ANKLE SPRAINS

An ankle sprain is a sudden sideways motion, a twist, or a misstep. When your foot lands off-balance, muscles may give way, allowing the ankle joint to move too far. If ligaments connecting the foot and ankle bones overstretch or tear, a sprain is the result.

These sudden injuries are painful, both at the time they occur, and throughout the healing process. Depending on the sprain, swelling and bruising may extend from your ankle into your foot. With proper care, however, sprains can heal correctly, and in many cases, you can reduce the risk of re-injury.

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 ankle joints. Sprains on the inside ligaments are less common. 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 ball and socket type 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 bone or outside the foot bone 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 may also be 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.

Treatments

The physician will examine your ankle and foot, feeling for damaged ligaments, inflamed tendons, and any displaced bones or joints. Ankle x-rays may be taken to rule out a fracture. Depending on the injury, treatment may range from pain control to immobilization of the joint. If the sprain is severe, or if a bone is damaged, surgery may be needed.

Initial treatment includes rest, ice, compression and elevation (RICE). The "RICE" method promotes healing, decreases pain, and reduces swelling around the ankle joint. In more severe cases, nonweightbearing activities are encouraged and crutches may be recommended. Compression may be achieved with an elastic bandage, splint, short leg cast or brace, depending on severity. Compression 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. 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.

Conservative treatment of many foot and ankle problems often promotes pain relief. For example, ankle strengthening exercises following the injury help prevent recurrence of injury. Most of these exercises can be done at home after appropriate instruction. Ankle supports and braces or taping around the ankle joint is especially helpful for individuals participating in sports. Your podiatric surgeon may recommend preventive bracing to help prevent future injury.

Pain Control

For a mild to moderate sprain, a few days of home care will help speed up healing. The RICE principle (Rest, Ice, Compression, and Elevation) will help reduce pain and swelling.

Rest the sprained ankle.

Do not stand on it for one or two days.

Ice the sprain often. Apply ice for 20 minutes, then remove the cold pack for 20 minutes.

Repeat this process. Protect the skin by placing a bandage or thin towel between the ice and skin.

Compression can be applied by wrapping the ankle with an elastic bandage.

Elevate the sprained ankle above the level of your heart.

If the damage or pain is severe, your doctor may tape, splint, or cast the sprain. Once the ankle is immobilized, the torn tissues can rest and heal in the proper position. You may need to use crutches temporarily if your foot cannot support weight.

Surgery

In some cases, a sprain may completely tear a ligament, or pull it away from the bone. This type of injury may require surgery. After surgery, your foot will be placed in a cast to insure proper healing.

Summary

The adage "it is better to break an ankle than sprain one" need not apply if the injury is appropriately diagnosed and treated by the podiatric surgeon. Properly treated, the rehabilitated ankle can tolerate normal activities and the stress of participating in sports. The podiatric surgeon is a foot and ankle specialist who diagnoses foot and ankle conditions and determines appropriate treatment.