Ankle sprain

What is ankle sprain?

Ankle sprains are a common sports injury. An ankle sprain occurs when there is an overstretching or tearing of the ligaments that support the joint, resulting in pain and swelling. Ligaments are a strong connective tissue that hold bones together.

Most commonly, ankle sprains occur as a result of sudden shifting movement on a planted foot or the foot being rolled inwards (inversion injury). 

The ankle joint

The ankle joint connects the foot and the leg. The ankle joint has three interlocking bones - the shin bone (tibia), a thinner bone running alongside the shin bone (fibula), and the heel bone (talus). 

The bones are stabilised by muscles, tendons and ligaments. There are two major groups of ligaments on either side of the ankle joint, which allows for the ankle's normal range of movement and nothing further. Damage to these ligaments result in ankle sprain. 

Signs and symptoms

Symptoms of ankle sprain include pain and swelling. The pain is often felt when moving. The swelling can last hours to days, depending on how bad the sprain is. There can also be bruising around the heel. 

Types

Ankle sprains can range from mild to severe depending on the degree of damage to the ankle ligaments:

  • Mild (grade I) - only minimal stretching or tearing of ligament(s);
  • Moderate (grade II) - ligament(s) are partially torn, or;
  • Severe (grade III) - entire ligament(s) are torn.

Methods for diagnosis

Ankle sprain is often diagnosed by physical examination.

An X-ray can be taken to check for a fracture.

An MRI scan is only performed in cases where a severe ankle injury is suspected.

Types of treatment

Immediate treatment

If you have sprained your ankle, it is important to:

  • Stop the activity you are doing;
  • Rest your injured ankle;
  • Apply icepacks regularly to the ankle to reduce pain and swelling;
  • Apply compression usng firm bandage to stabilise the joint and reduce swelling;
  • Elevate your ankle.

This can be remembered using the mnemonic RICE - rest, ice, compression and elevation.

Also, avoid exercise, alcohol, heat and massage for two days after your sprain.

Ongoing care

Once swelling has improved and pain is controlled, it is important to gently and gradually start using your ankle. 

Physiotherapy may be used and could include:

  • An exercise program to improve mobility and strengthen the surrounding muscles;
  • Advice regarding ankle braces and tape use during activities, and;
  • The use of a wobble board or trampoline to promote balance.

Surgery may be needed if the ankle injury is severe, there is an associated fracture or the ankle injury is not improving even with physical therapy.

Complications

The main complication associated with ankle sprain is the increased risk of repeat sprains due to the stretching and loosening of ligaments caused by previous sprains.There is also the possibility of an underlying fracture. 

Prognosis

Once you've sprained your ankle, you are at increased risk of spraining it again. This is because ankle sprains result in stretched and loosened ligaments. If you've sprained your ankle, it is important to take steps to prevent spraining it again, as damage caused by recurring ankle sprains may eventually require surgery.

Prevention

You can reduce your risk of ankle sprain by:

  • Warming up before sport or exercise;
  • Wearing supportive shoes;
  • Avoiding risks such as wet or uneven ground that might result in an accident causing injury, and;
  • Wearing ankle braces or tape as directed by your physiotherapist.

Fracture

A complete or incomplete break in a bone.

Ligaments

Short, flexible fibrous tissue that connects the bones and cartilage of joints.

Physiotherapist

A healthcare professional trained in treating injury or disability with physical remedies, such as massage or exercise.

Physiotherapy

A healthcare profession that treats bodily weaknesses or defects with physical remedies, such as massage or exercise.

Tendons

Dense bands of connective tissue that attach muscles to bones.

X-ray

A scan that uses ionising radiation beams to create an image of the body’s internal structures.