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Ankle Sprain

 - Visakhapatnam
HEMANTH PRAVEEN MALLA

Orthopaedic Surgeon

Visakhapatnam   |   29 Aug, 2023

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Ankle Sprain

What is an Ankle Sprain?

An ankle sprain is an injury at the ankle joint region where there is either a partial or a complete tear of the ligaments that support it due to an abnormal rolling, twisting, or turning movement.

Alternate names

  • Twisted ankle
  • Rolled ankle

Is Ankle Sprain condition a medical emergency?

An ankle sprain is not a medical emergency, but seeking medical attention at the earliest is advisable to avoid complications.

Types

An ankle sprain may be of the following types:

  • Inversion or Lateral Ankle Sprain: This is the most common type of sprain. It occurs when the foot is bent or turned too much to the inside. This strains the ankle ligaments on the outer side of the joint.
  • Eversion or Medial Ankle Sprain: It is less common and occurs when the foot rotates towards the outside, resulting in a stretching of the ankle ligaments on the inner side of the joint.
  • High or Syndesmotic Ankle Sprain: This is usually seen in sportspersons, where the ligaments present above the ankle joint and keeping the two leg bones, tibia and fibula, are stretched. It usually occurs when the foot rotates to the outside.

Causes

The main cause is an abnormal movement or motion of the ankle joint that results in excessive stretching and subsequent partial or complete tearing of the ankle ligaments. The ankle joint has three main ligaments that provide strength and help keep it in place.
Some of the causes of a sprained ankle may include:

  • Walking or exercising on an uneven surface or wet, slippery surfaces
  • A fall from a height on the feet that results in a twisting or turning of the foot or ankle
  • Injuries sustained while playing sports, especially tennis, rugby, basketball, athletics, etc.

Risk factors

Some of the risk factors include:

  • Returning to sporting activity without fully regaining the strength of the ankle ligaments
  • Weak muscles and tendons
  • Weak or loose ankle ligaments - Hereditary or due to repeated sprains.
  • Shoes with inadequate heel support and high heeled footwear
  • Improper or reduced balance or coordination

Symptoms & Signs

The symptoms and signs of an ankle sprain can include:

  • Pain that increases on bearing weight
  • Tenderness on touching the ankle
  • Swelling and bruising
  • Restricted movements
  • The feeling of instability in the joint
  • A sensation that the bones have moved at the time of injury

Investigations

The following investigations may be done:
Imaging tests:

  • X-ray of an ankle joint - Done based on the Ottawa ankle rule to rule out an ankle fracture
  • MRI scan - To assess the soft tissues
  • CT scan - To assess the bone
  • Ultrasound - It is for real-time assessment of the ligaments when the foot is moved

Diagnosis

An ankle sprain is diagnosed based on the medical history, clinical evaluation, and results of the investigations, if any.

Course & stages

An ankle sprain may be graded as follows based on the severity:

  • Ankle Sprain grade 1 - Mild damage to the ligament or ligaments without instability of the affected joint.
  • Ankle Sprain grade 2 - A partial tear of the ligament or if it is stretched to the point where it becomes loose. The joint is unstable.
  • Ankle Sprain grade 3 - A complete ligament tear is present, and the joint is unstable.

Treatment options

The treatment depends on how severe and what grade the sprain is. The main aim of treatment is to reduce the pain and swelling and promote the ligament's healing and strength.

Medical management

Medical management of an ankle sprain may include:

  • Analgesics: For relief from pain and to reduce the swelling.

Interventional including surgery and indications for surgery

Surgery may be required in severe cases of an ankle sprain, and there are specific indications for performing surgical procedures in acute Ankle Sprain and chronic ankle pain.
The surgical procedures help to:

  • Repair a torn ligament that is not healing with conservative therapy, as seen in grade 3 sprains
  • Reconstruct a torn ligament with a graft from a nearby tendon or ligament

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Self-care for a Twisted ankle involves the following, which can be remembered as R.I.C.E:

  • Rest - Avoid putting any strain or weight on the affected joint and giving it rest.
  • Ice - Apply an ice pack immediately and after that every 2 -3 hours. It is not advised for diabetics or individuals with vascular disease.
  • Compression - Using an elastic bandage to compress and reduce the swelling.
  • Elevation - Keeping the feet above the level of the heart to reduce the swelling.

In addition, the following may also be required:

  • Physiotherapy - Helps to regain the strength of the ligaments and the muscles. It helps in early recovery and prevents long term complications from developing. Regaining the joint's strength, range of motion, stability, and flexibility is essential.
  • Crutches or ankle braces - This may be required during the recovery period to avoid putting excess weight on the joint or to provide stability to the joint.

Some measures that can be taken to prevent ankle sprains include:

  • Wearing proper footwear
  • Participating in sports of physical activity after proper training and warm-up
  • Build bone strength through diet and supplements
  • Strengthening the muscles of the calf and ankle
  • Balance and stability training
  • Protecting the ankle joint while participating in an activity by using tape or ankle braces if there is a previous history of ankle injury or sprain

Complications

Some of the complications of an ankle sprain may include:

  • Chronic pain
  • Long term instability of the ankle joint
  • Arthritis of the ankle joint

Prognosis

The prognosis for ankle sprains that are diagnosed and managed well is excellent. The prognosis for recurrent ankle sprains that are treated and managed well is also excellent. Severe injuries with extensive ligament damage that require surgical intervention also have a good prognosis if managed well, and rehabilitative therapy is aggressively pursued to prevent long term complications.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if there is any pain and swelling combined with difficulty bearing weight on the affected joint. It is advisable to rule out an ankle fracture or severe sprains before resorting to self-care.

Indications for hospitalization if required

Hospitalization is not required for an ankle sprain. However, it may be needed in the case of severe degree sprains that require surgical intervention.

Suggested clinical specialist/ Departments to consult for this condition

Specialists from the Department of Orthopedics or the Emergency Department will attend to an ankle sprain.
 

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