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Ankle Sprain Overview

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The ankle joint, which connects the foot with the lower leg, is commonly injured, in fact, ankle sprains are the most common musculoskeletal injury. A twisting motion can occur when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Usually the ankle is twisted in a direction that leads to the heel twisting inward under the ankle. Such injuries happen during athletic events, while running or walking, or even doing something as simple as getting out of bed.

  • The ankle joint is made up of 3 bones.
    • The tibia is the larger bone of the lower leg. It bears most of the body's weight. The lower portion forms the medial malleolus, the inside bump of the ankle.
    • The fibula is the smaller of the 2 bones in the lower leg. Its lower end forms the outer bump of the ankle or lateral malleolus.
    • The talus is the first bone of the foot.
  • Tendons connect muscles to bones.
    • Several muscles control motion at the ankle. Each has a tendon connecting it to one or more of the bones of the foot.
    • Tendons can be stretched or torn when the joint is subjected to more than the tendon can tolerate.
    • An incomplete tear of the tendon is called a strain.
    • Tendons also can be pulled off the bone to which they attach or can tear through the substance of the tendon. The most common tendon injured in the foot is the Achilles tendon. This is the large tendon in the back of the ankle.
  • Ligaments provide connection between bones. Injuries to the ligaments are called sprains. They provide the stability to the joints.
    • The ankle has many ligaments holding it together. There are two groups of ligaments. One group is on the inside and attaches the medial malleolus to the talus. The other is on the outside and attaches the fibula or lateral malleolus to the talus and calcareous (or heel bone). Stress on these ligaments can cause them to stretch or tear.
    • The most commonly injured ligament is on the lateral side. The anterior talofibular ligament that connects the front part of the fibula to the talus bone is the most commonly injured ligament.
      Ankle Sprain Causes: (click here to find out more)

Ligaments are injured when excess stretching force is applied to them. This happens most commonly when the foot is turned inward or inverted. Usually the injury happens in one of the following ways:

  • Awkwardly planting the foot when running, stepping up or down, or during simple tasks such going down the stairs while you are not watching
  • Stepping on a surface that is irregular or uneven , such as stepping in a hole
  • Athletic events when one player steps on another player or catches the foot while running (A common example is a basketball player who goes up for a rebound and comes down on top of another player's foot.)
    Ankle Sprain Symptoms (click here to find out more)
  • Swelling because of increased fluid in the tissue: Sometimes the swelling is so severe that you can leave an indentation in the swollen area by pressing on it with your finger. This is called “pitting edema”.
  • Pain because the nerves are more sensitive: The joint hurts and may throb. You can make the pain worse by pressing on the sore area, by moving the foot in certain directions (depending upon which ligament is involved), and by walking or standing.
  • Redness and warmth caused by increased blood flow to the area. Bruising occurs when there is damage to the blood vessels and bleeding occurs under the skin.

When to Seek Medical Care

Usually, an ankle sprain itself does not call for a trip to the doctor.  Most heal with observation and rest. The problem is how to tell a sprain from a more serious injury such as a fracture. If the following happen, you should contact your doctor:

  • Your pain is uncontrolled, in spite of over-the-counter medications, elevation, and ice.
  • You cannot walk or cannot walk without severe pain.
  • Your ankle fails to improve within 5-7 days. The pain need not be gone, but it should be improving.
  • A follow-up visit 1-2 weeks after the injury is advisable to help with flexibility and strengthening exercises.

The indications to go to a hospital's emergency department are similar to those for which to call the doctor. The following conditions suggest you might have a fracture, or you may need a splint for pain control.

  • Severe or uncontrolled pain
  • Foot or ankle is misshapen beyond normal swelling
  • Cannot walk 4 steps, even with a limp
  • Severe pain when pressing over the lateral malleolus, the bump on the outside of the ankle or any pain on the inside of the ankle

Exams and Tests

The doctor will check to see if a fracture or other serious injury has happened to require immediate care.

  • The examination should make sure that you haven’t injured the tendons, nerves or arteries to the foot.
    • The doctor will handle and move the foot and ankle to determine what bony areas are involved.
    • Finally, the Achilles tendon will be checked for signs of rupture.
  • X-rays are often, but not always, needed to make sure that a fracture is not present.
    Ankle Sprain Treatment (click here to find out more)

Self-Care at Home

Care at home is directed toward lessening the pain and helping healing. Because most of the pain is caused by inflammation, you should try to reduce inflammation and keep it from happening.  A common course of treatment is RICE (Rest, Ice, Compression and Elevation>).

  • Rest prevents further injury and avoids stress on already inflamed tissue.
    • Put the ankle joint at rest by wearing a brace or splint.
    • The best type is made of canvas with laces and usually is available at sporting goods stores or a pharmacy
  • Ice is probably the best treatment.
    • Applying ice to the injury will do more for most people than medications.
    • Ice will counteract the increased blood flow to the injured area.
    • It will reduce the swelling, redness, and warmth.
    • Applied soon after the injury, ice will prevent much of the inflammation from happening.
    • Do not apply ice directly to the skin. Use a towel between the ice and the injury, or use an ice bag. Apply ice for 20 minutes at a time, with at least 20 minutes between applications. This is to prevent frostbite, which can occur if you use ice too much or use it directly on your skin.
  • Compression
    • Compression wraps, such as Ace bandages, do not provide much support to prevent movement of the ankle, but do limit the amount of swelling
    • Do not apply them too tightly and rewrap it often.
  • Elevation (keeping the injured area up as high as possible) will help the body absorb fluid that has leaked into the tissue and limit the amount of swelling.
    • Ideally, prop the ankle up so that it is at or above the level of your heart.
    • You can do this in a reclining chair.
  • Anti-inflammatory pain medications will reduce the pain and combat the swelling. Several are available over-the-counter, such as ibuprofen (Motrin IB and Advil are common brands) and naproxen sodium (Aleve or Naprosyn are examples).

Medical Treatment

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Treatment by a doctor will be very similar to that described for home care, especially using ice to lessen the inflammation.

  • The doctor may elect to apply a brace to reduce motion of the ankle. Braces especially limit the forces that could stretch out the ligament as it heals.  Crutches are frequently provided so you do not have to bear weight on the injured ankle.
  • The ankle may also require extra immobilization if it is a severe sprain.  This can be in the form a walking boot or cast.
  • The most common medications used for ankle sprains are anti-inflammatory pain medications that both reduce pain and help control inflammation. If you cannot tolerate these drugs, acetomenophen (such as Tylenol) or narcotics are common alternatives.
  • Only very rarely does a severe ankle sprain require surgery.  This is usually in the case of repeated injuries in athletes.