Acute Ankle Sprain

An acute ankle sprain is a tear in on or more of the ligaments of the ankle due to traumatic injury. The severity of the injury depends on both the number of ligaments sprained and the grade of sprain. There are 3 categories of sprains. A grade 1 strain is a mild strain. There is a slight pull without obvious tearing. There is no loss of strength, and the muscle and tendon are the correct length. A grade 2 strain is a moderate strain. There is tearing of fibers within the substance of the tendon, at the bone-tendon junction, or at the muscle-tendon junction. The length of the tendon or whole muscle-tendon-bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the tendon and is uncommon. In addition to the grade of sprain, there are three types of ankle sprains.

Types of ankle sprains

  • Lateral ankle sprain: This is a sprain of one or more of the 3 ligaments on the outer side ( lateral) of the ankle. These are the most common sprains.
  • Medial ankle sprain: There is one large triangular ligament of the inner side ( medial) of the ankle that is susceptible to injury. Medial ankle sprains are less common.
  • Syndesmosis, "high ankle" sprain: The syndesmosis is the ligament that connects the two bones of the lower leg. Syndesmosis sprains usually only occur with very severe ankle sprains.

Symptoms of ankle sprains

  • Pain, tenderness, and swelling in the ankle, starting at the side of injury that may progress to the whole ankle and foot with time
  • "Pop" or tearing sensation at the time of injury
  • Bruising that may spread to the heel
  • Impaired ability to walk soon after injury

Causes of ankle sprains

  • Acute ankle sprains are caused by trauma placed on the ankle that temporarily forces or pries the ankle bone (talus) out of its normal socket
  • Stretching or tearing of the ligaments that normally hold the joint in place (usually due to a twisting injury).

Ankle sprain risk factors

  • Previous ankle sprain
  • Sports in which the foot may land awkwardly (ie. basketball, volleyball, or soccer) or walking or running on uneven or rough surfaces
  • Shoes with inadequate support to prevent sideways motion when stress occurs
  • Poor strength and flexibility
  • Poor balance skills
  • Contact sports

How to prevent ankle sprains

  • Warm-up and stretch properly before activity
  • Maintain physical fitness
  • Ankle and leg flexibility, muscle strength, and endurance
  • Cardiovascular fitness
  • Balance training activities
  • Use proper technique and have a coach correct improper technique
  • Taping, protective strapping, bracing, or high-top tennis shoes may help prevent injury. Initially, tape is best; however, it loses most of its support function within 10 to 15 minutes.
  • Wear properly fitting protective shoes (High-top shoes with taping or bracing is more effective than either alone)
  • Provide the ankle with support during sports and practice activities for 12 months following injury

Prognosis for ankle sprains

If treated properly, ankle sprains can be expected to recover completely; however, the length of recovery depends on the degree of injury.

  • A first-degree sprain usually heals enough in 5 to 7 days to allow modified activity and requires an average of 6 weeks to heal completely.
  • A second-degree sprain requires 6 to 10 weeks to heal completely.
  • A third-degree sprain requires 12 to 16 weeks to heal.
  • A syndesmosis sprain often takes more than 3 months to heal.

Ankle sprain complications

  • Frequent recurrence of symptoms may result in a chronic problem. Appropriately addressing the problem the first time decreases the frequency of recurrence and optimizes healing time. Severity of initial sprain does not predict the likelihood of later instability.
  • Injury to other structures (bone, cartilage, or tendon)
  • Chronically unstable or arthritic ankle joint are possible with repeated sprains.

Treatment for ankle sprains

Treatment initially involves the use of ice, medication, and compression bandages to help reduce pain and inflammation. Ankle sprains are usually immobilized in a walking cast or boot to allow for healing. Crutches may be recommended to reduce pressure on the injury. After immobilization, strengthening and stretching exercises may be necessary to regain strength and a full range of motion. Surgery is rarely needed to treat ankle sprains.

Medication

  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take for the first 3 days after injury or within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your provider. Contact your provider immediately if any bleeding, stomach upset, or signs of an allergic reaction occur from these medications.
  • Ointments applied to the skin may be helpful.
  • Pain relievers may be prescribed as necessary by your provider. Do not take prescription pain medication for longer than 4 to 7 days. Use only as directed and only as much as you need.

Heat and cold

  • Cold treatment (icing) is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.
  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver. Use a heat pack or a warm soak.

When to seek immediate medical care

Seek immediate medical care if:

  • Pain, swelling, or bruising worsens despite treatment.
  • You experience pain, numbness, discoloration, or coldness in the foot or toes.
  • New, unexplained symptoms develop (drugs used in treatment may produce side effects.
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