What is an ankle sprain?
An ankle sprain is the medical term used when the ligaments of the ankle have been injured by being overstretched or torn. The ankle joint is made up of one strong capsule that forms around the joint encapsulating it and preventing either boney ends of the lower leg and foot from connecting or impacting. The ankle is in fact made of two joints in order to allow it a lot of movement and flexibility. The point where the lower leg connects to the foot is through the tibiotalar joint (the joint between the tibia and the talus), this joint allows the foot to point downwards and upwards. The second joint is the subtalar joint (the joint between the talus and calcaneus) this joint allows the ankle to bend from side to side. The two joints are encompassed by the one strong capsule. The capsule itself is filled with a small amount of thick fluid called synovial fluid that acts as a cushion and there is protective layer of articular cartilage that covers each boney surface. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments that surround the joint are made of thick, tough, fibrous tissue; they overlap the joint and work in co-ordination with the strong lower leg muscles to provide protection and stability for the ankle.
What is the difference between an ankle sprain and an ankle strain?
Sprain injuries are commonly confused with strains. The injury is very similar except a strain affects the muscles and tendons not the ligaments.
Why & when does an ankle sprain happen?
Ankle sprains are a common injury and affect people of all ages. They are normally the result of landing awkwardly after a jump or fall, sport activities like football tackles or even twisting your ankle in high heels. In fact, any activity where the ankle rolls and twists with your body weight behind it can result in an ankle sprain. There are some risk factors that may leave you more prone to suffering from ankle sprains, such as wearing inappropriate footwear like high heels or flip flops, as well as muscle weakness and being overweight.
The ankle joint is supported by a matrix of ligaments; the most commonly affected is the lateral ligament. This is due to the normal mechanism of a sprain being partly from both joints combining plantar flexion (pointing downwards) with inversion (turning inward), placing most stress on the outside of the foot where the lateral ligament is situated. Eversion (turning outwards with the foot) sprains also occur but are less common. In some cases of reoccurring ankle sprains there is normally a loss of ankle joint stability and underlying weakness that increases the pressure on the ligaments and means that minor activities can cause a sprain. Ankle sprains also occur slightly above the true ankle joints, in between the tibia and fibula. These ankle sprains normally occur in sports, in particular skiing and take slightly longer to heal, they are sometimes referred to as high ankle sprains.
Due to the nature and symptoms of the injury most severe sprains are hard to distinguish between strains or fractures which can also cause damage to the surrounding ligaments. Due to the risk of damage to the arterial and nervous supply to the foot, ankle fractures are considered a medical emergency. Therefore, it is advisable to seek medical attention if you are unsure of your diagnosis
The severity of the damage done to a ligament varies, overstretching can cause small tears in the ligament itself or with more traumatic sprains partial or complete tears can occur. The overstretching and tears cause high levels of inflammation to gather around the ligament and joint causing the huge levels of swelling you notice after the injury. The swelling is normally accompanied by a considerable amount of bruising caused by bleeding from the ligament and joint. All sprains are graded by their severity;
Grade I - Mild sprain where stretching of the ligament causes small tears but the ankle joint remains fully functional and stable.
Grade II – Moderate sprain where a partial tear of the ligament occurs but the ankle joint remains fully functional and only mildly unstable.
Grade III – Severe sprain that causes a complete tear of the ligament resulting in a loss of joint function and instability.
What does an ankle sprain feel like?
An ankle sprain causes a very intense, immediate sharp pain around the site of the sprained ligament. This pain can radiate up into the shin, calf and knee and down into the foot. In some cases a tearing or snapping noise is heard during the injury. The sprain will be accompanied by swelling and bruising that will be incredibly tender to touch. In severe grade 3 cases there will possibly be visible joint deformity. Pain levels will be aggravated by any foot movements, making weight bearing and walking excruciating. In some milder sprain cases, such as a grade 1, patients can still fully use their ankle with only slight stiffness and a feeling of discomfort on weight bearing resulting in a mild limp. The intense pain that some patients experience after a sprain will last for several hours which will be aggravated or prolonged by any walking or examination.
What to do if an ankle sprain is suspected?
Your actions immediately after an ankle sprain can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol. This involves Protection for the ankle by either strapping it or using an elastic bandage like a tubigrip. Rest your ankle, try not to walk about on it too much and if you have to then ensure you are wearing high sided boots that offer your ankle some support or use crutches. Ice the area by applying a covered ice pack, this may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the ice pack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
You should also follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days, after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating movements should be avoided in case of further injury. Massage or manipulation should be avoided for the first three days after injury as it will also increase any bleeding and swelling.
How long does an ankle sprain take to heal?
A mild ankle sprain can recover in as little as one to two weeks, more moderate or severe ankle sprains take longer. However, most sprains will have fully healed within six weeks. If you experience pain for longer than six weeks it is advisable to attend your GP.
How will an ankle sprain be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis unless a fracture is suspected.
What treatment options are available for a sprained ankle?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be advised to follow the P.R.I.C.E and H.A.R.M protocols above. An ankle sprain can take anything from 4-6 weeks to heal, if not longer for a more severe sprain. Your GP or therapist will be able to provide you with exercises to strengthen ankle ligaments and muscles to aid the healing process and prevent reoccurring injury. Many people find manipulative therapies such as physiotherapy, chiropractic and osteopathy help through mobilisation treatment of the ankle. This works to reduce the severe stiffness levels and return the joint back to its normal movement. More severe sprains that result in complete tears and joint instability may need surgery, however in most instances a cast or splint will be enough to aid the healing process.