Ankle Sprain

Topic Overview

What is an ankle sprain?

Most people have twisted an ankle at some point in their life. But if your ankle gets swollen and painful after you twist it, you have most likely sprained it. This means you have stretched and possibly torn the ligaments in your ankle.

Even though ankle sprains are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

What causes ankle sprains?

Most types of ankle sprains happen when you make a rapid shifting movement with your foot planted, such as when you play soccer or get tackled in football. Often the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel "wobbly." You can't walk, because the ankle gives out and may be very painful.

What are the symptoms?

With most sprains, you feel pain right away at the site of the tear. Often the ankle starts to swell immediately and may bruise. The ankle area is usually tender to touch, and it hurts to move it.

In more severe sprains, you may hear and/or feel something tear, along with a pop or snap. You will probably have extreme pain at first and will not be able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal.

How is an ankle sprain diagnosed?

Your doctor will ask you how the injury occurred and if you have hurt your ankle before. He or she will check your foot and ankle, your lower leg, and even your knee to see if you are hurt anywhere else.

In some cases, the doctor may order X-rays to be sure there is not a broken bone in the ankle or the foot.

How is it treated?

In many cases you can first use the RICE approach to treat your ankle:

• Rest. You may need to use crutches until you can walk without pain.
• Ice. For at least the first 24 to 72 hours or until the swelling goes down, apply an ice pack for 10 to 20 minutes every hour or two during the day. Always keep a thin cloth between the ice and your skin, and press the ice pack firmly against all the curves of the affected area.
• Compression. An elastic compression wrap, such as an ACE bandage, will help reduce swelling. You wear it for the first 24 to 36 hours. Compression wraps do not offer protection. So you also need a brace to protect your ankle if you try to put weight on it.
• Elevation. Raise your ankle above the level of your heart for 2 to 3 hours a day if possible. This helps to reduce swelling and bruising.

If you are not taking any prescription pain relievers, you may want to take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling.

Proper treatment and rehabilitation (rehab) exercises are very important for ankle sprains. If an ankle sprain does not heal right, the joint may become unstable and may develop chronic pain. This can make your ankle weak and more likely to be reinjured. Before you return to sports and other activities that put stress on your ankle, it's a good idea to wait until you can hop on your ankle with no pain. Taping your ankle or wearing a brace during exercise can help protect your ankle. Wearing hiking boots or other high-top, lace-up shoes for support may also help. But use caution. Don't force your foot into a boot if you feel a lot of pain or discomfort.

If your ankle is still unstable after rehab, or if the ligament damage is severe, your doctor may recommend surgery to repair the torn ligaments.

What kind of rehabilitation program should you follow?

Rehab exercises can begin soon after the injury. You can try to walk or put weight on your foot. You may need to use crutches until you can walk without pain. Depending on your pain, you can also begin range-of-motion exercises while you have ice on your ankle. These exercises are easy to do-you just trace the alphabet with your toe. This helps the ankle move in all directions.

Ask your doctor about other rehab. Stretching, strength training, and balance exercises may help the ankle heal totally and may prevent further injury.

Frequently Asked Questions

Cause

Ankle sprains occur when ligaments that connect the bones in the foot, ankle, and lower leg stretch or tear. There are different types of ankle sprains.

An inversion injury, the most common cause of ankle sprains, occurs when the ankle rolls outward and the foot turns inward. It results in stretching and tearing of the ligaments on the outside of the ankle.

In an eversion injury, the ankle rolls inward and the foot turns outward, damaging the ligaments at the inside of the ankle.

In a "high" ankle sprain, a less common type of injury, ligaments that join the two lower leg bones together above the ankle, called the syndesmosis, are injured. This usually happens if the foot is forced up, or if the leg is forcefully twisted while the foot is planted. This injury can occur either by itself or with an inversion or eversion sprain. If the ligaments of the syndesmosis are injured, the sprain is more severe and takes longer to heal.

Damage to the ligament varies from simply stretched or slightly torn to completely torn. Your doctor will grade your sprain accordingly.

• Grade I is stretching or slight tearing of the ligament with mild tenderness, swelling, and stiffness. The ankle feels stable, and it is usually possible to walk with minimal pain.
• Grade II is a larger but incomplete tear with moderate pain, swelling, and bruising. The ankle sometimes feels stable, but the damaged areas are tender to the touch, and walking is painful.
• Grade III is a complete tear of the affected ligament or ligaments with severe swelling and bruising. The ankle is unstable and may feel "wobbly." Walking is usually not possible, because the ankle gives out and there is intense pain, although initial pain may quickly subside.

Symptoms

People usually feel immediate pain at the site of an ankle sprain. Often the ankle starts to swell immediately and may develop bruising. The affected area is usually tender to touch and may feel "wobbly" or unstable.

In a mild sprain, swelling usually goes down within a few days.

The severity of your symptoms usually depends on how much tearing has occurred. In more severe sprains, you are often not able to walk or even put weight on your foot, and your ankle may feel unstable. You usually have extreme pain at first, but some people start to feel better fairly soon. You may also hear and/or feel a tearing sensation and a pop or a snap.

If a sprain does not heal correctly, your ankle joint may be more likely to be injured again or the pain may not go away. This often occurs with even a slight trauma, such as stepping off a curb or walking on uneven pavement. Some people complain of persistent pain and swelling.

When to Call a Doctor

Call your doctor now or seek immediate medical care if:

• Your pain is getting worse.
• Your swelling is getting worse.
• Your splint feels too tight or you are unable to loosen it.

