Healthtips

With an estimated 25,000 people spraining their ankles in the United States on a daily basis, this injury is very common and usually considered minor. However, about 25% of those suffering from an ankle sprain experience long-term joint pain and weakness. Understanding what happens when an ankle is sprained, and how to assess the damage is crucial to developing an effective treatment plan and preventing ongoing problems.

The ankle becomes sprained when the ligaments that connect the bones to the foot, ankle and lower leg are stretched or torn. Ankle sprains usually happen when you make a rapid shifting movement with your foot planted. It is a common injury when playing soccer or being tackled in football.

Generally, the ankle rolls outward while the foot turns inward, resulting in what is called an “inversion injury.” The ligaments on the outside of the ankle will become stretched and possibly torn. Less frequently, the ankle will roll inward while the foot rolls outward and this is defined as an “eversion injury” which damages the ligaments on the inside of the ankle.

The injury to the ligaments varies in severity and podiatrists grade these based upon the intensity of damage. Grade 1 involves stretching or slight tearing of the ligament with mild tenderness, swelling and stiffness. While experiencing some discomfort, you will be able to walk with minimal pain. Grade II is diagnosed as a larger but incomplete tear with moderate pain, swelling and bruising. Damaged areas will be tender to the touch and walking is painful. The most severe version, Grade III is a complete tear of the affected ligament or ligaments with extensive swelling and bruising. Walking is usually impossible because the ankle will give out and the pain is intense.

Symptoms usually increase in severity with increased damage to the ligaments. In more serious sprains, you may hear or feel a tearing sensation and a pop or snap. You will usually experience extreme pain initially and become unable to walk or put any weight on your foot.

If moderate or severe sprains do not heal correctly, your ankle joint may become prone to re-injury. This can occur with the slightest of trauma, such as stepping off a curb. In extreme cases, your ankle may become unstable and easily re-sprained with persistent pain and swelling.

When a patient comes to me with an ankle sprain, I ask them about prior injuries and examine their ankle to see if additional injury has occurred. If the sprain is mild, X-rays may not be needed. In more severe sprains, X-rays are usually taken as it is possible that a bone in the ankle or foot may break at the same time a sprain occurs. The treatment I prescribe for ankle sprain patients usually follows what is described as the PRINCE approach. Protection involves the use of a protective brace, such as an air stirrup or another form of ankle support along with a compression wrap, such as an ACE bandage for the first 24 to 36 hours. Rest entails using crutches until walking without them is no longer painful.

For at least 24 to 72 hours or until the swelling goes down, I tell my patients to apply an ice pack for 10 to 20 minutes every 1 to 2 hours during the day. After 48 hours, a contrast bath which alternates cold and warm water is prescribed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be taken as directed, not only when you have pain, but throughout the day and night for the first few days after injury. Compression involves the application of an elastic compression pack such as an ACE bandage which will help decrease swelling for the first 24 to 36 hours. I also advise my patients that a compression wrap does not offer protection, so they should also wear a protective brace if they want to walk on their injured ankle. Elevation entails raising the ankle above the level of the heart for two to three hours a day to decrease swelling and bruising.

Appropriate treatment and rehabilitation exercises are critical to the healing of ankle sprains. Surgery to the torn ligaments may be recommended if there is a severe ligament tear or multiple tears, or if the bone remains unstable after rehabilitation. Surgery is also a consideration if a bone has been broken.

Ankle sprains may be minor, but if they are not, they may develop into a lifetime of discomfort. As a podiatrist who has treated thousands of these injuries, I encourage those who have sprained their ankle to monitor the injury carefully, and if it does not respond to common sense home remedies, be sure to check with your doctor for treatment before it becomes a chronic problem.