Sprained Ankle

A sprained ankle is a very common injury—nearly 25,000 people experience one daily. A sprained ankle can happen to anybody: athletes, non-athletes, children and adults. It can happen in any sport or physical activity. It can also occur by stepping on an uneven surface or stepping down at an angle.

Sprained Ankle and Ankle Ligaments
The ligaments of the ankle are highly elastic structures. They hold the anklebones and joint in position. They protect the ankle joint from abnormal movements.

With normal use, these ligaments stretch within their limits and return to their normal positions. When a ligament is forced beyond its normal range, a sprain occurs. A severe sprain causes tearing of the elastic fibers. The most common causes of an ankle sprain involve twisting, rolling or turning the foot beyond its normal range resulting in stretched ligaments.

Sprained Ankle Symptoms
The amount of pain depends on the amount of stretching and tearing, as well as a number of structures injured. Instability occurs when there has been stretching or a complete tear of the ligaments, or a complete dislocation of the ankle joint. If there is a severe in-turning or out-turning of the foot relative to the ankle, the force causes the ligaments to stretch beyond their normal length.

If the force is too strong, the ligaments can tear. Balance can be lost, especially if the foot is placed unevenly on the ground. When excessive force is applied to the ankle's soft tissue structures, there may an audible “pop.” Pain and swelling in or around the joint can result.

Sprained Ankle Diagnosis
Gwinnett Medical Center–Duluth recommends a physical examination and diagnostic testing. The physical exam may be painful. Your physician may need to move the ankle in various ways to see which structures have been injured and to what extent.

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 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.

Non-surgical Treatment of Sprained Ankle
Walking may be difficult because of the swelling and pain. Crutches should be used if walking causes pain. Usually, swelling and pain will last two to three days. Depending upon the severity of the injury, the doctor may tell you to use support devices, such as walking boots or air splints.

Most ankle sprains need a period of rest to heal. The healing process takes about four to six weeks. Your doctor may tell you to incorporate motion early in the healing process to prevent stiffness.

Even a complete ligament tear can heal without surgical repair if it is immobilized properly. If an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion. Non-steroidal anti-inflammatory drugs like aspirin and ibuprofen may be used to control pain and inflammation.

RICE (rest, ice, compression and elevation):

  • Rest your ankle by not walking on it.
  • Ice should be applied to keep swelling down. It can be used for 20 to 30 minutes, three to four times per day. Combine ice with wrapping to decrease swelling, pain and dysfunction.
  • Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.
  • Elevate your ankle above your heart level over the next 48 hours.

Sprained Ankle Rehabilitation
Rehabilitation is used to help 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 other strengthening exercises, such as toe raising, are too painful. Lower extremity exercises and endurance activities are added as tolerated.

Sprained Ankle Recovery Happens in Three Phases:

  • Phase 1 includes resting, protecting the ankle and reducing the swelling (one week).
  • Phase 2 includes restoring range of motion, strength and flexibility (one to two weeks).
  • Phase 3 includes gradually and safely returning to activities that do not require turning or twisting the ankle.

Surgical Treatment of a Sprained Ankle
Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to non-surgical treatments and for constant instability after months of rehabilitation and non-surgical treatment.

Surgical options include arthroscopy and reconstruction. In an arthroscopy procedure, a surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage, or if part of the ligament has been caught in the joint. In a reconstruction procedure, a surgeon repairs the torn ligament with stitches or sutures, or uses other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.

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