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 cast.

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 Treated?

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
	Ibuprofen: 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 playing basketball.

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.