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Ankle Sprain

informationAn ankle sprain involves twisting an ankle, resulting in a painful and swollen joint. The swelling comes from stretched or torn ligaments of the ankle. While ankle sprains are common, they are not always considered to be minor injuries. 

A person can have a severe sprain or multiple minor sprains that lead to having chronic pain in the joint and joint laxity and weakness. This is why it’s important to treat a sprained ankle so it doesn’t lead to long term ankle problems.

In this article:

What is an Ankle Sprain?

There are three kinds of an ankle sprain. They include the following:

  • Inversion injury. This is the most common type of ankle sprain. It causes tearing or stretching of the anterior talofibular ligament. It happens when the ankle is turned in.
  • Eversion injury. This is when the ankle is turned outward. It is less common than an inversion injury and causes damage to the anterior or posterior talofibular ligaments.
  • High ankle sprain. This is the least common type of sprain. It occurs when the foot rotates outward or when the foot is planted and the leg rotates inward. The injury is higher up on the ankle than the other two types of sprains.

Ankles sprains can be mild or can be severe. It depends on the ligament and its degree of damage and on how many ligaments have been damaged. In a mild sprain, the ankle is swollen, stiff, and tender but it feels relatively stable and you can walk on it.

A moderate sprain may show some bruising along with tenderness and swelling. The ankle may even feel a bit unstable. In a severe sprain, it is difficult to walk on the ankle because of instability and there is a great deal of bruising, swelling, and tenderness.

Ankle sprains can be any one of three degrees. These include the following and can occur with any type of ankle sprain.

First-Degree Sprain

This type of sprain occurs when the ligaments have been somewhat stretched but not torn. These are the primary symptoms:

  • Minimal to mild pain
  • Mild joint stiffness
  • Mild swelling
  • Minimal joint stability
  • Problems jumping on the leg
Second-Degree Sprain

This type of sprain is the most common type of sprain and involves at least a partial tear of the ligament. These are the major symptoms:

  • Significant swelling
  • Moderate pain
  • Bruising over the ligament
  • Lack of ability to move the ankle
  • Difficulty ambulating
Third-degree Sprain

This is the worst kind of sprain you can get in the ankle. The ligament has been completely torn. The major symptoms include:

  • Severe pain
  • Severe swelling
  • Joint instability
  • Walking becomes too painful
  • Extreme loss of motion
Causes of an Ankle Sprain

Ankle sprains are caused by rapidly shifting your leg movement with your foot planted in one spot. It can also happen when your ankle shifts to one side or the other with your whole weight on it. The supporting ligaments stretch in some cases and break in others. Common causes of ankle sprain include:

  • Soccer
  • Running
  • Football
  • Walking on uneven terrain
  • Walking downstairs
Symptoms of an Ankle Sprain

The symptoms of an ankle sprain can sometimes be similar to that of a fracture. The only way to tell if the ankle is fractured or sprained is to do an x-ray to look for a fracture. Typical symptoms of an ankle sprain include:

  • The feeling of a pop or snap in the lateral or medial aspect of the ankle, representing a tear in the affected ligaments.
  • Pain in the ankle, which is worse when attempting to bear weight on the ankle.
  • A feeling of instability of the ankle when stepping on it
  • Swelling on the side of the sprain
  • Tenderness to touch on the ankle
  • Inability to have a full range of motion of the ankle
  • Bruising over the affected ligament

The symptoms of an ankle sprain tend to be worse the more that the ligaments have been affected. A completely torn ligament will lead to the worst and most obvious symptoms.

Diagnosis of Ankle Sprain

An ankle sprain can be difficult to diagnose because a plain film x-ray won’t show anything abnormal. A plain film x-ray, however, will show whether or not the injury was a fracture or a sprain in most cases.

If there is some question that the injury might be a fracture, an MRI of the ankle can be done, which will show soft tissue injuries such as ligamentous tears and any occult fractures that might be present.

The diagnosis is therefore based on a careful history and physical examination. The doctor stresses the ankle and looks for areas of bruising to see if the ligament has been left intact or not.

Treatment of an Ankle Sprain

There are simple, first-aid remedies for a sprained ankle that everyone should have shortly after suffering an ankle sprain. These include using the RICE treatment, which involves the following choices:

  • Rest—This is done in the first one to two days following the injury
  • Ice—This is given for twenty minutes at a time for the first 48 hours
  • Compression—Wear an air cast brace or a snug ACE wrap to keep the swelling down
  • Elevation—keep the ankle above the level of the heart if you can

Most ankle sprains are treated conservatively. If it is a first-degree sprain, wear an orthopedic walking boot for at least two weeks and use crutches for at least a week. Use the RICE method as directed above.

Casting or braces allow you to ambulate with or without crushes. Bandages are less successful but they can compress the wounded area and keep swelling to a minimum.

A great deal of the recovery process of ankle sprains depends on rehabilitation and exercising. Rehabilitation should be done no matter how severe or mild the injury was. Rehabilitation exercises should begin around week 2 after the injury.

Ankle exercises are designed to increase strengthening, flexibility, agility, and balance.

If the exercises are done correctly, they will prevent chronic pain and re-injury to the ankle in the future. Exercises can be done using the air cast or below the knee cast and are proven substantially better at preventing re-injury than the compression bandage.

In one study, ankle exercises that focused on activation of the ankle, sensorimotor control, and strengthening were carried out for twenty minutes three times daily. Patients also rested the first few days after the injury. Almost all injured persons healed completely.

Ankle exercises bring the ankle through its complete range of motion using ankle circles. Another exercise has the individual draw the letters of the alphabet with the toes through the air. Eversion exercises with prevent an inversion injury and vice versa. Stretching between exercises is important. Balance is worked on by balancing on the affected foot. One exercise has the person go on tiptoe on the affected foot. Some physical therapy devices are used to strengthen the ankle.

Agility exercises include squat jumps and power skipping and are done after the ankle has regained its strength.

Complications of Ankle Sprain

Most people recover after a couple of weeks but the pain and instability last for up to a year in up to 30 percent of patients. Patients can have ongoing instability and re-injury if the sprain is not treated properly.

Sacramento Traumatic Injury Lawyer

If you or a loved one has suffered an ankle sprain injury as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 or 800.404.5400 to set up a FREE consultation.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 10.14.20

Photo by ThisIsEngineering from Pexels

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