What is a Sprained Ankle?

A sprained ankle is a common injury sustained when some kind of force is applied to the foot compromising the soft tissue, particularly the ligaments, connecting the foot and lower leg. An ankle sprain may occur as the result of abnormal, forced rolling, or twisting of the ankle. This stretches the ligament and causes instability in the foot.

Sprained ankles are common sports injuries sustained in a variety of sports including football, basketball, baseball, soccer, and lacrosse.

Classifications of an Ankle Sprain

There are three classifications of an ankle sprain:

• Grade I
• Grade II
• Grade III

The grade, or severity, of your ankle sprain is determined during an exam with a physician and depends on how much the ligaments have been stretched or torn.

Grade I

A Grade I ankle sprain means the ligament was only slightly stretched and will generally heal on its own with a home care plan. The injury typically resolves in 2-4 weeks.

Grade II

A Grade II sprain is a larger but incomplete tear and is accompanied by a higher degree of swelling and discomfort. A Grade II sprain may also show significant bruising. Consulting with your physician and a physical therapist is advised, as medical direction may help alleviate these symptoms sooner than if you manage it on your own. The injury may resolve as soon as 4 weeks, but could take 6-8 weeks to fully heal.

Grade III

A Grade III ankle sprain is a complete tear of the affected ligaments with severe swelling and bruising. Ankle instability is prevalent with this grade of sprain. A patient with a high Grade II or Grade III sprain may be placed in a walking boot for several weeks to allow the injury time to heal. If the ligaments are completely torn away from the bone, called an avulsion fracture, surgery may be necessary to repair the ligaments.

High Ankle Sprains

These tend to be much less common than a traditional ankle sprain, yet much more serious in nature. The high ankle ligaments (also called the syndesmosis) are located above the ankle, as opposed to the more commonly injured ligaments on the outside of the ankle.

This occurs usually from the ankle rolling outwardly away from the ankle or adjacent foot and there is tearing and damage to the high ankle ligaments. This is more serious because the high ankle ligaments connect the tibia to the fibula. When you bear weight on the leg, the tibia and fibula experience high forces that spread them apart. The ligaments of the syndesmosis serve as shock absorbers, preventing the tibia and fibula from spreading too far apart. Without them functioning properly, running and walking become very painful.

What are the Symptoms of a Sprained Ankle?

Sprained ankles usually present with tenderness, swelling, bruising, and pain. It may be difficult to move your foot up and down, or to the left and right, without feeling pain. You may also feel a popping or stretching sensation.

Your physician will conduct a physical/visual examination and discuss the history of your injury. An X-ray may be ordered for the evaluation of an ankle sprain.

How Long is the Recovery from a Sprained Ankle?

Initially, over-the-counter anti-inflammatory medications will help ease swelling and control pain. Icing your ankle for no more than 15-20 minutes once every hour may also relieve symptoms. A severe high-ankle sprain may often present with similar symptoms as a fractured bone. An X-ray can confirm or rule out a broken bone.

Recovery and Return to Activity

Recovery depends largely on the type and grade of ankle sprain. Three phases of recovery for sprains which do not require surgery generally include:

• Phase 1 includes resting, protecting, and reducing swelling of your injured ankle.
• Phase 2 includes restoring your ankle’s flexibility, range of motion, and strength.
• Phase 3 includes gradually returning to straight-ahead activity and doing maintenance exercises, followed later by sport-specific exercises (e.g., sprinting and cutting).

**For high ankle sprains, sprains that are more severe, or sprains that require surgery recovery times vary and should be estimated by your physician or physical therapist.

If rehab is prescribed

It’s important to complete the rehabilitation program because it makes it less likely that you’ll hurt the same ankle again. If you don’t complete rehabilitation or if your ligament heals in a stretched-out position and cannot perform its normal function, you could suffer chronic pain, instability, and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament or ligaments have not healed right, or that some other injury occurred at the time of the ankle sprain (e.g., cartilage damage or tendon injury).

Do You Feel or Have Any of These Symptoms?

• After an event where the ankle became twisted
• Ankle tenderness
• Ankle swelling
• Bruising around the ankle
• Pain around the ankle
• It may be difficult to move your foot up and down, or to the left and right, without feeling pain.
• You may also feel a popping or stretching sensation.

*Important to note high ankle sprains typically do not cause a tremendous deal of swelling or bruising which can be frustrating for athletes as it might not “look bad”.

Before You See a Physician  

Consider how the ankle was injured and if it could be a normal ankle sprain or potentially a high ankle sprain.

Potential At-home Nonsurgical Treatments

Surgery is not required in the vast majority of ankle sprains. Even in severe sprains, these ligaments will heal without surgery if treated appropriately. (However, if the ankle is not improving the possibility of a fracture should be considered) The grade of the sprain will dictate treatment. Some at-home treatments to try before scheduling, or while waiting for, a doctor’s appointment include

R.I.C.E

• Rest– your ankle by not walking on it until you can do it comfortably (this may require a boot brace or lace up brace).
• Ice – Applying ice several times a day for 20 minutes at a time can help reduce swelling. Avoid applying it directly to skin.
• Compression – compressive bandages help immobilize and support your injury
• Elevation – If lots of swelling remains elevate your ankle above your heart level for 48 hours

Medications

Nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and reduce swelling. Other medications can be prescribed to help pain and swelling in patients with more severe sprains.

Limit Weight-bearing Activities

You should limit weight-bearing as comfort permits for at least a few days, and then increase weight bearing as you can tolerate it. In the case of a severe sprain and slow recovery, your doctor may prescribe a CAM walker boot or ankle brace to provide protective weight-bearing.

Reasons to See a Physician and Treatment Options

You should see a doctor if you have persistent moderate or severe pain, swelling or bruising after applying the treatments above for three to five days. But if the pain or other symptoms are very intense, such as if it hurts too much to put any weight on the ankle and you can’t walk, you should see an orthopedist or sports medicine doctor as soon as possible to ensure that you do not have a broken ankle or to learn whether your sprain is severe enough to require special treatment.

Some of these treatments would include stabilization of the foot with a boot or brace. If it is a high ankle sprain or severe common sprain it could require surgery.

Prevention Methods and Tips

• Use proper equipment – Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat.
• Aim for balanced fitness – Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility.
• Warm up – Warm up to prepare for exercise. Warming up increases your heart and blood flow rates and loosens up muscles, tendons, ligaments, and joints.
• Drink water – Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Have a drink of water every 20 minutes or so while you exercise.
• Cool down – Make cooling down the final phase of your exercise routine. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely.
• Stretch – Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 10 to 20 seconds, then slowly and carefully release it. Do each stretch only once.
• Rest – Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons not to exercise.
• Avoid the “weekend warrior” syndrome – Try to get at least 30 minutes of moderate physical activity every day.

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