Sprained Ankle: symptoms and treatment options

Updated 2/16/2023
Dr. Baravarian discusses ankle sprains and why not ignore them.

Ankle sprains often while participating in sports, walking on uneven surfaces, or just awkwardly planting the foot.

 

A sprain is an acute injury that can happen in the blink of an eye and typically occurs when the foot is twisted or turned out of its normal range of motion. 

 

The most frequent type of sprain is called an inversion sprain, which is when the outer ligaments stretch or tear when the foot is rolled outward, with the sole facing in. Less common is a medial sprain, which is when the foot rolls inward and overstretches the inside ankle ligaments.

What are the symptoms of an ankle sprain?

Ankle sprains are one of the most common injuries for children and adults alike. They are also the most under-treated. Repeat sprains and sprains that aren't treated properly can result in re-injury, long-term pain, chronic ankle instability, and unnecessary surgeries. For this reason, it is important to have the injury evaluated by a specialist.

 

Typical symptoms of a sprained ankle include:

  • Ankle pain and swelling on the outside of the ankle and foot.

  • Some patients can't place their foot on the ground without pain.
  • The injured area becomes bruised and discolored.
  • There can be a feeling of imbalance as well; it may feel as though the ankle can roll again at any time.
  • You may also experience locking or clicking of the ankle when it is moved.

 

 

Diagnosing the severity of a sprained ankle?

After suffering for months from an ankle sprain that didn't heal, Cynthia is feeling relief from just a few sessions of physical therapy at UFAI.

It is likely that your doctor will take X-rays in the office to determine if there are any fractures or bone chips from the ligament tear, which are not uncommon. In some, usually chronic cases, special stress x-rays are taken to determine the amount of dislocation.

 

Occasionally, an MRI is needed to provide an enhanced image of the ligaments, tendons, and cartilage of the joint to determine the true extent of your injury. 

 

There are three grades of severity for sprained ankles:

 

Grade 1 Sprain – Mild

The ligaments are only slightly stretched, marked by swelling and soreness in the injured ankle.

 

Grade 2 Sprain – Moderate

There is a small tear in the ligament that loosens the ankle joint. The ankle appears swollen, and patients feel pain and have a hard time putting weight on the injury.

 

Grade 3 Sprain – Severe

A severe sprain is a complete tear of the ligament. There is quite a bit of pain and swelling. The ankle will feel very weak and patients won’t be able to put any weight at all on the foot.

 

Repeat sprains of the same ankle can cause a chronic ankle sprain. Chronic ankle sprains can cause pain for months, or even years, after the initial trauma, flaring up whenever the patient tries to play sports, dance, or exercise.

 

High ankle sprain

A high ankle sprain is when you tear or damage the high ankle ligaments that connect the tibia to the fibula. High ankle sprains involve turning inward or outward while your foot is flexed up. Most low ankle sprains happen when the ankle rolls inward, while other low ankle sprains happen when the ankle rolls outward. The low ankle sprains don’t involve the high ankle ligaments. Low ankle sprains are what most of us think of when we hear someone has a sprained ankle.

 

 

Treatment for ankle sprains

If you may have an ankle sprain, call your foot and ankle specialist. You may be asked to schedule an appointment for a closer examination, or your doctor may be able to give you a home treatment plan.

 

While the treatment options will depend on the severity of the injury, many ankle sprains can be successfully treated at home within 4-6 weeks with attentive care and rest.

 

RICE method

    • Ankle Sprain Treatment and RICE, University foot and ankle institute
      Rest. Avoid putting weight on the foot as much as possible, especially for the first week. Limit walking, and use crutches or a scooter to get around.

    • Ice. Use ice to bring down the swelling. Wrap a bag of ice or a cold ice pack in a paper towel and apply it to the ankle immediately after the injury. Ice the sprain for 15-20 minutes every 3-4 hours for the first couple of days after the injury.

    • Compression. Your doctor may splint the ankle, or recommend an elastic wrap to limit the joint’s motion and compress the injury. Compression helps your ligaments to heal and prevent further injury.

    • Elevate. Prop the leg up at or above the level of your heart

 

Ankle brace

If there is minimal damage, a simple lace-up ankle brace will be used with weight-bearing. An elastic bandage can also be used to immobilize the joint and provide ankle support.

 

Physical Therapy

Physical therapy is often critically important to a successful ankle sprain recovery. A physical rehabilitation program can be the difference between a fully healed ankle and chronic ankle instability.

 

Successful physical therapy is not only for reducing swelling and inflammation along with the important strengthening exercises you learn. Physical therapy plays an important role in reconnecting the patients’ minds with their ankles’ physical apparatus.

 

Medication

For pain relief, you can use nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

 

Immobilization

Grade iii sprains usually require complete immobilization in a cast or a boot. This helps to make sure the ligaments have enough time to heal before they are used again.

 

Surgery

In rare and very severe cases, your foot and ankle specialist might recommend surgery. An arthroscopy is performed through a small incision near the joint. The doctor inserts a narrow, flexible camera into the incision and makes the necessary repairs.

 

It is important to remember that proper protection of the ligament after a sprain and active physical therapy during a sprain will result in a better long-term outcome. Even with proper protection and bracing, 30% of ankle sprains can have secondary factors leading to pain. These include chronic ankle instability from loose ligaments, tendon tears, cartilage damage, and scar tissue in the ankle joint. These problems can cause ankle instability, pain, and swelling that often need to be corrected surgically.

 

 

Preventing ankle sprains 

Some ankle sprains simply can’t be prevented. Here are a few tips for keeping your ligaments safe and strong:

  • Take caution on slippery or uneven surfaces.
  • Stretch before and after athletic activities: prepare your body and muscles for the activity. Changes in your activity level expose your body to injury. Balance: improving balance will improve your ability to control your body in all types of positions
  • Strength training: the stronger the muscles that support the ankle, the less likely you are to suffer a sprain
  • Wear well-fitted shoes, appropriate for your activity
  • Avoid sudden turns and changes in direction during athletic activities
  • Be aware of the surface on which you walk, run, or jump
  • Taping and bracing to support the ligaments

 

 

When ankle sprains turn into chronic ankle instability

It’s estimated that roughly 30% of individuals will develop some level of chronic ankle instability after the initial lateral ankle sprain occurs due to under-treatment of the injury.

 

Chronic ankle instability is a condition characterized by a feeling of the ankle "giving way" during normal activities. It is often caused by a previous ankle injury that did not fully heal or was not properly rehabilitated. People with chronic ankle instability may experience pain, swelling, weakness, and difficulty walking or participating in sports. Treatment typically involves physical therapy, strengthening exercises, and sometimes bracing or surgery.

 

Why partner with UFAI for your ankle treatment?

University Foot and Ankle Institute is one of the largest and most technologically advanced providers of foot and ankle care in the country. The team of doctors at the Institute offers expert knowledge in the evaluation and treatment of all conditions of the foot and ankle for children and adults.

 

Our on-site physical therapy services, comprehensive imaging, and bracing facilities allow for a team approach and one-stop care of your ankle injury.

 

Our physicians documented the largest-ever study on a triad injury of the ankle. This triad consists of chronic scar tissue, ankle instability, and tendon tear that can occur together due to ankle sprains. Our revolutionary surgical treatment of these cases has resulted in over a 97% return to full and unrestricted activity in our study group of more than 700 cases.

 

UFAI has worked with many orthopedic product companies to build or improve their products related to chronic ankle instability and pain. From bone and ligament anchors to tendon repair equipment and techniques, we are at the forefront of this revolutionary technology and techniques for foot and ankle care.

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