Illness, Injuries & Medical Conditions Index - Ankle
What is an Ankle Sprain?
An ankle sprain is a stretching or tearing of a ligament in the ankle.
Ligaments are strong fibrous tissues that connect bone to bone. Their
function is to stabilize the joint. A sprain may be classified as Mild
(grade I), Moderate (grade II), or Severe (grade III), depending on how
much of the ligament was stretched or torn.
What causes Ankle Sprains?
The most common cause of a sprained ankle is an inversion injury. This
occurs when the foot is suddenly turned inward, causing damage to
the outside (lateral) ligaments. It is less common for the foot to be
turned outward, called eversion, so sprains of the inner (medial)
ligaments are less common. An ankle sprain may be suspected after an
injury when pain, swelling, and/or bruising occur.
Classification of Sprains
Mild Sprain - A mild sprain has occurred when there is
stretching or minimal tearing of the ligaments. Swelling is
normally slight; walking is possible with minimal pain. In casesof mild
ankle sprain, it is possible for a health care provider using specific
criteria to avoid the need for an x-ray to rule out a fracture.
Treatment is often: ankle elevation, ice packs, compression wraps (Ace
bandages), and occasionally crutches.
Moderate Sprain - A moderate sprain occurs when the ligaments
are partially torn. Swelling and bruising are significant; walking may
be very difficult. Treatment may involve: elevation, ice packs,
compression wraps, crutches, and the possibility of a splint or air
Severe Sprain - A severe sprain has occurred when the ligaments
are completely torn. Swelling, bruising, and pain are intense; walking
may not be possible. A piece of bone may have been pulled away by the
ligament (called an avulsion fracture) due to the force of the injury.
Treatment will involve: elevation, ice, crutches, and pain relief
medications; casting or surgery may occasionally be necessary.
How do Ankle Sprains Heal?
Ligaments and connective tissue have been torn and traumatized as a
result of the sprain. Blood vessels, capillaries, and nerves may be
damaged as well. The resulting escape of blood and tissue fluids
produces swelling and bruising. Swelling may be intense for several
days. The swollen tissues may become firm. The bruising (ecchymosis) may
occur immediately or be delayed, or may spread to include the toes or
lower portion of the heel. The bruise may be of various colorations, as
the blood pigment is broken down by the body. The damaged ligaments and
connective tissue are repaired by new fibrous tissue. This tissue is
strong, but it is also less elastic. The entire healing process may not
be completed for many weeks.
How are Ankle Sprains
Elevation- Raise the ankle above the level of the heart.
Standing or dangling the leg can lead to fluid accumulation (further
swelling) and can lead to more throbbing or pain. Support the ankle with
pillows or padding for comfort.
Ice - Apply cold to newly injured ankles to prevent excessive
swelling and to reduce inflammation. Ice or cold compresses (such a 50%
ice and 50% water) should be applied to the area at least 4 times per
day for 20 minutes at a time for the first 48-72 hours. Cold also acts
as a anesthetic.
Crutches - Crutches are a form of treatment and need to be
prescribed by a clinician. The normal progression for weight
bearing with mild sprains is:
Crutches with non-weight bearing for 2-3 days, then:
Crutches with partial weight bearing for 2-3 days then:
Walking Air Casts - For injuries that do not require complete
non-weight bearing, the air cast may be prescribed to help support mild
ankle sprains in the healing phase.
Ace Bandages - The benefits of Ace wraps are controversial;
however, most feel they help to: prevent excessive swelling; serve as a
form of immobilization; and function as a reminder of the injury. The
wraps need to be correctly applied in a figure-8 configuration and to be
rewrapped every few hours for maximum benefit.
Medications - Aspirin and Ibuprofen are analgesics (pain
relievers) and anti-inflammatory medicines (decrease swelling). Acetaminophen is an analgesic but is not an anti-inflammatory
agent. Adult dosage is:
Aspirin: 2 tablets, 325mg each, every 4 hours
3-4 tablets, 200mg each, every 6-8 hours
Acetaminophen: 2 tabs, 325mg each, every 4 hours
Rehabilitation - After a moderate or severe sprain has healed
(i.e. no tenderness, able to walk on heels and toes without pain) range
of motion and strengthening exercises, using a towel or elastic
band, will be prescribed. A physical therapist may also be consulted.
Your physician may recommend an ankle brace to wear as you return to any
strenuous activity or sport.
Reconditioning should begin with:
walk 50% - jog 50% for 4-5 days then
jog 50%, run 50% for another 4-5 days
Do not work the ankle to the point of pain at any time. After a mild
sprain it may take 3-4 weeks to return to usual physical activities like
When Should I Consult a Health Care Provider?
If a steady improvement in your ability to walk and run normally does
not occur over 3-4 weeks, you should consult with a health care
provider. This is especially important if it was felt that you did not
need an x-ray for a mild sprain. Recurrent mild ankle sprains or ankle
instability warrant an evaluation by a health care provider. A specific
physical therapy regimen may need to be prescribed to treat or prevent
these problems from recurring.