A sprain is the stretching or tearing of ligaments. Ligaments connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs with a sudden fall or twist to the ankle joint, Ankle ligament injury may also be caused by a blow to the joint or any abnormal movement or by walking down a slope or over any uneven surface Most commonly, it occurs during sports participation. The injury can range from mild to severe, depending on the condition of the injured ligament and the number of ligaments involved.
Ligaments are made up of elastic tissues that interconnect bones to one another. They bind the joint together providing stability and support to the joint. The ligaments protect the ankle joint from abnormal movement and stabilize the joint during movement. When stretched beyond its limit, the ligament may partially or completely tear.
Use of inappropriate shoes during physical activity, or any forceful movement over an uneven surface may also cause a ligament injury. Previous ankle or foot injury and congenitally weak ankle increase the propensity for ankle sprain.
A sprain is defined in terms of the severity of the tearing of the ligaments in the ankle. For example, a Grade I sprain is a stretch or strain with no tearing, a Grade II sprain is a moderate tear, and a Grade III is a complete tear of the supporting ligaments of the ankle.
Ankle sprains can cause pain, swelling, tenderness, bruising, stiffness, and inability to walk or bear weight on the ankle. Pain is the most common symptom of ankle ligament injury and can be associated with swelling and bruising. Sometimes the joint may develop stiffness and the patent may have difficulty walking. The symptoms of ankle ligament injury depend on the severity of the injury which correlates with the extent of damage to the ligaments.
The diagnosis of an ankle sprain is usually made by evaluating the history of the injury and through a thorough physical examination of the ankle. X-ray(s) of the ankle may be ordered to eliminate the presence of a fracture. A complete physical examination by the physician will determine the degree and nature of the injury. The doctor may move the ankle in different directions to evaluate the extent of the injury. The examination may be painful. X-rays may be needed to confirm the severity of the injury and rule out the possibility of a fracture. In severe cases, an MRI scan may also be ordered.
RICE (rest, ice, compression, and elevation) is the most common treatment recommended for ankle sprains.
- Rest: Do not move or use the injured foot to reduce pain and prevent further damage. Crutches may be ordered to limit weight-bearing while walking.
- Ice: An icepack should be applied over the injured area for up to 3 days after the injury. Do not place ice directly over the skin. Use a cold pack or crushed ice wrapped in a towel. Ice packs help to reduce swelling and relieve pain.
- Compression: Compression of the injured area helps to reduce swelling and bruising. This is usually accomplished by using an elastic wrap for a few days or weeks after the injury.
- Elevation: Place the injured ankle above your heart level for about 2 to 3 hours a day to reduce swelling.
A brace or splint may also be ordered to reduce motion of the ankle. Anti-inflammatory pain medications may be prescribed to help reduce pain and control inflammation. Ankle ligament injuries need immediate medical attention as if left untreated they may cause chronic ankle instability. Conservative as well as surgical treatment may be used for the management of ankle ligament injuries.
Surgery is not commonly recommended for the management of ankle sprain. However, if the conservative treatment fails to provide any benefit, surgery may be required. Surgery is recommended for ankle joint instability persisting even after months of rehabilitation. Common surgical procedures performed for the management of ankle sprain include ankle reconstruction surgery and ankle arthroscopy.
Rehabilitation exercises may be recommended in Physical Therapy to strengthen and improve range of motion in your foot. Pivoting and twisting movements should be avoided for 2 to 3 weeks. Physical therapy may include strengthening and mobilization exercises as well as gait training. PT provides long term benefits to the patient and can help prevent a recurrence of the injury.