Sprained Ankles

An ankle sprain happens when the strong ligaments that support the ankle extend beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, based upon just how much damage there is to the ligaments.

The majority of sprains are minor injuries that heal with home remedies like rest and applying ice. But if your ankle is really swollen and painful to walk on — or if you are having difficulty putting weight on your ankle at all, be sure to see your doctor. Dr. Weaver treats patients of all ages at Audrain Orthopaedics in Mexico, Missouri.

Without proper treatment and rehabilitation, a more serious sprain can weaken your ankle—making it much more likely that you'll wound it again. Repeated ankle sprains may result in long-term problems, including chronic ankle pain, arthritis, and ongoing instability.

Description

Ligaments are sturdy, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in the correct position and stabilize the joint.

Most sprained ankles occur in the lateral ligaments on the outside of of the ankle. Sprains can vary from small tears in the fibers that make up the ligament to complete tears through the tissue.

If there's a total tear of the ligaments, the ankle can become unstable after the preliminary injury phase passes. With time, this instability can result in damage to the bones and cartilage of the ankle joint.

Cause

Your foot can twist suddenly during many different activities, such as:

• Walking or working out on a jagged surface
• Falling down
• Taking part in sports that need cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
• During athletics, somebody else may step on your foot while you are running, causing your foot to twist or roll to the side.

Symptoms

A sprained ankle is painful. Other symptoms may include:

• Inflammation
• Bruising
• Tenderness to contact
• Instability of the ankle—this may occur when there's been complete tearing of the ligament or a total dislocation of the ankle joint.

If there's serious tearing of the ligaments, you might also hear or feel a "pop" whenever the sprain occurs. Symptoms of an extreme sprain are like those of a broken bone and call for expeditious medical evaluation.

Doctor Examination

Physical Examination

Your doctor in Central Missouri will diagnose your ankle sprain by performing a careful examination of your foot and ankle. This physical exam can be painful.

Palpate. Your doctor will gently press around the ankle joint to find out which ligaments are injured.

Range of motion. He or she might also move your ankle in different directions; however, a stiff, swollen ankle usually will not move much.

If there is no broken bone, your doctor may have the ability to tell the seriousness of your ankle sprain based upon the quantity of swelling, pain, and bruising.

Imaging Tests

• X-rays. X-rays provide images of dense structures, such as bone. Your doctor may order x-rays to rule out a broken bone in your ankle or foot. A broken bone can cause comparable symptoms of pain and swelling.
• Stress x-rays. Along with plain x-rays, your physician may also order stress x-rays. These scans are taken while the ankle is being pushed in different directions. Stress x-rays help to demonstrate whether the ankle is moving unusually because of injured ligaments.
• Magnetic resonance imaging (MRI) scan. Your physician may order an MRI if he suspects an extremely severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another issue. The MRI might not be ordered until after the period of swelling and bruising resolves.
• Ultrasound. This imaging scan permits your doctor to observe the ligament directly while he or she moves your ankle. This allows your physician to figure out how much stability the ligament offers.

Grades of Ankle Sprains

Following the examination, your physician will determine the grade of your sprain to help develop a plan for treatment. Sprains are graded based on how much damage has happened to the ligaments.

Grade 1 Sprain (Mild)

• Slight stretching and microscopic tearing of the ligament fibers
• Mild tenderness and swelling around the ankle

Grade 2 Sprain (Moderate)

• Partial tearing of the ligament
• Moderate tenderness and inflammation around the ankle
• If the doctor moves the ankle in specific ways, there's an abnormal looseness of the ankle joint

Grade 3 Sprain (Severe)

• Total tear of the ligament
• Immense tenderness and swelling around the ankle
• If your physician pulls or pushes on the ankle joint in particular movements, considerable instability occurs

Treatment

Virtually all ankle sprains may be treatable without surgery. Even a total ligament tear can heal without surgical repair if it is immobilized appropriately.

• A three-phase program guides treatment for all ankle sprains—from mild to severe:
• Phase 1 includes resting, protecting the ankle, and decreasing the swelling.
• Phase 2 includes restoring range of motion, strength and flexibility.
• Phase 3 includes maintenance exercises and the steady return to activities which don't require turning or twisting the ankle. This will be followed later by having the capacity to do activities that require sharp, sudden turns (cutting activities)—such as tennis, basketball, or football.

This three phase treatment program may take only two weeks to complete for minor sprains, or as much as 6 to 12 weeks for more severe injuries.

Home Treatments

For less severe sprains, your doctor may recommend simple home treatment.

The RICE protocol. Follow the RICE protocol as quickly as possible after your injury:

Rest your ankle by not walking on it.

Ice ought to be directly applied to keep the swelling down. It can be used for 20 to 30 minutes, three to four times every day. Do not apply ice directly to your skin.

Compression dressings, bandages, or ace-wraps will immobilize and support your injured ankle.

