most sprained ankles occur in the lateral ligaments on the outside of the ankle. Sprains can range from tiny tears in the fibers that make up the ligament to complete tears through the tissue.

If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes.

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Ligaments are strong fibrous tissues that connect bone to bone. The ankle ligaments keep the bones in place and stabilize the joint.

Most ankle sprains involve the lateral ligaments on the outside of the ankle. Sprains range from minor tears in the fibers that make up the ligaments to complete tears in the tissue.
If there is a complete tear of the ligaments, the ankle may become unstable after the initial stages of injury have passed. Over time, this instability can lead to bone and cartilage damage in the ankle joint.

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Cause

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Your foot can twist unexpectedly during many different activities, such as:

  • Walking or exercising on an uneven surface

  • Falling down

  • Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer

  • During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.

 

When doing various activities, you may twist your leg unexpectedly. for example,

  • Walking or exercising on uneven surfaces

  • fall

  • Trail running, basketball, tennis, American football, soccer, and other sports that require cutting, rolling, and twisting motions

  • During sports, when your foot is stepped on while running, twisting your foot, or rolling sideways

Symptoms Symptom

A sprained ankle is painful. Other symptoms may include:

  • Swelling

  • Bruising

  • Tenderness to touch

  • Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.

 

Ankle sprains are painful. Other symptoms include

  • swelling

  • subcutaneous bleeding

  • Tenderness

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Ankle Instability – Occurs with complete ligament tear or total ankle dislocation.

 

If there is severe tearing of the ligaments, you might also hear or feel a "pop" when the sprain occurs. Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation.

 

If the ligaments are severely torn, you may hear or feel a "pop" during the sprain. The symptoms of a severe sprain are similar to those of a broken bone, so immediate medical attention should be sought.

Doctor Examination

Physical Examination

Your doctor will diagnose your ankle sprain by performing a careful examination of your foot and ankle.

  • Palpate. Your doctor will gently press around the ankle to determine which ligaments are injured.

  • Range of motion. He or she may also move your ankle in different directions; however, a stiff, swollen ankle usually will not move much.

If there is no broken bone, your doctor may be able to tell the severity of your ankle sprain based upon the amount of swelling, pain, and bruising.

 

Your doctor will do a thorough examination of your foot and ankle to make the diagnosis of an ankle sprain. The physical examination may be painful.

  • Palpate Gently press around the ankle to determine which ligaments are damaged.

  • Range of motion Move the ankle in different directions; a stiff, swollen ankle will usually not move much.


If there is no fracture, the severity of the sprain may be determined by the swelling, pain, and bleeding under the skin..

Imaging Tests

X-rays.  X-rays provide images of dense structures, such as bone. Your doctor may order x-rays to rule out a broken bone in your ankle or foot. A broken bone can cause Similar symptoms of pain and swelling.

Stress x-rays. I n addition to plain x-rays, your doctor may also order stress x-rays. help to show whether the ankle is moving abnormally because of injured ligaments.

Magnetic resonance imaging (MRI) scan.  Your doctor may order an MRI if he or she suspects a very severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. The MRI may not be ordered until after the period of swelling and bruising resolves.

Ultrasound.  This imaging scan allows your doctor to observe the ligament directly while he or she moves your ankle.

 

X-ray. Transmits dense structures such as bones. Take x-rays to rule out fractures. Fractures present with pain and swelling.

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Stress X-ray. In addition to plain X-rays, stress X-rays are taken. Shoot while pressing the ankle joint in different directions. A stress x-ray will show if the ankle joint moves abnormally due to ligament damage.

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MRI. An MRI may be done if doctors suspect severe damage to the ligaments, damage to the cartilage or bone on the surface of the joint, small bone fragments, or another problem. An MRI may not be done until the swelling and bruising have subsided.

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ultrasound. You can directly observe the ligaments while moving the ankle joint. It helps determine how stable the ligaments are.

Grades of Ankle Sprains Severity of ankle sprains

After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments.

Grade 1 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 Sprain (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

 

After the examination, we will determine the severity of the sprain and help plan treatment. Sprains are classified according to the degree of ligament damage.

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Grade 1 (mild)

  • micro-stretching and micro-tearing of ligaments

  • Mild tenderness and swelling around the ankle

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Grade 2 (moderate)

  • partial tear of ligament

  • Moderate tenderness and swelling around the ankle

  • Abnormal ankle joint laxity when the ankle is passively moved in a particular direction

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Grade 3 (severe)

  • complete rupture of the ligament

  • Marked tenderness and swelling around the ankle


Substantial instability when pulling or pushing the ankle in certain movements

TreatmentTreatment

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Almost all ankle sprains can be treated without surgery.

A three-phase program guides treatment for all ankle sprains—from mild to severe:

  • Phase 1 includes resting, protecting the ankle and reducing the swelling.

