Ankle sprains occur as a result of a twisting injury to the ankle in which the ligaments that connect the ankle bones (fibula and/or tibia) to the foot bones (talus) are stretched or torn either partially or completely.
Types of Ankle Sprains
There are different classification systems for ankle sprains. All of these systems are based on the degree of severity of the ankle sprain injury.
Typically, ankle sprains are described as mild, moderate or severe.
Alternatively, ankle sprains are referred to as:
- Grade 1 (mild) – stretching/incomplete tearing of the ligaments, or a tear of just 1 of the 3 ligaments that connect the fibula to the talus
- Grade 2 (moderate) – partial ligament tearing, or tearing of 2 of the 3 ligaments connecting the fibula to the talus
- Grade 3 (severe) – complete ligament tear, or tearing of all 3 ligaments connecting the outside ankle bone/fibula to the foot/talus
These are the most typical patterns for ankle sprains and are more commonly known as “low ankle sprains”. Less commonly (10% of the time or less), a more severe type of ankle sprain injury occurs which is referred to as a “high ankle sprain”. As the name suggests, this type of sprain leads to tearing of the ligaments higher up the leg or above the ankle.
How do you know if you’ve sprained your ankle vs. broken it?
It may be difficult to know the difference between a fracture or a sprain without evaluation by an orthopaedic surgeon.
In general, if you are unable to bear weight and if you have pain or tenderness directly over the bone, then concern for a fracture is a greater.
Typically an X-Ray is obtained in these situations in order to confirm the presence (or absence) of an ankle fracture. It is also important to understand that sometimes, fractures to other bones can occur by the same mechanism as an ankle sprain. Examination by an orthopaedic surgeon and xrays are important to rule out these injuries as well.
Who is most susceptible to ankle sprains?
#1 – Athletes
Anyone is susceptible to an ankle sprain – even individuals who are not participating in athletic activities. Athletes, however, are more likely to sustain an ankle sprain. This is especially the case with athletes who participate in sports like soccer, basketball and football.
#2 – Individuals with Certain Types of Foot Alignment
Individuals who have a certain type of foot alignment (cavus or cavovarus) are also susceptible to ankle sprains. These individuals tend to have a foot with an exaggerated or high arch.
As a result, they may naturally shift more of their body weight to the outer border of the foot, which in turn, increases the likelihood for the ankle/foot to turn inward (inversion).
#3 – Individuals with Loose Ligaments
Another risk factor occurs in those individuals having generally loose ligaments. Certain, rare inherited conditions, but more often individuals with generalized joint hypermobility (ex: people who are double jointed) are more susceptible to ankle sprain.
If you sprain your ankle, are you more likely to re-sprain or injure that ankle in the future?
The greatest risk factor for an ankle sprain is having a personal history of having had an ankle sprain in the past.
This is especially the case in combination with any of the risk factors mentioned earlier, such as: type of athletic participation, pre-existing foot alignment, etc.
What is the best course of treatment for a sprained ankle?
#1 – See a physician.
Always seek care from a knowledgeable physician first.
#2 – RICE
After speaking to your doctor, the best course of treatment will typically include Rest, Ice, Compression, and Elevation (RICE) for the first 48-72.
#3 – Anti-inflammatory Medications
Anti-inflammatory medications such as ibuprofen (Motrin/Advil) or naproxen (Aleve) can help reduce pain/swelling.
#4 – Immobilization
Individuals who are unable to bear weight will usually have an X-Ray to rule out a fracture or some other unrecognized injury. If diagnosed with a sprain, these individuals typically require some form of immobilization (cast, walking boot or ankle brace) in order to facilitate a quicker and a more functional recovery.
#5 – Physical Therapy
Physical therapy is usually incorporated after the acute period of inflammation has subsided. Physical therapy is focused on regaining a functional range of ankle motion, improving the strength of the muscles which provide stability to the ankle and also coordinating the actions of these muscles in order to prevent subsequent re-injury.
#6 – MRI
Rarely, an MRI is obtained if there is a heightened concern for an injury other than just an ankle sprain which may require surgical intervention, such as torn tendons or cartilage in the ankle. This is usually based on clinical evaluation and X-Ray findings.
An MRI may also be necessary in those individuals who follow the above steps but still see no physical improvement during the usual expected course of recovery.
When can you play sports again after a sprain?
The vast majority of individuals recover from an ankle sprain as quickly as 1-2 weeks (mild/Grade 1 sprains) or take as long as 6-8 weeks (severe/Grade 3 sprains).
Rarely will it take much longer to recover from an ankle sprain, unless it’s a high ankle sprain. There is no exact time table for when it’s ok to return to play sports. Generally, this decision is reached with the help of your physical therapist.
As a general rule, return to play occurs when you are able to bear weight without pain and perform basic daily activities without restrictions. Often, an ankle brace is utilized to permit earlier return to play in those individuals who have sustained an ankle sprain and have certain risk factors for repeat injury.
When should you see a doctor? What kind of doctor?
You should see a doctor any time you experience a twisting injury to the ankle with associated pain and swelling and are unable to bear weight.
Although rare, a more severe injury can occur if treatment is delayed or the injury is unrecognized This can lead to a prolonged recovery or even the need for surgery.
Whenever there is suspicion, make an appointment with your physician or preferably a physician with expertise in conditions affecting the ankle/foot, such as an orthopaedic surgeon.
About Corey Thompson, MD
Dr. Corey Thompson is an orthopaedic doctor with Wake Orthopaedics and has surgical interest in operative and non-operative foot and ankle care, including trauma and sports-related injuries, ligament and tendon injuries, post-traumatic arthritis, and deformity correction.
Dr. Thompson is a member of the American Academy of Orthopedic Surgeons and the American Orthopedic Foot and Ankle Society and has published work in multiple peer-reviewed orthopedic surgery journals.