Ankle Sprain

Ankle Sprain Overview

 

The ankle joint, which connects the foot with the lower leg, is injured often. An unnatural twisting motion can happen when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Such injuries happen during athletic events, while running or walking, or even during everyday activities such as getting out of bed.

  • The ankle joint is made up of three bones. 

    • The tibia is the major bone of the lower leg, and it bears most of the body's weight. Its bottom portion forms themedial malleolus, the inside bump of the ankle. 
    • The fibula is the smaller of the two bones in the lower leg. Its lower end forms thelateral malleolus, the outer bump of the ankle. 
    • The talus is the top bone of the foot.
  • Tendons connect muscles to bones. 

    • Several muscles control motion at the ankle. Each has a tendon connecting it to one or more of the bones of the foot. 
    • Tendons can be stretched or torn when the joint is subjected to greater than normal stress. 
    • Tendons also can be pulled off the bone. An example of an injury of this type would be an Achilles tendon rupture.
  • Ligaments provide connection between bones. Sprains are injuries to the ligaments

    • The ankle has many bones that come together to form the joint, so it has many ligaments holding it together. Stress on these ligaments can cause them to stretch or tear. 
    • The most commonly injured ligament is the anterior talofibular ligament that connects the front part of the fibula to the talus bone on the front-outer part of the ankle joint.

Ankle injuries can be painful and can make it difficult to carry out daily activities.

Ankle Anatomy and Common Injuries

Click to larger picture of the ankle anatomy

 

 

Ankle Sprain Causes

 

Ligaments are injured when a greater than normal stretching force is applied to them. This happens most commonly when the foot is turned inward or inverted. This kind of injury can happen in the following ways:

  • Awkwardly planting the foot when running, stepping up or down, or during simple tasks such as getting out of bed
  • Stepping on a surface that is irregular, such as stepping in a hole
  • Athletic events when one player steps on another player (a common example is a basketball player who goes up for a rebound and comes down on top of another player's foot. This can cause the rebounder's foot to roll inward.)

 

Ankle sprain. Inversion injury of ankle. Note it is turned inward. 
Click to view larger picture of sprained ankle

 

Ankle Sprain Symptoms

 

When an ankle is injured with a sprain, tissue injury and the resulting inflammation occur. Blood vessels become "leaky" and allow fluid to ooze into the soft tissue surrounding the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well. Typical changes that happen with inflammation include the following:

  • Swelling because of increased fluid in the tissue is sometimes severe.
  • Pain because the nerves are more sensitive: The joint hurts and may throb. The pain can worsen when the sore area is pressed, or the foot moves in certain directions (depending upon which ligament is involved) and during walking or standing.
  • Redness and warmth caused by increased blood flow to the area.

When to Seek Medical Care

 

Usually, an ankle sprain itself does not call for a trip to the doctor. The problem is how to tell a sprain from a more serious injury such as afracture. If any of the following occur, you should contact your doctor:

  • Unable to walk or cannot walk without severe pain.
  • The ankle fails to improve within five to seven days. The pain need not be gone, but it should be improving.
  • A follow-up visit one to two weeks after the injury is advisable to help with flexibility and strengthening exercises.

The indications to go to a hospital's emergency department are similar to those for which to call the doctor. The following conditions suggest the patient might have a fracture or more serious injury, or a splint may be needed for pain control:

  • Severe or uncontrolled pain
  • The foot or ankle is misshapen beyond normal swelling
  • Cannot walk four steps, even with a limp
  • Severe pain when pressing over the medial or lateral malleolus, the bumps on each side of the ankle
  • Loss of feeling in the foot or toes
  • Pain and swelling in the back of the ankle, over the Achilles tendon area, or inability to push the toes down (forward-like pressing a gas pedal).
  • Pain or swelling to the upper part of the lower leg just below the knee or swelling of the calf muscle.

 

Exams and Tests

 

The doctor will perform a physical exam to see if a fracture or other serious injury has happened that requires immediate care.

  • The examination should check that the nerves or arteries to the foot have not been injured, and also check that the knee or the rest of the leg is not involved. 

