A sprained ankle or twisted ankle as it is sometimes known, is a common cause of ankle pain. A sprain is stretching and or tearing of ligaments (you sprain a ligament and strain a muscle). The most common is an inversion sprain (or lateral ligament sprain) where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.
A medial ligament sprain is rare but can occur particularly with a fracture. This happens when the ankle rolls the other way, so the sole of the foot faces outwards, damaging the ligaments on the inside of the ankle.
The most common damage sustained in a sprained ankle is to the anterior talofibular ligament shown towards the front of the image opposite. This ligament, as the name suggests, connects the talus (ankle bone) with the fibula (smaller of the two bones in the lower leg). If the sprain is severe there might also be damage to the calcaneofibular ligament (connects the heel bone to the fibula) which is further back towards the heel. This ligament only becomes injured in more severe injuries due to its increased strength and laxity whilst the toes are pointed (a common position for ankle sprains).
In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. If possible an X-ray should be used, as small fractures or avulsion fractures are not uncommon.
Severely sprained ankles, where there are complete ruptures of the anterior talofibular, calcaneofibular and posterior talofibular ligaments, result in dislocation of the ankle joint which are often associated with a fracture.
Grades of Severity for Sprained Ankles :
Sprained ankles, as with all ligaments sprains, are divided into grades 1-3, depending on their severity:
Grade 1 sprain:
- Some stretching or perhaps minor tearing of the lateral ankle ligaments.
- Little or no joint instability.
- Mild pain.
- There may be mild swelling around the bone on the outside of the ankle.
- Some joint stiffness or difficulty walking or running.
Grade 2 sprain:
- Moderate tearing of the ligament fibres.
- Some instability of the joint.
- Moderate to severe pain and difficulty walking.
- Swelling and stiffness in the ankle joint.
- Minor bruising may be evident.
Grade 3 sprain:
- Total rupture of a ligament.
- Gross instability of the joint.
- Severe pain initially followed later by no pain.
- Severe swelling.
- Usually extensive bruising.
Treatment of a Sprained Ankle
Treatment of a sprained ankle can be separated into immediate first aid and longer term rehabilitation and strengthening.
Immediate First Aid for a sprained ankle:
Aim to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible.
- R is for rest. It is important to rest the injury to reduce pain and prevent further damage. Uce crutches it necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation.
- I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack or similar immediately following injury for 15 minutes. Repeat this every 2 hours.
- C is for compression - This reduces bleeding and helps reduce swelling. A Lousiana wrap bandaging technique is excellent for providing support and compression to a recently injured ankle.
- E is for Elevation - Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you!
Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible. Range of motion exercises such as ankle circles can help to get the ankle moving again, as well as reducing swelling if performed with the leg elevated. The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.