Ankle injuries occur quite frequently and are a common reason for a visit with a primary care doctor or emergency department in the United States.
Teenagers and young adults have the highest incidence of ankle sprains, and nearly half occur during an athletic activity. Ankle injuries account for approximately 20% of all sport related injuries.
People with previous history of ankle injury or those with decreased balance are at highest risk of ankle sprain.
Symptom duration of an ankle sprain depends on severity and grade of injury, and should be followed up four to six weeks after the injury to assess for ligament instability.
What Causes An Ankle Sprain?
Dr. Abbas Rizvi, a Board Certified Family Doctor in Orlando, Florida wants his patients to understand the importance of balance training and appropriate equipment when participating in athletic activities. Although less common, he states, "ankle injuries can occur outside of the athletic environment, and a prompt office visit is required if one can not bear weight to evaluate for an ankle fracture."
Ligaments are connective tissue made mostly by collagen attached to bones. These fibrous materials hold bone structures together assisting in stability of a joint and these ligaments are often involved in sprains.
The main ligaments involved in ankle injury include three ligaments on the outside (laterally) and one thick ligament called the deltoid ligament supporting the inner side of the ankle (medial). There are other ligaments surrounding the ankle as well.
Ankle injury occur in many ways but most commonly occur when the ankle is inverted with the ankle flexed. The ligaments involved in inversion injury include the anterior talofibular, calcaneofibular, and posterior talofibular.
Less commonly, ankle sprains can occur with eversion and rotational injuries. High ankle sprains involve the tibiofibular syndesmosis and rarely, an eversion injuries occur affecting the deltoid ligament.
Usual ankle injuries occur after blunt trauma, or a fall resulting in ligament sprains due to inversion.
How Are Ankle Sprains Diagnosed?
Ankle sprains are graded based on severity of symptoms:
Grade 1 Sprains: Minimal pain and swelling, minimal bruising, and one can bear weight on the ankle.
Grade 2 Sprains: Increased swelling and bruising with significant pain associated with difficulty bearing weight of the injured ankle
Grade 3 Sprains: Inability to bear weight associated with severe pain, swelling and diffuse bruising.
When pain is in the ankle and spreads higher up in the fibula (lower bones of leg), this can be considered a high ankle sprain.
Your Doctor will use your history and physical exam prior to diagnosis, along with utilizing evidence based decision rules to help guide the indication for an ankle or foot X-ray to evaluate for a fracture.
The physical exam is more sensitive 3-5 days after an injury to detect lateral ligament rupture. This should not delay an evaluation by your doctor after an ankle injury with significant pain associated with weight bearing.
How Are Ankle Sprains Treated?
After you have been evaluated to determine if your ankle sprain is not a fracture, conservative treatment methods include the PRICE method
P: Protection
R: Rest
I: Ice
C: Compression
E: Elevation
Icing is effective immediately after an injury, and research indicates that intermittent icing resulted in improvement of pain compared to continuous icing.
Ankle braces and supports, including semirigid or preferably lace- up supports are better for recovery compared to immobilization for return to activity. These supportive braces reduce healing time and provide adequate support to prevent further injury.
Over the counter pain medications such as NSAID (non steroidal anti-inflammatory drugs) along with acetaminophen help decrease swelling and pain allowing you to improve function of the joint.
Rehab and physical therapy allow patients to return to sports and work sooner. Rehab allows supervised ankle exercises to help improve joint stability and improve balance.
Ankle exercises include ankle circles, drawing alphabet letters with your foot, and toe and heel raises which are well tolerated in the healing phase and very effective in recovery.
When Should You Be Seen By A Surgeon?
If pain is severe with inability to bear weight both immediately or after taking a few steps should prompt a surgical evaluation to review for a possible ankle fracture.
If significant pain is near the malleoli, the bony structure on both sides of the ankle joint, then there is increased risk of fracture. Increased risk of ankle fracture also is seen if the malleoli bone is tender to touch.
If these symptoms occur, it is important to obtain an image to evaluate for fracture, and we are trained in providing these assessments.
How Long Does It Take For Ankle Sprains To Heal?
Patients with grade 1 sprains, typically recover on their own within days, but more higher grade sprains can last up to 4 weeks depending on severity.
Ankle injuries can lead to long term pain, and development of arthritis if left untreated or improperly diagnosed. Poor treatment and rehabilitation can also lead to ankle instability.
Follow up appointments should be made 4-6 weeks following an injury to ensure there is no need for surgical referral or re-evaluation of the injury.
Athletes who have suffered a severe ankle sprain, should utilize supporting devices while playing for at least 6 months while improving their overall joint stability, supportive muscle strength, and proprioception.
How Do You Prevent An Ankle Sprain?
It is important to improve balance, strength, and improve your body's ability to sense movement, action and location. This is called proprioception and improvement in these aspects will help prevent an ankle injury in the future.
In student athletes, include balance training programs to reduce ankle sprains.
If you have a prior history of ankle sprain and are performing high risk activity, such as playing sports, consider ankle support devices. This decreases the risk of sprains and aids in ankle support.
Overall, improving strength of supporting muscles, along with adequate bracing and taping when necessary is an effective measure to prevent recurrent ankle sprains.