Ankle Sprain

What is it?

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury that affects many people during a wide variety of activities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs independently

What are the treatment options?

Surgery is not required in the vast majority of ankle sprains. Even in severe sprains, the ligaments will most likely heal without surgery. The grade of the sprain will dictate treatment. Sprains are traditionally classified into several grades. Perhaps more important, however, is the patient’s ability to bear weight. Those that can bear weight even after the injury are likely to return very quickly to play. Those who cannot walk may need to be immobilized.

In general, treatment in the first 48 to 72 hours consists of resting the ankle, icing 20 minutes every two to three hours, compressing with an ACE wrap, and elevating, which means positioning the leg and ankle so that the toes are above the level of patient’s nose. Those patients who cannot bear weight because of pain, may be given crutches or a walker as well as a removable walking boot until they can comfortably bear weight.

Physical therapy is very important after an ankle sprain to restore motion and strength but also to prevent future injuries. Patients should learn to strengthen the muscles around the ankle, particularly the peroneals. An ankle brace can be used in athletes until a therapist believes that the ankle is strong enough to return to play without it.

Surgery is rarely indicated but may be needed in a patient who has cartilage damage or other related injuries. Ligaments are only repaired or strengthened in cases of chronic instability in which the ligaments have healed but not in a strong fashion.

Recovery depends on the severity of the injury. As noted above, for those minor injuries, people can return to their activities and/or sports within several days. For very severe sprains, it may take longer and up to several weeks or months. It should be noted that high ankle sprains take considerably longer to heal.

Outcomes for ankle sprains are generally quite good. Most patients heal from an ankle sprain and are able to get back to their normal lives, sports and activities. Some people, however, who do not properly rehab their ankle and have a rather severe sprain may go on to have ankle instability. Chronic instability occurs in patients repeatedly spraining the ankle. Such repeated episodes can be dangerous because they can lead to damage within the ankle. These patients should be identified and considered for repair.

Rehabilitation Plan - Exercises

Rehabilitation following an ankle sprain is key in preventing future injuries as well as returning the patient back to their prior level of activity. Initially, range of motion exercises are performed to maintain and or improve ankle flexibility and joint mobility after injury. Once pain and swelling have improved, and the patient is able to bear weight through the ankle with minimal or no pain, exercises will be progressed into weight bearing and include strengthening and balance activities to improve stability about the ankle and prevent future instability. Sport and activity specific exercises will be introduced once the patient shows adequate strength and control.

Frequently Asked Questions

What is a high ankle sprain and is that different from a regular ankle sprain? 
A high ankle sprain refers to tearing of the ligaments that connect the tibia to the fibula (this connection is also called the syndesmosis). These are different and much less common than the standard lateral ankle sprains, meaning those that occur on the side of the ankle.

Do ankle sprains ever need to be repaired acutely? 
Ankle sprains rarely, if ever, needed to be treated with surgery. The vast majority simply need to be treated with rest, ice, compression and elevation followed by physical therapy and temporary bracing.

I have sprained my ankle many times. Should I be concerned? 
Yes. The more you sprain an ankle, the greater the chance that problems will develop. For example, turning the ankle can lead to damage to the cartilage inside the ankle joint. You should see your doctor if you have sprained your ankle multiple times or if you are noticing increased instability.

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