  • Phase 2 includes restoring range of motion, strength and flexibility.

  • Phase 3 includes maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. such as tennis, basketball, or football.

This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries.

 

Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgery if properly secured.

From simple to complex, our 3-step program guides you through the treatment of ankle sprains:

  • The first stage is rest, protection of the ankle joint and reduction of swelling.

  • The second phase restores range of motion, strength and flexibility.

  • In the third phase, maintenance exercises are used to gradually return to movements that do not require ankle rotation or twisting. You will then be able to do activities that require sharp and rapid turning movements such as tennis, basketball and soccer.

This 3-step treatment program can be completed in 2 weeks for minor sprains and 6-12 weeks for severe sprains. .

 

 

Home Treatments

For milder sprains, your doctor may recommend simple home treatment.

The RICE protocol. Follow the RICE protocol as soon as possible after your injury:

  • Rest your ankle by not walking on it.

  • Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily.

  • Compression dressings, bandages or ace-wraps will immobilize and support your injured ankle.

  • Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. than narcotic pain medicines.

 

For minor sprains, your doctor may recommend simple home care.

RICE Treatment Follow RICE treatment as soon as possible after an injury.

  • (R) Do not walk and rest.

  • (I) Immediate icing is required to reduce swelling. 3 to 4 times a day for 20 to 30 minutes. However, be careful not to put the ice directly on your skin.

  • (C) Compress and cover. Stabilize the ankle and support the injured ankle.

  • (E) Elevate the ankle above heart level as much as possible for the first 48 hours.

Medication  Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce pain and swelling. They are better than narcotic pain relievers for minor sprains because they improve function by reducing swelling and controlling pain.

 

 

Nonsurgical treatment

Some sprains will require treatment in addition to the RICE protocol and medications.

Crutches. In most cases, swelling and pain will last from 2 to 3 days. Walking may be difficult during this time and your doctor may recommend that you use crutches as needed.

Immobilization. During the early phase of healing, it is important to support your ankle and protect it from sudden movements. For a Grade 2 sprain, a removable plastic device such as a cast-boot or air stirrup -type brace can provide support. Grade 3 sprains may require a short leg cast or cast-brace for 2 to 3 weeks.

Some sprains require treatment in addition to the RICE procedure and medication.

Crutches  In most cases, the swelling and pain last 2-3 days. During this time walking may be difficult and crutches may be recommended if necessary.

 


Immobilization  In the early stages of healing, it is important to support the ankle and protect it from sudden movements. Grade 2 sprains can be supported with cast boots or removable plastic braces. Grade 3 sprains may require a cast for 2-3 weeks.

 

Your doctor may encourage you to put some weight on your ankle while it is protected.

Physical therapy. Rehabilitation exercises are used to prevent stiffness, increase ankle strength, and prevent chronic ankle problems.

  • Early motion.  To prevent stiffness, your doctor or physical therapist will provide you with exercises that involve range-of-motion or controlled movements of your ankle without resistance.

  • Strengthening exercises.  Once you can bear weight without increased pain or swelling, exercises to strengthen the muscles and tendons in the front and back of your leg and foot will be added to your treatment plan. may be used if land-based strengthening exercises, such as toe-raising, are too painful.

  • Proprioception (balance) training.  Poor balance often leads to repeat sprains and ankle instability. A good example of a balance exercise is standing on the affected foot with the opposite foot raised and eyes closed. Balance boards are often used in this stage of rehabilitation.

  • Endurance and agility exercises.  Once you are pain-free, other exercises may be added, such as agility drills. Running in progressively smaller figures-of-8 is excellent for agility and calf and ankle strength The goal is to increase strength and range of motion as balance improves over time.

 

While protecting the ankle joint, you may also be encouraged to load the ankle joint. This promotes healing.

Physiotherapy  Rehabilitation exercises are performed to prevent contracture, increase ankle joint strength, and prevent chronic ankle joint trouble.

  • Early Motion  To prevent contractures, doctors and physiotherapists perform exercises that involve movement and range of motion in which the ankle joints can be controlled without resistance.

  • Strengthening Exercises  Once you can bear the load without increasing pain or swelling, begin exercises to strengthen the muscles and tendons in the front and back of the foot. If land-strength exercises, such as tiptoeing, are painful, exercises in water may be done. Exercise with resistance is added within tolerance.

  • Proprioception Training  Poor balance often leads to repeated sprains and ankle instability. A good example of a balancing exercise is standing on one leg with your eyes closed. A balance board is often used at this stage of rehabilitation.

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Endurance and Agility Exercises  Once the pain is gone, you can add other exercises such as agility drills. Running smaller figure eights is great for developing agility and calf and ankle strength. The goal is to improve your balance over time, increasing your strength and range of motion.

