Ankle sprains is an injury that often occurs when the ligaments connecting the bones of the foot and ankle either stretch or tear (partially or completely). This type of injury is often associated with athletes that are involved in side to side motions such as quick changes in direction or speed. People who suffer such an injury usually feel instant discomfort at the level of the ankle and depending on the severity of the injury, associated swelling and/or ankle weakness.
Types of Ankle Sprains
There are 3 different types of ankle sprains which are identified by the nature of the injury alongside which structures are affected. These types include:
– Inversion sprain: often referred to as ‘rolling your ankle’. This is perhaps the most common type of ankle injury and occurs when the foot turns inwards as a results stretching and/or tearing the ligaments located on the outside of the ankle.
– Eversion sprains: occur when the foot turns inwards often causing injury to the ligaments located on the inside of the ankle.
– High ankle sprains: are the least common type of ankle injury but often are the most serious. It can involve either the inversion or eversion type and occurs when the foot is forced upwards or the leg severely twisted with the foot positioned on the ground. The injury can cause damage to a ligament called the syndesmosis, which connects the two leg bones together and can take quite a while to heal if damaged.
Symptoms of Ankle Sprains
The signs and symptoms of an ankle sprain injury will largely depend on the severity of the injury and how badly the internal structures have been damaged. The severity of injury is often classified using a grading system (1-3).
– Grade 1 injury
o Involves mild to moderate stretching or partial tearing of the ligaments of the ankle.
o Usually associated with mild tenderness, swelling and stiffness
o The ankle generally remains stable enough to walk on although discomfort may persist.
o Prognosis and recovery is often prompt and uncomplicated.
– Grade 2 injury
o Involves a larger tear of the ligaments but these tears are not complete.
o Associated with moderate pain, swelling and may result in bruising on the affected side.
o The damaged, swollen and bruised areas will be fairly tender to the touch.
o The ankle may still feel stable enough to walk on however walking is often painful.
o Prognosis is generally good. Recovery may take a number of weeks to return to pain free physical activity.
– Grade 3 injury
o Involves a complete tear of the affected ligaments.
o Associated with initially severe pain alongside very prominent swelling and bruising.
o The ankle is unstable and walking is not often possible due to a combination of pain and unstable structures.
o Recovery may involve surgical repair of the torn ligaments alongside an extensive strength and rehabilitation program.
There are a number of factors that can potentially predispose a person to an increased likelihood of suffering an ankle sprain. Some risk factors include:
– Participating in sports such as basketball, soccer, tennis and other that require quick changes of direction or speed.
– A history of ankle sprains may lead to weakened and unstable internal structures that may result in a person suffering repeat occurrence of the injury.
– Hypermobile (overly flexible joints)
– Certain foot types are more susceptible than others. A ‘rearfoot varus’ position (heel that is turned inwards) may result in excessive strains of the outside ligaments of the ankle.
– Unsuitable footwear.
– Excessively worn out shoes, particularly at the heel level.
– Weak peroneal muscles.
The initial stages of treatment for ankle sprains will usually focus on reducing the swelling, bruising and pain. The standard method of achieving this is by following the RICE protocol.
– R: Rest – focus on resting the injured ankle and avoid excessive weight bearing for the first 24-28 hours.
– I: Ice – the application of ice to the area helps to reduce swelling and promote the removal of inflammatory factors which contribute to pain. Ice can be liberally applied to the affected area daily for 10-20 minutes, being careful not to suffer ice burns.
– C: Compression – Compression in the form of bandaging can help to reduce swelling as well as offer some stability to the affected ankle.
– E: Elevation – Raising the affected leg above the level of the heart whilst at rest promotes the reduction of swelling and bruising by assisting in the return of blood and fluid back up towards the heart and upper extremities.
Other treatments that may be utilised in the event of an ankle injury includes:
– Pharmaceutical pain relief such as anti-inflammatories and analgesics.
– Using crutches or braces.
– Foot strapping to improve foot stability.
– Controlling and supportive footwear.
– Custom made orthotic inserts to correct biomechanical causes of injury.
– Muscle and ligament retraining and strengthening.
– Cortisone injections into the affected ankle.
– Surgery may be required to correct severely torn and injured ligaments and tendons that have failed to recover after an extended period of time and after all conservative methods have failed to achieve a sufficient enough result for the patient.
Generally the prognosis for an ankle sprain is good and recovery may take anywhere from a couple of days to a couple of months depending on the severity of the injury. Podiatrists are well trained in dealing with ankle sprains and are able to work with you to tailor a treatment plan that best suits your recovery, giving you the best possible chance of returning to work, sports or play as soon as possible.
If you or anyone you know has a problem with ankle sprains or you need some more information please do not hesitate to contact us at The Podiatry Centre.
Dr Anel Kapur (Podiatrist)