Ankle Sprains

What are ankle sprains?

Ankle sprains occur when you stretch or tear ligaments in the ankle beyond their normal range of motion. This strain can happen when you roll, twist, or turn your ankle during any physical activity. Ankle sprains are incredibly common and can occur at any age and at any activity level. The ligaments in the ankle work by stabilizing the joints in the foot and ankle. Tears or stretches to the ligaments can range from minor to severe. 

Minor ankle sprains can heal on their own with over-the-counter pain medications and rest, but more serious sprains require medical attention. No matter the severity of the sprain, it is best to seek a medical evaluation to determine how serious the injury may be and the best treatment plan. 

What causes ankle sprains?

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The overextension of your ankle’s ligaments causes an ankle sprain. Any number of actions can trigger this abnormal movement of the ankle ligament. Sprained ankles are so common in part because many actions can stretch the ligament. Common causes of an ankle sprain include: 

  • Falling down or tripping that causes your ankle to twist
  • Exercising or walking on an uneven surface
  • Having someone else step on your ankle 
  • Jumping and awkwardly landing on your foot
  • Straining the ankle while participating in sports that require fast cutting and jumping movies, like running, basketball, football, soccer, and tennis.

What are symptoms of ankle sprains?

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The symptoms you may experience with an ankle sprain depend on the severity of the sprain. Common symptoms include:

  • Swelling in the ankle 
  • Bruising 
  • Pain at rest or when the impacted ankle bears weight 
  • Tenderness at the touch 
  • Stiff or otherwise restricted range of motion in the ankle
  • Instability or wobbly feeling 
  • Popping feeling at time of the sprain

What are the ankle sprain classifications?

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There are three grades of ankle sprain. The grade of the sprain depends on the damage to the ligament. 

Grade 1: Mild

  • No pain with weight bearing
  • Mild bruising and swelling around the ankle 
  • Slight ligament stretch and tear

Grade 2: Moderate

  • Partial tear of the ligament
  • Mild difficulty with weight bearing
  • Moderate tenderness and bruising 

Grade 3: Severe

  • Full tear of the ankle ligament
  • Severe tenderness and swelling
  • Significant pain with weight bearing
  • Substantial instability 

Are there any risk factors or groups for ankle sprains?

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Ankle sprains can happen to anyone at any age, but there are certain factors that put a person at a higher risk of an ankle sprain. 

Participating in sports: Ankle injuries occur frequently while playing sports. People who play sports that involve jumping, rolling, twisting, pivoting, or cutting are at a higher risk of an ankle sprain. These actions are common in sports like basketball, tennis, and soccer. 

Walking or running on uneven surfaces: Any type of uneven surface poses a risk for an ankle injury. Attempting to walk or run on unsteady surfaces with obstacles makes you more likely to hurt your ankles. 

History of ankle injuries: Prior ankle injuries make your ankle more vulnerable to future ankle injuries. Taking key precautions to protect your ankles can reduce your risk. 

Unsupportive shoes: The wrong shoes can put you at risk of injuring your ankle. Shoes without adequate ankle support or that do not fit well can cause you to lose your footing and trip. 

Physical condition: You are at a higher risk of an ankle sprain if you don’t have strength or are inflexible. These factors can increase your chance of an ankle injury. 

How are ankle sprains diagnosed?

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Your doctor will likely be able to confirm an ankle sprain diagnosis with an in-office physical examination and review of your health history. During the examination, the doctor will perform manipulations on the ankle to assess the range of motion to detect stiffness or instability. Your ankle may have visible signs of a sprain such as swelling and bruising, which the doctor will observe and compare to your non injured ankle. 

Since sprained ankles can cause tenderness around the ligaments, your doctor may carefully apply pressure around the ankle to pinpoint the location of the stretch or tear. For more minor sprains, you may have to do stability testing so that the doctor can notice any stability issues or problems when the ankle bears weight. 

