Ankle Sprain


Ankle sprains are very common ankle injuries, usually the result of the ankle turning inward. An ankle sprain occurs when a ligament connecting the ankle bones is stretched or torn. If treated quickly and properly, most ankle sprains heal completely, allowing a safe and early return to activity. Recurrent sprains are common, so it is important to strengthen the muscles that stabilize the ankle.

Contributing Factors to Ankle Sprains

  • Muscle weakness or imbalance
  • Inappropriate footwear
  • Overweight
  • Family tendency
  • High-arch foot
  • Previous injury

Grades of Ankle Sprains

Ankle sprains are graded as mild, moderate and severe. The more severe the sprain, the longer the time to recover.

First Degree (Mild)

This injury is the most common and usually the most minor. Ligaments connecting the bones of the ankle are “stretched”, causing a small amount of injury to the ankle ligaments. There is slight swelling but no instability. With a first degree injury, you can expect to be back to sports within 1 to 3 weeks.

Second Degree (Moderate)

When this injury occurs, the ankle ligaments are more deeply tom, resulting more pain and swelling. There is bruising of the skin and pain with walking. There can be looseness and minor instability. A second-degree sprain may require the use of a protective brace and 3 to 6 weeks of rest and recovery before you can return to full activity.

Third Degree (Severe)

This injury results in a full tearing or rupture of an ankle ligament usually on the inner and outer side of the ankle. The ankle can be very swollen and weight-bearing is painful. Crutches are often necessary and sometimes the ankle will be placed in a cast or cast-boot to allow the injury time to rest and heal. Surgery is rarely necessary, but the third-degree ankle sprain can take many months to fully heal and may result in residual looseness of the ankle joint.

Symptoms and Diagnosis

  • Pain
  • Swelling
  • Difficulty walking

An X-ray is often taken to insure that there are no broken bones in the ankle. For severe or recurrent ankle sprains, an MRI may be obtained to confirm a ligament rupture.

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Treatment Options

Non-operative treatment is divided into four stages. The rate of progress from one stage to the next depends upon the amount of pain and swelling present, and whether an elastic bandage, tape, a brace or a cast was used to stabilize your ankle.

Stage 1 (up to 72 hours)

To reduce pain and swelling, apply ice to the ankle for 20 minutes every hour while awake. Crushed Ice application in a plastic bag with a towel between the ice and your skin is a safe method to use. Compression of the ankle with an elastic bandage will help to limit swelling. The ankle should be elevated, as much as possible, to a position higher than your heart to reduce swelling. A splint, brace or cast may be applied to support or immobilize the ankle.

Stage 2 (first week)

You can walk and bear weight on the ankle as soon as it is comfortable. Crutches can be used as partial support when you begin to walk. Continue using taping, bracing or a cast. Let pain be your guide as to how much activity is enough.

After an injury your ankle will get stiff. It is important to maintain the full range of motion your ankle. As an exercise to increase the ankle motion, rest your heel on the floor and write the alphabet in the air with your big toe, making the letters as large as you can.

Stage 3 (second week and after)

After the pain and swelling have subsided, you should try to walk normally with a brace or elastic support. Maintain ankle motion and strengthen the supporting muscles using theraband elastic bands.

Stage 4 (variable)

Your ankle should be strong when you return to full daily activity or sports. Returning too early to full activity may lead to re-injury and a chronic problem.

If you have recurrent ankle sprains, you may have torn the supporting ligaments that maintain the stability of the ankle joint. This can be diagnosed on physical exam and confirmed with an MRI. If you have completely torn ligaments and have failed non-operative care, then you may be a candidate for a ligament repair.

Risks and Results

The goal of surgery is to restore the stability of the ankle joint. Overall, the vast majority of patients are happy with the results after surgery. In addition to the general surgical risks, the risks specific to this procedure are mainly stiffness and recurrent instability.

General Risks of Surgery

As with any invasive procedure, there are inherent risks which include, but are not limited to:

  • Infection
  • Injury to blood vessels and nerves
  • Bleeding
  • Blood Clot
  • Joint stiffness
  • Continued pain
  • Need for further surgery

If you are having a fracture repair there is also a risk of the fracture not healing. For procedure specific risks please refer to that section or ask your doctor.

There are also risks of aesthesia which are best reviewed with your anesthesiologist at the time of surgery.

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Further Reading

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