An Overview of a Sprained Ankle

Young man holding ice pack on ankle
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Ankle sprains are common injuries and can occur when your ankle twists (stretching the ligament) during athletics, due to a fall, or even when awkwardly stepping on an uneven surface. A sprained ankle can be painful, limiting your ability to walk. Usually, rest and simple at-home measures can help a mild ankle sprain heal within a week.

However, severe ankle sprains—which often involve tearing of the ligament—produce persistent pain and decreased ankle movement, and may require rehabilitation and/or surgery.

Symptoms

Most people experience discomfort after spraining an ankle. Right after an injury, it can be hard to know if you indeed sprained your ankle or just twisted it a little. Generally, with a sprain, the symptoms are intense and/or persist. It is usually painful to move or stand on your leg, sometimes to the point of severely limiting your movement. With a minor bump or twist, discomfort would likely get better within a few hours.

The most common signs of an ankle sprain include:

  • Swelling of the ankle joint
  • Bruising around the ankle
  • Pain around the ankle
  • Slight difficulty bending the ankle up or down
  • Discomfort when trying to walk

Bruising moves toward the toes in the days after the ankle sprain as gravity pulls the blood down in the foot.

An ankle sprain should not cause true weakness. If your leg or foot is weak, you may have an injury that involves more than your ankle, or a broken bone, muscle impairment, or nerve damage.

When to See a Doctor

Moderate pain and swelling are to be expected following a simple sprained ankle, but severe ankle pain, bone pain, or inability to stand should raise concern. Seek urgent care if any of the following apply:

  • Inability to walk on the ankle
  • Significant swelling
  • Symptoms that persist beyond a few days
  • Pain in the foot or above the ankle

Causes

An ankle sprain is an injury to the ligaments that support the ankle. Ligaments are structures that connect bones to each other within a joint. They stabilize and help control the degree and direction of joint movements, such as in the ankle.

When a ligament is stretched too far (or is partially or completely torn), a sprain occurs. This happens due to sudden sideways or twisting movement of the foot that usually occurs when a person lands from jumping or running onto an uneven surface.

For example, you can sprain your ankle if you come down from a basketball layup and land on another player's foot. Ankle sprains also occur with routine daily activities such as stepping off a curb or slipping on ice.

Diagnosis

Ankle sprains are evaluated based on a careful physical examination. There are several ways to categorize your sprained ankle based on the location of your pain and bruising, and the extent of ligament damage.

Types

There are three major categories used to describe a sprained ankle, which vary based on the direction of the injury and its location.

  • Inversion ankle sprain: About 90 percent of ankle sprains are inversion injuries, which occur when the foot is inverted (twisting inward). This type of ankle sprain happens when any of the three lateral (outer) ligaments that support the ankle are stretched too far. Inversion ankle sprains cause pain on the outside of the ankle, and there is usually minimal pain or no pain on the inner side of the ankle joint.
  • Eversion ankle sprain: When the foot is twisted outward, the inner (deltoid) ligament can stretch too far or tear. An eversion ankle sprain produces pain on the inner side of the ankle joint.
  • High ankle sprain: This is an injury to the ligaments directly above the ankle. These ligaments, called the syndesmosis ligaments, connect the tibia and fibula (shin bones). This type of injury may require a longer course of rehabilitation.

Grades

Grading of a sprained ankle describes the severity of the ligament injury. The intensity of the symptoms tends to correlate with the extent of ligament damage. The grading scale can give a sense of the prognosis for recovery:

Grade Extent of Injury Typical Symptoms
Grade I ankle sprain Stretched ligaments -Limited to pain and swelling
-You can probably walk without crutches, but may not be able to jump or jog.
Grade II ankle sprain Partial tearing of the ligament -Swelling and bruising
-Pain without walking, but you can take a few steps
Grade III ankle sprain Complete tearing of the ligaments -Intense pain
-Walking is difficult
-Ankle instability (i.e., a feeling that it will give way)

Differentiating between a sprained ankle, an ankle fracture, and a strained ankle (tendon or muscle injury) can be difficult. When the symptoms and physical evaluation do not completely correspond with an ankle sprain, imaging tests or other evaluations may help.

Treatment

Early treatment of a sprained ankle can help speed recovery and minimize symptoms so you can return to your normal activities. A medical professional can assess the problem and advise you about recovery.

Pain relief and comfort are important in the first few days after your injury. Often, it is what you do at home that determines how quickly you will recover and whether you will have any lasting damage.

At-Home Techniques

Treatment begins with a standard R.I.C.E. (rest, ice, compression, and elevation) approach. 

Rest

Giving your injured ankle some rest limits swelling and inflammation and helps prevent further injury to the joint. Don't walk on your sprained ankle for a few days, and be sure to protect it. Your doctor may give you a splint or brace to immobilize it and protect it from further injury.

So that you're not entirely inactive, try using crutches to get around, which take pressure and stress off the injured joint and allow swelling to subside.

Ice

You can ice your ankle several times a day for 15 to 20 minutes sessions. This will decrease swelling and reduce pain. After the first 48 hours, icing is less important, but it can still be an effective way to help control pain around the joint.

Never ice for more than 20 minutes. Many people think "the more the better," but this is not true.

Compression

Compression can help limit the amount of fluid that accumulates around your ankle joint (swelling), preserving ankle motion and reducing pain. Compression bandages should be snug, not tight, as that can dangerously impair circulation.

A simple elastic wrap (e.g., ACE bandage) is fine for light compression, which you only need when you are not elevating your foot.

Elevation

Raising your injured ankle also prevents fluid from accumulating in and around the ankle. You should try to have your ankle above the level of your heart for a few hours per day and while you are sleeping, especially if you have a lot of swelling.

Leg elevation will only effectively reduce swelling when you are lying down. A few pillows under your ankle will adequately raise your leg while keeping your ankle comfortable.

The less swelling and inflammation around your ankle, the quicker you can progress to your next phase of rehabilitation.

Medical Intervention

As the initial pain and swelling begin to subside, rehabilitation can begin. While most ankle injuries are simple and heal naturally over a short time, some injuries are more severe and necessitate interventional treatment.

Medication

You may need pain medication or anti-inflammatory medication to reduce pain and swelling. Most of the time, your doctor will recommend an over-the-counter (OTC) medication, like Tylenol (acetaminophen) or Advil (ibuprofen). Be sure to get your doctor's advice before taking OTC medications, as some of them can increase bleeding and bruising.

Surgery

While uncommon, damage or injury to tendons, cartilage, or nerves may complicate and prolong your treatment. You may need surgery to help repair severe damage or to restore the integrity of an unstable joint.

Ankle Rehabilitation

To ensure a full recovery, you will have to regain mobility, strength, and balance in your injured ankle joint. Working with a therapist, athletic trainer, or personal fitness coach can help ensure that you are taking the right approach to your ankle rehabilitation.

Rehabilitation involves a number of exercises, some of which you can do under your therapist's supervision and some that you can do at home. You may be guided and instructed on how to do range-of-motion exercises, strengthening exercises, sensory activities, and sport-specific practices.

Prevention

Proprioception, which is your ability to sense your body's position and movement, is a skill that can be built, which can help you avoid falls and other missteps that can lead to a sprained ankle. Consider working proprioception exercises into your routine.

A Word From Verywell

Sprained ankles are common. Having one does not mean that you will have long-term mobility problems. However, being attentive to your injuries during the recovery and rehabilitation periods is very important because putting too much pressure on a sprained ankle can prolong this time and put you at risk of falling, which can lead to additional injuries.

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