Ankle Sprains

Most people have twisted an ankle at some point in their life. But if an ankle gets swollen and painful after twisting it, it is most likely sprained. This means you stretched and possibly tore the ligaments in the ankle.

Even though ankle sprains are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

Most types of ankle sprains happen when making a rapid, shifting movement with the foot planted, such as when playing soccer or getting tackled in football. Often the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen and stiff. But it usually feels stable, and it is possible to walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking can be painful. If the ankle is severely sprained, it is unstable and may feel wobbly. Walking is impossible, because the ankle gives out and may be very painful.

With most sprains, pain is felt right away at the site of the tear. Often, the ankle starts to swell immediately and may bruise. The ankle area is usually tender to touch, and it may hurt to move it.

In more severe sprains, you may hear and/or feel something tear, along with a pop or snap. You will probably have extreme pain at first and will not be able to walk or even put weight on the foot. Usually, the more pain and swelling there is, the more severe the ankle sprain is and the longer it will take to heal.

Your doctor will ask how the injury occurred and if the ankle was previously injured. The doctor will check the foot and ankle, lower leg and even the knee to see if you are hurt anywhere else. In some cases, the doctor may order X-rays to be sure there are not any broken bones in the ankle or foot.

In many cases, you can first use the rest, ice, compression and elevation (RICE) approach to treat the ankle:

• Rest: First, rest and protect the injured area. You may need to use crutches until you can walk without pain.
• Ice: Pressing firmly against the curves of the affected area, apply an ice pack for 10 to 20 minutes every hour or two for the first 24 to 72 hours or until the swelling goes down. (Always keep a thin cloth between the ice and skin.)
• Compression: Wear an elastic compression wrap, such as an ACE bandage, for the first 24 to 36 hours to help reduce swelling. (Compression wraps do not offer protection; an ankle brace will still be necessary if putting weight on the injured ankle.)
• Elevation: Raise the ankle above the level of your heart for two to three hours a day, if possible, to help reduce swelling and bruising.

If not taking any prescription pain relievers, your doctor may recommend an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling.

Proper treatment and rehabilitation (rehab) exercises are very important for ankle sprains. If an ankle sprain does not heal correctly, the joint may become unstable and may result in chronic pain. This can make the ankle weak and more likely to be reinjured. Before returning to sports and other activities that put stress on the ankle, it’s a good idea to wait until you can hop on the ankle with no pain. Taping the ankle or wearing a brace during exercise can further help protect it. Wearing hiking boots or other high-top, lace-up shoes for support may also help. Use caution. Don’t force the foot into a boot if feeling a lot of pain or discomfort.

If the ankle is still unstable after rehab or if the ligament damage is severe, your doctor may recommend surgery to repair the torn ligaments.

Rehabilitation exercises can begin soon after an injury. Try walking or putting weight on the foot. Crutches may need to be used until it’s possible to walk without pain. Depending on the pain, you can also begin simple range-of-motion exercises while icing the ankle, such as tracing the alphabet with a toe, which will help the ankle move in all directions.

Stretching, strength-training and balance exercises may help the ankle heal fully and prevent further injury. Consult a doctor for recommendations.