Ankle sprains- we have all had one to some degree. Either we have been running, diving for a ball, or simply stepped down off a curb and had our ankle roll inward. Ankle injuries are one of the most common injuries in sports, second only to knee injuries. They are especially high in wall climbing, indoor volleyball, mountaineering, and field events in track & field. Ligament sprains are the most common ankle injuries.

The vast majority of ankle sprains are lateral sprains which involve the anterior talofibular ligament. A lateral ankle sprain occurs when the weight-bearing ankle turns inward, over-stretching the ligaments on the lateral side of the ankle. Ligament sprains are classified in 3 degrees of severity. A first degree sprain is an injury with mild ligament damage and is associated with mild pain. With second degree sprain, there is both stretching and tearing of some ligaments that results in inflammation, discomfort, and a moderate loss of stability. With a third degree sprain, at least one ankle ligament is torn, causing severe swelling and pain. In addition, the ankle joint is loose and unstable. An ankle sprain can be severe enough to cause the ligament to tear off the bone, and occasionally the ligament will tear a piece of bone away resulting in an avulsion fracture. Occasionally, a rolled ankle can produce both ligamentous sprains and fractures.

If an ankle injury should happen, it is important to stay off of it and rest it immediately. Apply ice for 15 minutes at a time 4-6 times per day. Then apply compression with a compression bandage, and elevate the leg to reduce swelling. Expect some bruising. Your ankle pain should start to subside with rest within a few days, although it still may be painful to walk or stand on it. Signs and symptoms that an ankle injury is more than just a sprain include excessive pain, and pain that stops an individual from bearing weight on the foot. Seek the advice of your doctor or go to the emergency room for any of the following symptoms: inability to bear weight on the ankle, pain that remains intolerable despite using over-the-counter pain medications, home care failing to reduce the pain, continued numbness of the foot or ankle, a gross deformity of the ankle bones, bones, bone fragments visible outside the ankle skin, inability to move the toes, inability to move the ankle, or a cold or blue foot. These symptoms may indicate a fracture that would require immediate medical assistance to prevent irreversible loss of bone and/or nerve damage.

Proper care of a sprained ankle early is critical for healing of your ankle over the long-term. A single ankle sprain increases your risk for future ankle sprains. Greater than four ankle sprains leads to instability issues which may make it difficult to participate in everyday walking or returning to sporting activities. Returning to full weight-bearing activities too soon is one of the most common reasons physical therapists see patients struggling after ankle sprains, as tissues are not able to heal correctly and continued disability occurs. One should have full range of motion and be able to stand on 1 leg fully before trying to walk without use of crutches or a cane. If you are limping secondarily to pain or stiffness, then you should be using a crutch. This is true even if the injury is older and has been healing well, but you are especially painful from normal daily activities. Limping, or compensatory strategies, will cause worse problems in the long run, including inefficient healing of the ligament sprain and possibly lead towards pain or injuries to the knee, hip, and/or low back. One can expect healing time for full return to sports to be approximately 10-12 weeks after a significant ankle sprain injury.

In my next blog, I plan to talk about how to safely return to exercises and weight bearing activities after an ankle injury.