    • The doctor will handle and move the foot and ankle to determine what bony areas are involved. 
    • The Achilles tendon will be checked for signs of rupture.
  • X-rays are often, but not always, needed to make sure that a fracture is not present. In some cases of fracture, a CT scan may be needed.

 

Ankle Sprain Treatment

 

Self-Care at Home

 

Care at home is directed toward lessening pain and helping healing. Because most of the pain is caused by inflammation, the goal is to reduce inflammation and keep it from happening.

  • Ice is the best treatment. 

    • Applying ice to the injury will do more for most people than medications. 
    • Ice counteracts the increased blood flow to the injured area. 
    • It reduces the swelling, redness, and warmth. 
    • Applied soon after the injury, ice prevents much of the inflammation from developing. 
    • Do not apply ice directly to the skin. Use a towel between the ice and the injury, or use an ice bag. Apply ice for 20 minutes at a time, with at least 30 minutes between applications. This is to prevent frostbite, which can occur if you use ice too much or use it directly on your skin.
  • Rest prevents further injury and avoids stress on already inflamed tissue. 

    • Put the ankle joint at rest by wearing a brace or splint. 
    • Compression wraps such as Ace bandages provide some support to prevent movement of the ankle. You should not, however, apply them too tightly.
  • Elevation (keeping the injured area up as high as possible) will help the body absorb fluid that has leaked into the tissue. 

    • Ideally, prop the ankle up so that it is above the level of the heart. 
    • This can be done a reclining chair.
  • Anti-inflammatory pain medications will reduce the pain and combat the swelling. Several are available over-the-counter, such as ibuprofen (Motrin IB and Advil) and naproxen (Aleve or Naprosyn).

 

Medical Treatment

 

Treatment by a doctor will be similar to home care, especially using ice to lessen the inflammation.

  • The doctor may elect to apply a brace orcast to reduce motion of the ankle.Crutches are frequently provided so the patient does not have to bear weight on the injured ankle.
  • The most common medications used for ankle sprains are anti-inflammatory pain medications that both reduce pain and help control inflammation. If the patient cannot tolerate these drugs, acetaminophen (such as Tylenol) or narcotics are common alternatives.

 

Next Steps

 

Follow-up

 

Follow-up for ankle sprains is needed only if the ankle is not healing well. This could indicate there is a previously undetected fracture or torn ligaments. An orthopedic or podiatric specialist should be consulted if initial treatment fails. Go to a doctor for follow-up care if either of the following is true:

  • The patient cannot walk on the injured ankle within a week of the injury.
  • The patient's ankle continues to hurt after two weeks.

 

 

Prevention

 

Ankle sprain prevention can be as simple as wearing the right shoes or as complicated as balance training for athletes.

  • Keep the ankles strong and flexible. Consult with the doctor or physical therapist for strengthening exercises.
  • Wear proper shoes for the activity. Always wear stable shoes that give your ankle proper support. High-top basketball shoes are a good choice. (High heels or platform shoes are not the best choice if you're trying to prevent an ankle sprain.)
  • When participating in a sport, consider having a weak ankle taped to offer extra support. If the patient has repeated sprains, wearing an ankle brace while playing may help as well.
  • Making sure that the playing field (or home environment) is clear of any holes or obstacles also can help avoid injury.

 

Outlook

 

Most ankle sprains (70%-90%) heal without complications or difficulty.

  • Surgery is seldom needed for torn ligaments. Ligament tears are often noticed when sprains fail to get better. If the diagnosis of a tendon tear that needs surgery is not made right away, the outcome of the surgery is the same as if the doctor did the operation immediately.
  • Exercises should be started to maintain flexibility and strength when the swelling has resolved and the patient can walk without pain, usually within one week.

 

Multimedia

 

Media file 1: Medial and lateral malleoli, the "bumps" on either side of the ankle. The medial malleolus is formed by the tibia, while the fibula forms the lateral malleolus.
Click to view original file
Media type: Photo

Media file 2: Ankle sprain. Inversion injury of ankle. Note it is turned inward.
Click to view original file
Media type: Photo

 

Synonyms and Keywords

ankle sprain, twisted ankle, turned ankle, rolled ankle, tibia, medial malleolus, fibula, talus, anterior talofibular ligament

 

 

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