Ankle Sprain

Ankle Sprain Description
Ankle Sprains are the most common athletic injury. Ankle sprains typically results from inversion stress with the ankle in plantar flexed position (the foot turns in or under and the ankle roles over the top).

Ankle sprains may involve the ligaments on the outside of the ankle (lateral ankle sprain) or the inside of the ankle (medial ankle sprain) or may involve both sides of the ankle.  High ankle sprains occur when the ligaments between the two bones in the leg (the tibia and the fibula) are injured.

Ankle sprains are commonly graded based on the severity of injury and structures injured.  Grade I ankle sprains injury the  anterior talofibular ligament (ATFL) alone and cause mild swelling and tenderness but no instability.  Grade II ankle sprains involve an ATFL tear and calcaneofibular ligament (CFL) strain.  Grade II ankle sprains lead to  moderate swelling and tenderness, and moderate laxity with anterior drawer physical exam testing.  Grade III ankle sprains result from ATFL and CFL complete rupture.  Grade III ankle sprains cause severe swelling and tenderness, and instability with anterior drawer and talar tilt physical exam testing.

Over time patients with chronic or recurrent ankle instability may develop progressive osteoarthritis in the ankle.

Ankle Sprain Anatomy

The ankle has many ligaments which can be sprained or torn during an ankle sprain.  The ligaments on the outside (lateral) side of the ankle are most commonly injured.  The anterior talofibular ligament is most commonly injured and typically fails by midsubstance tearing.  The calcaneofibular ligament is the second most commonly injured ankle ligament in an ankle sprain.

Ankle Sprain Symptoms
Ankle Sprains typically cause pain and swelling around the ankle after a twisting injury to the ankle.   There may be bruising on the inside or outside of the ankle.  Initially after an ankle sprain it may be difficult to put weight on the ankle and it may not be possible to walk on the ankle.  A short period (up to 10days) of immobilization in a below-knee cast or Aircast has been shown to provide faster recovery than tubular compression bandages. Physical therapy or a home exercise program to improve proprioception and strengthening of the peroneal muscles is beneficial. Functional bracing or athletic taping for strenuous or high risk activity should be consider after recovery from an ankle sprain.

Surgical treatment for ankle sprains is generally only for patients who fail non-operative care or who have recurrent ankle sprains over time.  Surgical treatment is generally focused on recreating the lateral ankle ligaments with a procedure commonly refered to as a modificed

Ankle Sprain Treatment 

Ankle Sprain is diagnosed based on a detailed history, physical exam and xrays performed by an orthopaedic surgeon, or sports medicine specialist.   Initial treatment for a minor Ankle Sprain is begins with Rest, Ice, Compression and Elevation.  This has been termed R.I.C.E.   Early controlled motion and weight bearing has been shown to be beneficial.  Non-steroidal anti-inflammatory medications are beneficial. Ankle Braces

Athletes returning to sports after Ankle Sprain should begin with a graduated exercise program.  First they should be pain free with daily activities with full range of motion and at least 85% strength in the injured extremity compared to the uninjured extremity.  Exercise begins with light jogging in a  straight line, followed by sprinting in a straight line.  When these have been done without pain the athlete can proceed to doing agility type drills such as 45º cuts, 90º cuts and jumping.  Agility drills should begin at half-speed and proceed to full-speed provided the athlete remains pain free.

Ankle Sprain Prevention
Prevention of Ankle Sprains is based wearing appropriate footwear and ensuring proper conditioning and proprioception in the ankle.  Shoes shoes provide appropriate support and athletes in high risk sports or who have a history of ankle sprain should wear an ankle brace or have their ankles taped for sports.  Well kept playing surfaces are important in prevention as well.

Ankle Sprain Risk Factors
Ankle Sprain is associated the following sports: Baseball; Basketball; Boxing; Cycling; Dance; Diving; Equestrian Sports; Figure Skating; Football; Golf; Gymnastics; Hockey; Rowing; Rugby; Running; Skiing; Snowboarding; Soccer; Swimming; Tennis; VolleyballWeight Lifting; Wrestling. Ankle sprains  are more common in athletes who are poorly conditioned and do not adequately warm-up prior to their sporting activities.

Ankle Sprain Rehab and Exercise Program
Ankle Sprain

Ankle Sprain Outcomes
Most ankle sprains resolve over time  with minimal long-term problems.  Move severe ankle sprains take longer to heal than mild sprains.  Grade I sprains typically improve significantly over the first 7 to 10 days and heal fully in 6-8 weeks.  Grade II ankle sprains generally heal in 6 to 10 weeks.  Grade III ankle sprains may take 16-18 weeks for healing and often require formal physical therapy for complete resolution.

Similar injuries that can be confused with Ankle Sprain include:

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