In some cases, your doctor will want to make sure that the suspected sprain is not accompanied by a bone fracture. To confirm the severity of the injury, your doctor may order imaging scans, like an X-ray or MRI, to rule out bone fractures or more serious tender injuries. 

How are ankle sprains treated?

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Most ankle sprains can be treated with simple at-home treatments and minimal medical intervention. However, the severity of the sprain determines the appropriate treatment plan. Nonsurgical, home treatments help heal the ankle over time through the right series of care. 

It is best to divide the treatment timeline for a sprained ankle into phases. The complete healing process can take anywhere from 6 to 12 weeks. 

Phase 1: Utilize the RICE protocol to rest, ice, compress, and elevate the impacted ankle for the first few days immediately following the injury. This method of resting the ankle allows the damaged ligament to heal without putting weight on the ankle or worsening the injury. 

Be sure to apply ice for 20 to 30 minutes at a time, about 3 to 4 times a day with a towel or other layer in between the ice and your skin. Compression materials like bandages or ace wraps help stabilize and support the ankle while resting or light movement. Elevating your ankle above the level of your heart the days following the injury helps keep swelling down. More severe sprains may also use a brace, cast, or crutches to make sure the ankle bears no weight and stays completely immobilized. 

Phase 2: The focus of phase 2 is on rehabilitation and strength. After you have allowed the ankle to rest, it is important to get the joint back in motion to prevent stiffness and work on restoring a normal range of motion. You can begin to do exercise and physical therapy in this phase. 

Phase 3: The final phase of treatment should include returning to normal activities that still protect the ankle. You will want to avoid activities that include hard movements for the newly healed sprain, like twisting, turning, and cutting. 

Throughout each phase, you may need to take nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage pain and swelling. Surgery is a rare treatment for a sprained ankle. Ankle injuries that do not heal on their own or ankle sprains that cause other tendon tears may require surgery to repair the tear. 

Should you see a doctor for ankle sprains?

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You should see a doctor if you suspect a sprain and notice symptoms. While you can likely treat the sprain at home, your doctor will want to examine the ankle to ensure the injury is not serious. Failing to treat an ankle sprain can lead to future complications. Related conditions like chronic ankle pain, ankle instability, and arthritis can result from an untreated ankle sprain.

What is the outlook for people living with ankle sprains?

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With proper treatment, the outcome for a person with an ankle sprain is good. Rehabilitation and home treatments can help your ankle improve each day and build back strength and stability. Fully successful healing depends on the severity of the sprain and a person’s dedication to a treatment plan. Failing to work through each phase of healing and spending adequate time regaining strength through exercise. 

Since one ankle sprain makes you more likely to have future ankle sprains, you may experience chronic ankle sprains. When returning to normal activities, be sure to use caution and pay attention to how your ankle feels.

How can you prevent ankle sprains?

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There are simple preventative measures to help you avoid a sprained ankle or a recurring ankle sprain. Be sure to follow instructions from your primary care provider otherwise your ankle could be at risk of future injury. 

Ongoing strength and balance training: Concerted movements aimed at stabilizing and strengthening the ankle ligaments can help your ankle remain intact during a fall or misstep. 

Warm up and stretch before exercise: Warming up your muscles and joints before physical activity is a good practice to let the body adjust to movement before jumping into heavy exercise. 

Utilize ankle supports: Especially for recently recovered ankle injuries, ankle supports can add an extra layer of protection and bracing. 

Choose the right footwear: Look for well-fitting shoes with arch and ankle support. The right shoe can make a big difference in your ability to prevent an ankle injury. 

Avoid uneven or otherwise unstable surfaces: Walking on uneven ground increases your chances of an ankle sprain, so finding walking paths or sidewalks that are more level can help keep your ankles safe. 

Keeping these preventative measures in mind can help you avoid future ankle sprain injuries. Ankle sprains occur so frequently that you may still experience a sprain even while observing best practices. However, it is always best to use caution with your ankles. 

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