Ankle sprains are one of the most common injury that occurs to athletes and non-athletes alike. A sprain is a stretching or tearing of the ligaments that stabilize the bones in the ankle. A sprain may occur when involved in a sporting event, by stepping on another player’s foot, or stepping in a hole while running. A sprain may also occur while walking in the street, by stepping awkwardly off a curb or tripping on an uneven surface. Usually sprains occur to the ligaments on the outer side of the ankle, although occasionally the ones on the inner side are affected.
The severity of a sprain is relative to the level of symptoms. In the case of a mild sprain, there is pain, swelling and bruising, but you can walk on your foot without difficulty, and can resume your daily activities and sporting activities relatively quickly. A severe sprain is characterized by a lot of swelling and bruising, and is initially too painful to walk on. Often you have heard or felt a pop at the time of the injury if the sprain is severe. If a severe sprain is not treated properly, this can lead to long-term problems with recurrent ankle sprains (ankle instability).
When to seek medical treatment
If you are unable to walk after an ankle sprain, or if the pain and swelling from a sprained ankle persist for more than 7-10 days, you should seek medical treatment. An x-ray may be taken if the doctor is suspicious for a broken bone. If the diagnosis is a moderate or severe sprain, you will be treated with a brace or possibly a walking cast. The doctor will re-evaluate you at intervals, to see how your ankle is healing.
Treatment and Rehabilitation
Treatment for an ankle sprain begins with rest, ice, compression and elevation, known by the acronym R.I.C.E.
- Rest your ankle by not playing sports and limit your walking
- Ice your ankle to limit the swelling
- Compression bandages such as an ace-wrap help to support the ankle and limit swelling
- Elevate your ankle as much as possible
This first stage in treatment, rest, may take a few days for a mild sprain, to a month or more for a severe sprain.
Once the pain and swelling have decreased and you are able to walk on your foot, you are ready to start rehabilitation. This consists of regaining motion, strength, and balance in your ankle. This can be done through a home exercise program, or through the guidance of a physical therapist. This phase takes from one to three months. During this time you can begin non-impact physical activities such as bicycling, using the elliptical trainer, and swimming.
The final phase in rehabilitation is to gradually return to your previous level of physical activities. Once you are comfortable performing non-impact physical activities, you can return to straight-ahead running. After about one month, you can begin more aggressive sports, requiring cutting, such as basketball, soccer, and racket sports. You may feel more comfortable using an ankle brace, or taping your ankle when you first resume cutting sports.
If your ankle does not continue to improve through the rehabilitation process, it could mean that the sprained ligament(s) has not healed correctly. If you have not sought formal medical treatment, it is time to do so. If you have been under a physician’s care, it is time to return for re-evaluation. You may need further diagnostic studies such as an MRI scan. Despite appropriate treatment, ankle ligaments can heal in a stretched-out position. This is more likely to occur if you have previously sprained that ankle. Another cause for continued pain is that an additional injury occurred, such as cartilage damage in the ankle joint. An MRI can help to determine this.
Although surgery is rarely recommended as the initial treatment of an ankle sprain, surgery may be necessary if an ankle ligament heals in a stretched-out position. This is the common cause for people who recurrently sprain their ankles. Surgery is used to tighten up the damaged ligaments: see “Lateral Ligament Reconstruction.”