Ankle sprains are very common injuries. There’s a good chance that while playing as a child or stepping on an uneven surface as an adult you sprained your ankle–some 25,000 people do it every day.
Sometimes, it is an awkward moment when you lose your balance, but the pain quickly fades away and you go on your way. But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it. If it’s a severe sprain, you might have felt a “pop” when the injury happened.
A sprained ankle means one or more ligaments on the outer side of your ankle were stretched or torn. If a sprain is not treated properly, you could have long-term problems. Typically the ankle is rolled either inward (inversion sprain) or outward (eversion sprain). Inversion sprains cause pain along the outer side of the ankle and are the most common type. Pain along the inner side of the ankle may represent a more serious injury to the tendons or to the ligaments that support the arch and should always be evaluated by a doctor.
You’re most likely to sprain your ankle when you have your toes on the ground and heel up (plantar flexion). This position puts your ankle’s ligaments under tension, making them vulnerable. A sudden force like landing on an uneven surface may turn your ankle inward (inversion). When this happens, one, two or three of your ligaments may be hurt.
A sprain can be difficult to differentiate from a fracture (broken bone) without an x-ray. If you are unable to bear weight after this type of injury, or if there is significant swelling or deformity, you should seek medical treatment from a doctor (MD or DO). This may be your primary care physician or pediatrician, an emergency department, or an orthopaedist, depending on the severity of the injury.
Tell your doctor what you were doing when you sprained your ankle. He or she will examine it and may want an x-ray to make sure no bones are broken. Most ankle sprains do not require surgery, and minor sprains are best treated with a functional rehabilitation program. Depending on how many ligaments are injured, your sprain will be classified as Grade I, II or III.
Treating your sprained ankle properly may prevent chronic pain and instability. For a Grade I sprain, follow the R.I.C.E. guidelines:
- Rest your ankle by not walking on it. Limit weight bearing. Use crutches if necessary; if there is no fracture you are safe to put some weight on the leg. An ankle brace often helps control swelling and adds stability while the ligaments are healing.
- Ice it to keep down the swelling. Don’t put ice directly on the skin (use a thin piece of cloth such as a pillow case between the ice bag and the skin) and don’t ice more than 20 minutes at a time to avoid frost bite.
- Compression can help control swelling as well as immobilize and support your injury.
- Elevate the foot by reclining and propping it up above the waist or heart as needed.
Swelling usually goes down with a few days.
For a Grade II sprain, follow the R.I.C.E. guidelines and allow more time for healing. A doctor may immobilize or splint your sprained ankle.
A Grade III sprain puts you at risk for permanent ankle instability. Rarely, surgery may be needed to repair the damage, especially in competitive athletes. For severe ankle sprains, your doctor may also consider treating you with a short leg cast for two to three weeks or a walking boot. People who sprain their ankle repeatedly may also need surgical repair to tighten their ligaments.
Every ligament injury needs rehabilitation. Otherwise, your sprained ankle might not heal completely and you might re-injure it. All ankle sprains, from mild to severe, require three phases of recovery:
- Phase I includes resting, protecting and reducing swelling of your injured ankle.
- Phase II includes restoring your ankle’s flexibility, range of motion and strength.
- Phase III includes gradually returning to straight-ahead activity and doing maintenance exercises, followed later by more cutting sports such as tennis, basketball or football.
Once you can stand on your ankle again, your doctor will prescribe exercise routines to strengthen your muscles and ligaments and increase your flexibility, balance and coordination. Later, you may walk, jog and run figure eights with your ankle taped or in a supportive ankle brace.
It’s important to complete the rehabilitation program because it makes it less likely that you’ll hurt the same ankle again. If you don’t complete rehabilitation, you could suffer chronic pain, instability and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament has not healed right, or that some other injury also happened.
To prevent future sprained ankles, pay attention to your body’s warning signs to slow down when you feel pain or fatigue, and stay in shape with good muscle balance, flexibility and strength in your soft tissues.
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