Ankle Sprain

An ankle sprain is an injury to the soft tissue in or around the ankle joint. It occurs when there is a sudden stretching of these ligaments beyond their normal range of motion. Because the ankle joint comprises many small bones, several ligaments stabilize it, and ankle sprains typically involve injury to the ligaments that run outside the ankle. If these ligaments are torn, the ankle joint may become unstable. Ankle sprains are among the most common injuries.

Ankle sprains are usually caused by an unexpected twist or turn that overextends the ligaments in the ankle joint. Our ankle joints allow us to move our feet upwards, downwards and sideways. Since our feet tend to turn inwards rather than outwards, ankles are more likely to twist inwards. If, for instance, you land awkwardly on your foot after jumping, you may injure the ligaments that run along the outside of the ankle (outer or “lateral” ligaments). The ligaments inside the ankle (inner or “medial” ligaments) are less likely to be overstretched.

Some people have very weak ligaments, making them more likely to have sprains. The same applies to people with a high foot arch or muscle weakness. Athletes are at greater risk, too, with one-quarter of all sports injuries being torn outer ankle ligaments. These injuries often occur in people who play sports like volleyball, basketball or soccer.

Individuals with previous ankle injuries are at greater risk of repeat sprain over the next few years. The risk is particularly high when the joints are subjected to excessive strain, such as while playing soccer or basketball.

One or two out of 10 individuals who experience a severe ankle sprain remain (chronically) unstable for up to six months after the sprain. People with chronically unstable ankles are more likely to twist and sprain them again.

Chronic ankle instability and frequent twisting and spraining can also increase wear and tear on the cartilage in the ankle joint, the smooth tissue that covers and protects joints. Too much damage to the cartilage may lead to osteoarthritis.

The risk of developing a sprain can be reduced by wearing supportive shoes with good cushioning and arch support and avoiding uneven terrain when possible. Additionally, exercises that improve balance and coordination may help.

Some people benefit from wearing bandages or ankle braces when playing sports to stabilize their ankles and prevent further injuries. A special kind of tape called kinesiology tape is often used, which is very stretchy and moveable and is thought to stimulate the muscles and nerves when you move.

Strength and coordination exercises are particularly suitable for preventing chronic ankle instability. These exercises typically need to be done for weeks or even months to stabilize the joint structures. Typical exercises include training on a balance board (a board that easily tips sideways) while standing on one leg and trying to keep your balance while reacting to the board’s tipping. This trains the foot and ligaments to act against various strains and movements, helping to lengthen the muscles and increase the ankle’s stability.

Symptoms of an ankle sprain may include pain, swelling, bruising, inability to bear weight on the affected area, instability or weakness of the ankle joint and decreased range of motion.

When an ankle is twisted, the ligaments are overstretched, and in the worst case, they might tear. Small blood vessels may also tear, causing swelling around the ankle.

The following grades of severity are used to describe sprains:

• The most common and least severe sprain is mild (grade I). In this type of sprain, the ligaments are stretched but not torn, and the ankle is stable.
• A moderate sprain (grade II) is a more severe and painful injury. One or more ligaments are partially torn, the joint is somewhat unstable and movement is limited.
• A severe sprain (grade III) involves tearing one or more ligaments, resulting in an unstable ankle and making it challenging to move the foot. 

If you can put weight on your foot and walk immediately after twisting your ankle, you will unlikely have broken anything. If the ligaments have only been slightly stretched, you can usually move your foot normally again after a few days. But even minor ankle sprains can be painful.

To diagnose a sprain, your doctor will review your symptoms and medical history before physically examining the affected area. Tests such as X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans may also be used to rule out other possible causes of the injury.

The doctor will first ask you about the accident and any symptoms you have. Then, they will examine your foot and check how severe the injury is. An X-ray can rule out a possible fracture or break.

If the ankle sprain symptoms don’t improve after a few days, you might have a torn ligament. An MRI scan may be performed, which makes seeing the ligaments and surrounding tissue easier than with X-rays.

Sprained ankles swell and start to hurt quickly. To reduce pain and swelling, you can first keep your foot elevated (raised), cool the ankle by applying an ice pack and wrap it in a compression bandage to apply gentle pressure. These measures are usually enough to relieve mild ankle injuries.

After a few days, the foot can be stabilized with tight bandaging or a splint. If there is a lot of swelling, a temporary plaster cast may also be helpful.

There are good reasons to start gentle exercises early in recovery and avoid keeping your foot still for too long. Surgery is rarely needed, even for ankle sprains with one or more torn ligaments. 

The Montefiore Einstein team of experts will likely recommend:

• Physical therapy
• Non-narcotic-based pain management
• Home exercise programs

Most ankle sprains without torn ligaments will have healed after two weeks. The pain will likely be resolved even if you can’t put your full weight on the foot.

If ligaments are torn or partially torn, it can take weeks for the ankle to return to normal. In people with more serious ligament injuries, the ankle may take two to three years to become as strong and mobile as before the injury.