Lift up your ankle above the level of your heart as often as possible during the first two days.

Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help control pain and swelling. Since they improve function by both decreasing swelling and controlling pain, they're a more sensible choice for mild sprains than narcotic pain medicines.

Nonsurgical Treatment

Some sprains need treatment along with the RICE protocol and medications. If you reside in the Mid-MO area, Dr. Weaver may suggest any of the following:

• Crutches. More often than not, swelling and pain will last from two to three days. Walking may be hard during this period and your doctor may suggest that you use crutches as needed.
• Immobilization. During the early phase of healing, it is important to support your ankle and protect it from sudden movements. For a Grade 2 sprain, a removable plastic device like a cast-boot or air stirrup-type brace can provide support. Grade 3 sprains may require a short leg cast or cast-brace for two or three weeks.

Your doctor may encourage you to put some weight on your ankle while it is protected. This will help with healing.

• Physical therapy. Rehabilitation exercises are employed to avoid stiffness, increase ankle strength, and prevent chronic ankle problems.
• Early motion. To prevent stiffness, your doctor or physical therapist will provide you with exercises that include range-of-motion or controlled movements of your ankle without resistance.
• Strengthening exercises. When you can bear weight without increased pain or swelling, exercises to reinforce the muscles and tendons in the back and front of your leg and foot will be added to your treatment plan. Water exercises may be utilized if land-based strengthening exercises, like toe-raising, are too painful. Exercises with resistance are added as tolerated.
• Proprioception (balance) training. Poor balance frequently leads to repeat sprains and ankle instability. An excellent example of a balance exercise is standing on the affected foot with the opposite foot raised and eyes shut. Balance boards are often used in this stage of rehabilitation.
• Endurance and agility exercises. When you are pain-free, other exercises might be added, such as agility drills. Running in increasingly smaller figures-of-8 is great for agility and calf and ankle strength. The objective is to enhance strength and range of flexibility as balance gets better with time.

Surgical Treatment

Surgical treatment for ankle sprains is uncommon. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for patients who encounter persistent ankle instability after months of rehabilitation and nonsurgical treatment.

Surgical options may include:

• Arthroscopy. During arthroscopy, your doctor utilizes a small camera, called an arthroscope, to look within your ankle joint. Miniature instruments are utilized to remove any loose fragments of bone or cartilage, or parts of the ligament that may be caught in the joint.
• Reconstruction. Your physician may be able to fix the torn ligament with stitches or sutures. In many cases, he or she will rebuild the damaged ligament by replacing it with a tissue graft obtained from other ligaments and/or tendons found in the foot and around the ankle.
• Immobilization. There is usually a period of immobilization following surgery for an ankle sprain. Your physician may apply a cast or protective boot to protect the repaired or reconstructed ligament. Make sure to follow your physician's instructions about how long to wear the protective device; if you get rid of it too soon, a simple misstep can re-tear the fixed ligament.
• Rehabilitation. Rehabilitation following surgery requires time and attention to restore strength and range of motion so you can go back to pre-injury function. The length of time you are likely to spend recovering depends upon the extent of injury and the amount of surgery that was done. Rehabilitation might take from weeks to months.

Outcomes

Outcomes for ankle sprains are usually quite good. With proper treatment, the majority of patients can resume their day-to-day activities after a period of time.

First and foremost, successful outcomes are dependent upon patient commitment to rehabilitation exercises. Incomplete rehabilitation is the most frequent cause of chronic ankle instability after a sprain. If a patient stops doing the strengthening exercises, the injured ligament(s) will weaken and put the patient in danger of continued ankle sprains.

Chronic Ankle Sprains

After you've sprained your ankle, you may continue to sprain it if the ligaments don't have time to completely heal. It can be hard for patients to tell if a sprain has healed because even an ankle with a chronic tear can be highly functional because overlying tendons aid in stability and motion.

If pain continues for more than four to six weeks, you might have a chronic ankle sprain. Activities that usually make an already sprained ankle worse include stepping on uneven surfaces and taking part in sports that require cutting actions or rolling and twisting of the foot.

Abnormal proprioception—a prevalent complication of ankle sprains—can also lead to repeat sprains. There may be imbalance and muscle weakness that creates a re-injury. If you sprain your ankle time after time, a chronic situation may persist with instability, a feeling of the ankle giving way, and chronic pain. This may also happen if you return to work, sports, or other activities before your ankle heals and is restored.

Prevention

The easiest way to prevent ankle sprains is to maintain good muscle strength, balance, and flexibility. These precautions will help prevent sprains:

•   Warm up thoroughly before exercise and physical activity

•   Pay careful attention when walking, running, or working on an uneven surface

•   Wear shoes created for your activity

•   Slow down or stop activities when you are feeling pain or fatigue

Dr. Weaver of Audrain Orthopaedics has the experience needed to help you overcome an ankle sprain. Stop by if you live in Mexico, Columbia, or Moberly, Missouri.