ANKLE SPRAIN

CONDITION

An ankle sprain happens when the ligaments around your ankle are torn. Ligaments are fibrous tissue that connects bone to bone.

The ligaments around your ankle help hold your ankle bones together.
The outside (lateral) ligaments are torn most commonly (Figure 1), but the inside (medial) or front and back (high ankle) ligaments also sometimes tear.

There are three major ligaments on the outside of your ankle.
Ligaments can be partially or completely torn through.

Causes

Lateral ankle sprains usually happen when you land or step on your foot wrong and roll it or turn it inward.
Medial ankle sprains happen when your foot and ankle roll, turn or rotate outward.
High ankle sprains happen when your foot rotates outward, especially when the ankle is bent with the foot pointing down.
Ankle sprains are common in court sports, especially basketball.
Ankle sprains can occur in any sport that involves running, cutting and jumping. They commonly occur in soccer and football.
Previous ankle sprains, recurrent sprains and poorly rehabilitated sprains increase your risk for injuring your ankle.

Symptoms and Signs

You may hear a loud pop when your ligaments tear.
You will notice immediate pain over the torn ligaments.
You will notice swelling over torn ligaments shortly after the injury.
Swelling and stiffness over your torn ligaments may be worse the morning after your injury.
You may not be able to walk on your ankle.
It may be hard to bend your ankle up or down.
Sometimes you will notice numbness and tingling down the outside of your foot.
You may notice blue, purple and (later) yellow bruising over your ankle. You can also get bruising into your foot and toes from the blood that runs down into them from torn tissue.
If your have severe pain and your ankle looks like it is bent wrong or if there is a bone sticking out, you may have a fracture.

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WHEN TO CALL YOUR DOCTOR

Call 911 Iif:

Your ankle looks deformed, as if the bones no longer fit together as they should, and there is severe pain, especially if your foot is numb and cold or pale. This could mean your ankle is dislocated.

Call your doctor right away (day or night) if:

You are in severe pain.
You have numbness in your foot or ankle that does not go away in an hour or two.
You can’t put weight on your ankle right away or take a few steps.
Your ankle looks funny and you think you have broken a bone.

Seek immediate medical care if you have a cut and can see bone.

Call your doctor during regular office hours if you have injured your ankle and:

You have mild to moderate pain and swelling.
You do not have numbness that lasts more than a few hours.
You can put weight on your ankle and take a few steps.

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SELF-CARE AT HOME

Rest your ankle by using crutches to take all weight off of your injured ankle until pain and swelling go down some or until you see your doctor.
If your sprain is mild, you still may want to use crutches to help take some of the weight off your injured ankle.
Put an ice pack or cold pack over the injured ligaments for at least 20 minutes three times daily. You can do this hourly if you have a lot of pain and swelling. Place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite.
An elastic wrap can help hold the cold pack in place and can also put pressure over the swelling to help it go down. Keep your ankle wrapped even when you are not icing it.
Elevate your swollen ankle on a pillow or chair as much as you can until swelling goes down.
You may use ibuprofen (Advil® or Motrin®) or naproxen (Aleve®) to decrease pain and swelling. (See the labels for dose and risks.)
You may begin gently moving the ankle around as your pain allows. Drawing the alphabet in the air with your toes (act like your big toe is a pencil) a few times a day is helpful. If your sprain is mild and the pain and swelling is minimal, you can begin some strengthening and stretching exercises. It is usually safe to start these three simple exercises early on:

Push your toes and foot up (Figure 2), out (Figure 3) and in (Figure 4) against something that does not move, such as your other foot or a wall.

Hold the muscle contractions for 15 to 30 seconds and push as hard as you can without causing much pain.
Repeat each direction two to three times once daily.

You can stretch your heel tendons by putting the foot of your injured ankle flat on the floor behind you, keeping that back knee straight and then bending your forward leg and body toward a wall (Figure 5). Hold stretches for 30 seconds and don’t bounce. Repeat this three times, taking a brief rest between repetitions, once or twice daily.

Riding a stationary bike or swimming can sometimes help you keep in shape while you are recovering.
Lace-up braces or other quality ankle braces can be purchased at some sports stores (Figure 6).

You can wear these for added ankle pressure to reduce swelling and to provide some support for your torn ligaments until you see your doctor.
Simple elastic wraps, elastic wraparound sleeves or light wraparound braces do not give much support.

When your ankle starts to recover, it is important to retrain your sense of balance to prevent more sprains (Figure 7).

With your eyes open, stand on your injured ankle and practice balancing on one leg for 30 to 60 seconds.
When you can do this for two minutes, do it with your eyes closed. Start at 30 to 60 seconds and work up to two minutes.
When you can do this, you can stand on one leg on a couch cushion or balance board. You can usually find balance boards at sporting goods stores or in general merchandise stores or department stores that carry sports equipment.
Do each exercise three times, taking a brief rest between repetitions, once daily.
If you are in a hurry, you can practice these exercises while brushing your teeth.
You can also vary the position of your arms to further enhance your balance training.

Avoid running, jumping, cutting and walking on uneven surfaces until you see your doctor and have minimal pain, good ankle motion and normal ankle strength.

PREVENTION

A good stretching, strengthening and coordination program can help prevent ankle sprains.

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FOR MORE INFORMATION

REFERENCES

Casillas M: Ligament Injuries of the Foot and Ankle in Adult Athletes. In DeLee J, Drez J: DeLee and Drez’s Orthopeaedic Sports Medicine, 2nd ed., Elsevier, 2003.
Ivins D: Acute Ankle Sprain: An Update. American Family Physician 74(10): 1714-20, 2006.
Pommering T: Ankle and Foot Injuries in Pediatric and Adult Athletes. Primary Care 32(1): 133-61, 2005.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine (http://amssm.org)

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.