Ankle sprains are common injuries that occur when ligaments are stretched or torn. The ankle sprain is the most common athletic injury. Nearly 85% of ankle sprains occur laterally, or on the outside of the ankle, referred to as inversion sprains. Ankle sprains involving the inside aspect of the ankle are called eversion sprains and are uncommon. Many sprains occur when participating in sports, or by twisting the ankle when walking on an uneven surface. Some individuals, due to their bone structure or foot type, are more prone to ankle sprains.

Anatomy of the Ankle Joint

The ankle joint is made up of three bones. The bones are called the tibia, fibula, and talus. These bones form a socket in which the ankle joint moves.

The tibia, fibula and talus are connected to each other by ligaments. Think of ligaments as thick rubber bands that hold bones together so that joints are stable and function properly. When an ankle is sprained, a ligament is either stretched, partially torn or completely torn. Muscle and tendon structures surround the ligaments. These structures provide motion of the ankle joint for walking and running. Blood vessels, nerves and skin overlie the ligaments and tendons. The ankle joint moves the foot upward and downward. Just below the ankle joint is a joint that allows inward and outward motion.

Ankle Injury Symptoms

Ankle sprain symptoms vary depending on severity. Often, the ankle is tender, swollen and discolored. The ankle can be quite painful to touch. Walking is usually hampered and may become difficult depending on the severity of the sprain. A feeling of instability may occur, especially in severe ankle sprains when ligaments are torn. Ankle sprains are classified by "types" and range from mild to moderate to severe. Classifying ankle sprains helps the podiatric surgeon diagnose the specific structures involved in the injury. This also helps determine appropriate treatment plans for each type of ankle sprain. Type I ankle sprain, the least severe, occurs when ligament fibers have been stretched or slightly torn. Type II sprain occurs when some of these fibers or ligaments are completely torn. Type III, the most severe, occurs when the entire ligament is torn and there is significant instability of the ankle joint. Fractures of the ankle or foot bones may be present. Fractures require immediate diagnosis and attention for appropriate treatment.

Diagnosis

The podiatric surgeon examines the ankle to identify the type of ankle sprain and determine the appropriate method of treatment. X-rays or specialized X-ray views of the ankle and foot are used to reveal any fractures, dislocations or instability of the ankle joint. Less frequently, more sophisticated testing is necessary to examine soft tissue injuries. For example, computerized tomography (CT) and magnetic resonance imaging (MRI) give detailed views of the bone and soft tissue structures around the ankle joint. Once the diagnosis is made, the podiatric surgeon recommends appropriate therapy.

Treatment

Initial treatment includes rest, ice, compression and elevation (RICE). The "RICE" method promotes healing, decreases pain, and reduces swelling around the ankle joint. Oral anti-inflammatory medications may also aid in reducing swelling and relieving discomfort.

In more severe cases, non-weightbearing and crutches may be recommended, and an elastic bandage or a soft, compressive dressing applied with a short leg splint or cast. This decreases swelling and eliminates motion around the ankle joint. The ability to walk or participate in other weightbearing activities during the healing process depends on the severity or type of ankle sprain. This is determined by the podiatric surgeon once the diagnosis is made. After initial treatment, if pain persists and/or weightbearing is still not possible, further diagnostic testing is usually necessary.

Most ankle sprains heal in three to eight weeks. In more severe cases, ligaments may require more healing time to promote ankle stability. Repeated ankle sprains may cause chronic instability, interfering with walking or sports activities. In this case, the podiatric surgeon may recommend a surgical procedure to tighten or create new ligaments around the ankle joint to re-establish stability of the ankle joint.

Once an ankle sprain has occurred, the ligaments heal over time but never regain their original strength. For this reason, recurrent or "chronic" injury is very common. Rehabilitation and physical therapy are the key elements to a rapid recovery and avoiding recurrent injury. Strengthening of muscles and proprioceptive exercise are the most important facets of rehabilitation. Following this, an ankle brace, taping, high-top shoe or functional orthotic may also be necessary. The athlete should be cleared by a Podiatrist or Athletic Trainer before resuming running or jumping activities. If pain and or instability is still present following rehabilitation, surgery may be necessary.

Summary

The ankle sprain, especially the inversion sprain, is a very common and often debilitating injury. Accurate physical examination, diagnosis and treatment by the podiatric surgeon followed by thorough rehabilitation are essential to allow for a full, rapid recovery and prevention of recurrent sprains.

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