Ankle Sprain

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. See a picture of an ankle sprain.

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 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. See a picture of the different types of ankle sprains.

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. See a picture of an ankle sprain.

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.

If the sprain is mild, your doctor may not order X-rays. But with more severe sprains, you may need X-rays to rule out a broken bone in the ankle or the foot. It is possible to break a bone in your foot or ankle at the same time as a sprain.

In most cases, doctors order X-rays in children with symptoms of an ankle sprain. This is because it is important to find and treat any damage to the growth plates in bones that support the ankle.

How is it treated?

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

• Protection. Use a protective brace, such a brace with a built-in air cushion or another form of ankle support.
• Rest. 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.
• NSAIDs or acetaminophen. NSAIDs (such as Advil and Motrin) are medicines that reduce swelling and pain. Acetaminophen (such as Tylenol) reduces pain.
• 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.

Proper treatment and rehabilitation 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 while using crutches if it doesn't hurt too much. 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.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: January 11, 2008
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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