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Sprained Ankle

Sprained ankle

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

Most sprains are minor injuries that heal with home treatments like rest and applying ice. However, if your ankle is very swollen and painful to walk on — or if you are having trouble putting weight on your ankle at all, be sure to see your doctor.

Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle—making it more likely that you will injure it again. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and ongoing instability.

 
Normal anatomy of the foot and ankle
An ankle sprain is an injury to one or more of the ligaments that stabilize the ankle.
Reproduced from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Description

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

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

If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. Over time, this instability can result in damage to the bones and cartilage of the ankle joint.

 
Twisting injury to ankle
A twisting force to the lower leg or foot can cause a sprain. The lateral ligaments on the outside of the ankle are injured most frequently.
Reproduced from the Body Almanac @ American Academy of Orthopaedic Surgeons, 2003.

 

Cause

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

  • Walking or exercising on an uneven surface
  • Falling down
  • Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
  • During sports activities, someone 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:

  • Swelling
  • Bruising
  • Tenderness to touch
  • Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
 
Bruised and swollen ankle

Bruising and swelling are common signs of a sprained ankle.

If there is severe tearing of the ligaments, you might also hear or feel a “pop” when the sprain occurs. Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation.

Doctor Examination

Physical Examination

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

  • Palpate. Your doctor will gently press around the ankle to determine which ligaments are injured.
  • Range of motion. He or she may 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 be able to tell the severity of your ankle sprain based upon the amount of swelling, pain, and bruising.

 
Sprained ankle
To diagnose a sprain, your doctor will gently palpate around the outside of the ankle in the area of the pain (arrow).
Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

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 similar symptoms of pain and swelling.

Stress x-rays. In addition to plain x-rays, your doctor may also order stress x-rays. These scans are taken while the ankle is being pushed in different directions. Stress x-rays help to show whether the ankle is moving abnormally because of injured ligaments.

Magnetic resonance imaging (MRI) scan. Your doctor may order an MRI if he or she suspects a very severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. The MRI may not be ordered until after the period of swelling and bruising resolves.

Ultrasound. This imaging scan allows your doctor to observe the ligament directly while he or she moves your ankle. This helps your doctor to determine how much stability the ligament provides.

Grades of Ankle Sprains

After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred 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 swelling around the ankle
  • If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint

Grade 3 Sprain (Severe)

  • Complete tear of the ligament
  • Significant tenderness and swelling around the ankle
  • If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs
 
Grade 2 (moderate) ankle sprain

In a Grade 2 sprain, some but not all of the ligament fibers are torn. Moderate swelling and bruising above and below the ankle joint are common.

 

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