 

Surgical treatment

Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.

 


Surgical treatment for ankle sprains is rare. Surgery is indicated for patients who have not responded to non-surgical treatment or who have persistent ankle instability after several months of rehabilitation or non-surgical treatment.

 

Surgical options may include:

  • Arthroscopy. During arthroscopy, your doctor uses a small camera, called an arthroscope, to look inside your ankle joint. Miniature instruments are used to remove any loose fragments of bone or cartilage, or parts of the ligament that may be caught in the joint.

  • Reconstruction. Your doctor may be able to repair the torn ligament with stitches or sutures. In some cases, he or she will reconstruct the damaged ligament by replacing it with a tissue graft obtained from other ligaments and/ or tendons found in the foot and around the ankle.

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Surgery options include the following:

  • Arthroscope A small camera called an arthroscope is used to look inside the ankle. Used to remove loose pieces of bone, cartilage, or ligaments that may get caught in a joint.

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  • Reconstruction The torn ligament is sutured and repaired. In some cases, other ligaments and tendons from the ankle joint and surrounding areas are harvested and transplanted to reconstruct damaged ligaments.

 

 

Immobilization. There is typically a period of immobilization following surgery for an ankle sprain. Your doctor may apply a cast or protective boot to protect the repaired or reconstructed ligament. Be sure to follow your doctor's instructions about how long to wear the protective device; if you remove it too soon, a simple misstep can re-tear the fixed ligament.

Rehabilitation. Rehabilitation after surgery involves time and attention to restore strength and range of motion so you can return to pre-injury function. The length of time you can expect to spend recovering depends upon the extent of injury and the amount of surgery that was done. Rehabilitation may take from weeks to months.

Immobilization  There is usually a period of immobilization after ankle sprain surgery. A cast is worn to protect the repaired or reconstructed ligaments. Follow your doctor's instructions on how long to wear them.

Rehabilitation  Rehabilitation after surgery requires time and attention to restore muscle strength and range of motion to return to pre-injury function. The time required for recovery depends on the extent of the injury and the type of surgery performed. Rehabilitation may take weeks or months.

 

Outcomes

Outcomes for ankle sprains are generally quite good. With proper treatment, most patients are able to resume their day-to-day activities after a period of time.

The treatment results for ankle sprains are very good. With proper treatment, most people can resume normal activities after a period of time.

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Most importantly, successful outcomes are dependent upon patient commitment to rehabilitation exercises. Incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain. at risk for continued ankle sprains.

Most importantly, successful outcomes depend on patient rehabilitation efforts. Incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain. If patients discontinue strength exercises, the injured ligaments become weaker and risk recurrent ankle sprains.

 

 

Chronic Ankle Sprains

Once you have sprained your ankle, you may continue to sprain it if the ligaments do not have time to completely heal. It can be hard for patients to tell if a sprain has healed because even an ankle with a chronic tear can be highly functional because Overlying tendons help with stability and motion.

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Even if you sprain your ankle once, if you don't have enough time for the ligaments to heal completely, you may sprain it again. Even with a chronically torn ligament, it is difficult to tell patients whether the sprain has healed because the overlying tendon aids in stability and movement.

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If pain continues for more than 4 to 6 weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces and participating in sports that require cutting actions or rolling and twisting of the foot.

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If the pain lasts longer than 4-6 weeks, you may have a chronic ankle sprain. Activities that aggravate an already sprained ankle include walking on uneven surfaces, slicing steps, and sports involving rolling and twisting movements.

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Abnormal proprioception—a common complication of ankle sprains—can also lead to repeat sprains. There may be imbalance and muscle weakness that causes a reinjury. the ankle giving way, and chronic pain. This can also happen if you return to work, sports, or other activities before your ankle heals and is rehabilitated.

A common complication of ankle sprains, abnormal proprioception also leads to recurrent sprains. You may lose your balance or become so weak that you may not be able to recover. Repeated sprains can lead to continued instability, numbness, and chronic pain. This can also happen if you return to work, sports, etc. before your ankle heals and you are rehabilitated.

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PreventionPrevention

The best way to prevent ankle sprains is to maintain good muscle strength, balance, and flexibility.

  • Warm up thoroughly before exercise and physical activity

  • Pay careful attention when walking, running, or working on an uneven surface

  • Wear shoes that are made for your activity

  • Slow down or stop activities when you feel pain or fatigue

 

Strength, balance and flexibility are the best ways to prevent ankle sprains.

You can help prevent sprains by following these tips:

  • Thorough warm-up before exercise/exercise

  • Be careful when walking, running, or working on uneven surfaces

  • Wear shoes that match your activity

  • Slowing down or stopping activities when you feel pain or fatigue

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