A sprained ankle is a very common injury. Approximately 25,000 people experience
it each day. A sprained ankle can happen to athletes and non-athletes, children
and adults. It can happen when you take part in sports and physical fitness activities.
It can also happen when you simply step on an uneven surface, or step down at an
The ligaments of the ankle hold the ankle bones and joint in position. They protect
the ankle joint from abnormal movements-especially twisting, turning, and rolling
of the foot.
A ligament is an elastic structure. Ligaments usually stretch within their limits,
and then go back to their normal positions. When a ligament is forced to stretch
beyond its normal range, a sprain occurs. A severe sprain causes actual tearing
of the elastic fibers.
Ankle sprains happen when the foot twists, rolls or turns beyond its normal motions.
A great force is transmitted upon landing. You can sprain your ankle if the foot
is planted unevenly on a surface, beyond the normal force of stepping. This causes
the ligaments to stretch beyond their normal range in an abnormal position.
If there is a severe in-turning or out-turning of the foot relative to the ankle,
the forces cause the ligaments to stretch beyond their normal length. If the force
is too strong, the ligaments can tear. You may lose your balance when your foot
is placed unevenly on the ground. You may fall and be unable to stand on that foot.
When excessive force is applied to the ankle's soft tissue structures, you may even
hear a "pop". Pain and swelling result.
The amount of force determines the grade of the sprain. A mild sprain is a Grade
1. A moderate sprain is a Grade 2. A severe strain is a Grade 3 (see Table below).
Slight stretching and some damage to the fibers (fibrils) of the ligament.
Partial tearing of the ligament. If the ankle joint is examined and moved in certain
ways, abnormal looseness (laxity) of the ankle joint occurs.
Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint
in certain movements, gross instability occurs.
See your doctor to diagnose a sprained ankle. He or she may order X-rays to make
sure you don't have a broken bone in the ankle or foot. A broken bone can have similar
symptoms of pain and swelling.
The injured ligament may feel tender. If there is no broken bone, the doctor may
be able to tell you the grade of your ankle sprain based upon the amount of swelling,
pain and bruising.
The physical exam may be painful. The doctor may need to move your ankle in various
ways to see which ligament has been hurt or torn.
If there is a complete tear of the ligaments, the ankle may become unstable after
the initial injury phase passes. If this occurs, it is possible that the injury
may also cause damage to the ankle joint surface itself.
The doctor may order an MRI (magnetic resonance imaging) scan if he or she suspects
a very severe injury to the ligaments, injury to the joint surface, a small bone
chip or other problem. The MRI can make sure the diagnosis is correct. The MRI may
be ordered after the period of swelling and bruising resolves.
The amount of pain depends on the amount of stretching and tearing of the ligament.
Instability occurs when there has been complete tearing of the ligament or a complete
dislocation of the ankle joint.
Walking may be difficult because of the swelling and pain. You may need to use crutches
if walking causes pain. Usually swelling and pain will last two days to three days.
Depending upon the grade of injury, the doctor may tell you to use removable plastic
devices such as castboots or air splints.
Most ankle sprains need only a period of protection to heal. The healing process
takes about four weeks to six weeks. The doctor may tell you to incorporate motion
early in the healing process to prevent stiffness. Motion may also aid in being
able to sense position, location, orientation and movement of the ankle (proprioception).
Even a complete ligament tear can heal without surgical repair if it is immobilized
appropriately. Even if an ankle has a chronic tear, it can still be highly functional
because overlying tendons help with stability and motion.
For a Grade 1 sprain, use R.I.C.E (rest, ice, compression and elevation):
For a Grade 2 sprain, the RICE guidelines can also be used. Allow more time for
healing to occur. The doctor may also use a device to immobilize or splint the ankle.
A Grade 3 sprain can be associated with permanent instability. Surgery is rarely
needed. A short leg cast or a cast-brace may be used for two weeks to three weeks.
Rehabilitation is used to help to decrease pain and swelling and to prevent chronic
ankle problems. Ultrasound and electrical stimulation may also be used as needed
to help with pain and swelling. At first, rehabilitation exercises may involve active
range of motion or controlled movements of the ankle joint without resistance. Water
exercises may be used if land-based strengthening exercises, such as toe-raising,
are too painful. Lower extremity exercises and endurance activities are added as
tolerated. Proprioception training is very important, as poor propriception is a
major cause of repeat sprain and an unstable ankle joint. Once you are pain-free,
other exercises may be added, such as agility drills. The goal is to increase strength
and range of motion as balance improves over time.
All ankle sprains recover through three phases:
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control pain and inflammation.
If an ankle sprain is not recognized, and is not treated with the necessary attention
and care, chronic problems of pain and instability may result.
Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that
fail to respond to nonsurgical treatment, and for persistent instability after months
of rehabilitation and non-surgical treatment.
Surgical options include:
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.
The best way to prevent ankle sprains is to maintain good strength, muscle balance
If you have sprained your ankle in the past, you may continue to sprain it if the
ligaments did not have time to completely heal. If the sprain happens frequently
and pain continues for more than four weeks to six weeks, you may have a chronic
ankle sprain. Activities that tend to make an already sprained ankle worse include
stepping on uneven surfaces, cutting actions and sports that require rolling or
twisting of the foot, such as trail running, basketball, tennis, football and soccer.
Possible complications of ankle sprains and treatment include abnormal proprioception.
There may be imbalance and muscle weakness that causes a re-injury. If this happens
over and over again, a chronic situation may persist with instability, a sense of
the ankle giving way (gross laxity) and chronic pain. This can also happen if you
return to work, sports or other activities without letting the ankle heal and become