Watch closely for changes in your health, and be sure to contact your doctor if you are not getting better after 1 week.

If your pain is mild and you are able to put some weight on your foot, you may follow the recommendations in the Treatment Overview and Home Treatment sections of this topic. Early treatment followed by rehabilitation exercises help your ankle heal properly. If treatment recommendations are not followed, your ankle may stay weak and unstable.

Who to see

For evaluation, diagnosis, or treatment of an ankle sprain, you may see:

• An emergency medicine doctor.
• A primary care professional (family medicine doctor, nurse practitioner, physician assistant, general practitioner, or internist).
• An orthopedist.
• A sports medicine doctor.

For further treatment, you may be referred to:

• A physical therapist (for stretching and strengthening exercises and to help you return to your usual activities).
• An orthopedist.

Exams and Tests

Your doctor will ask you when and how the ankle sprain occurred and ask about any prior injuries.

Next, your doctor will examine your foot, ankle, and lower leg and even your knee to see if any other injury occurred. He or she may ask you to move your foot up and down and to take a few steps if possible. Your doctor will then carefully try moving your foot and ankle to see if the ligaments are intact and what movements cause pain.

If your sprain is mild, an X-ray may not be taken. If your sprain is more severe, you may need X-rays to evaluate the ankle. X-rays can help your doctor find out whether you have any ligament tears, broken bones, or bones that have moved out of their normal positions.

X-rays are often taken for children because of potential injury to the bone's growth plate and possible disruption of normal growth. Doctors may take X-rays of both ankles so they can compare the injured ankle with the one that is healthy.

Treatment Overview

Initial treatment for an ankle sprain is summarized as the RICE approach:

• Rest. You may need to use crutches until walking is not painful without them.
• Ice. For the first 48 to 72 hours or until swelling goes down, apply an ice pack for 10 to 20 minutes every 1 to 2 hours during the day. After 48 hours, you can continue with ice or try contrast baths. There is not good scientific evidence that ice or contrast baths help, but they are often used.
• Compression. An elastic compression wrap will help decrease swelling and should be worn for the first 24 to 36 hours. A protective brace should also be worn if you try to bear weight on your injured ankle. Don't apply the wrap too tightly. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. See instructions on how to wrap an ankle with an elastic bandage. Compression wraps do not offer protection, except by reminding you to be careful of your ankle.

  Sprained Ankle: Using a Compression Wrap

• Elevation. Raise your ankle above the level of your heart for 2 to 3 hours a day if possible to decrease swelling and bruising.

If you are not taking any prescription pain relievers, you may want to take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

It may help to wear hiking boots or other high-top, lace-up shoes for support. But use caution. Don't force your foot into a boot if you feel a lot of pain or discomfort.

Your doctor may suggest that you keep some or all of your weight off your ankle as it heals. If this happens, learn to use your crutches or walker properly and safely.

• Using Crutches
• Using a Walker

Almost all ankle sprains heal on their own with proper home treatment and rehabilitation (rehab) exercises.

Surgery to repair torn ligaments is usually only considered when there is a severe ligament tear (or tears) or if the ankle remains unstable after rehab. Surgery is also a consideration if you have broken a bone.

Home Treatment

Ankle sprains take an average of 6 weeks to heal but can take can up to 4 months, depending on the severity. An ankle brace, air stirrup, hiking boots, or other form of ankle support should be worn during this time to protect the ligaments. After the ankle is healed, wearing an ankle brace or taping the ankle may help prevent reinjury.

For more painful and severe sprains, you may not be able to walk, although you might be able to bear some weight while using crutches and a protective brace, such as a brace with a built-in air cushion or other form of ankle support. If pain is severe, use crutches until your doctor tells you that you can begin to bear weight. In general, if your pain is bearable, you should try to walk or bear some weight while using crutches and a protective brace, because these activities promote healing.

Some people who have repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems. Rehabilitation (rehab) exercises for an ankle sprain can be done at home to promote proper healing and prevent chronic pain and instability. When rehab exercises are not followed after a sprain, the ankle can become weak and unstable.

In the case of a minor sprain, rehab exercises begin soon after the injury with walking. You can try wearing hiking boots or other high-top, lace-up shoes for support. But use caution. Don't force your foot into a boot if you feel a lot of pain or discomfort.

Stretching exercises should be continued daily and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with muscle-strengthening exercises and balance and control exercises several times a week to keep your ankles strong.

The timing and type of rehab exercises may vary according to your doctor's or physical therapist's preferences. You will probably do the following types of exercise.

• Range-of-motion exercises to move the joint as far as you can in every direction that it moves. You can start these exercises soon after your injury.
• Stretching exercises to keep your Achilles tendon (heel cord) flexible while your ankle heals. You can start stretching as soon as you can do so without pain.
• Strengthening exercises to strengthen the muscles so they help support your ankle. Talk to your doctor or physical therapist about the timing of strengthening exercises for the ankle. In general, you can start these exercises after you are able to stand without increased pain or swelling, as long as you do not feel pain while you do them.
• Balance and control exercises to help your foot and ankle respond to activities, which can help prevent reinjury. You can usually start balance and control exercises when you are able to stand without pain. But talk to your doctor or physical therapist about the exact timing. You should not feel pain while doing these exercises. Also, don't try these exercises if you could not have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you are at risk of falling when you try them with an injured ankle.

Sprained Ankle: Rehabilitation Exercises