An ankle sprain is a soft-tissue (non-bone) injury to the ligaments surrounding the joint. Ligaments are tough bands of tissue that connect bone to bone and support the joints while allowing movement. The ankle is the most commonly sprained due to its many movements that are under constant stress. A sprain occurs when a sharp twisting or wrenching movement such as turning your ankle forces the joint beyond its natural limits. As a result, the ligament may be stretched to such an extent that it tears.

Ankle sprains in which the foot twists inward are called inversions injuries, damaging the lateral ligaments on the outside of the foot. Less common are pronation injuries, damaging the medial ligaments on the inside of the foot, caused by twisting the foot outward. Depending on the severity of the tear, appropriate treatment plans may include immobilization, physical therapy or even surgery.

On the lateral side of the ankle there are three ligaments that make up the lateral ligament complex. These include the anterior talofibular ligament (ATF), the calcaneofibular ligament (CF) and the posterior talofibular ligament (PTF). The very common inversion injury to the ankle usually injures the anterior talofibular ligament and the calcaneofibular ligament. The ATF ligament keeps the ankle from sliding forward and the CF ligament keep the ankle from rolling over on it side.

Low ankle sprains are among the most common injuries which occur in sports. In this type of ankle sprain, an athlete steps incorrectly on his or her foot or skate, and the ankle and foot turn in. This results in the structures in the outside portion of the ankle being stretched. The amount of stretch can vary from a mild, moderate, or a severe amount. In severe stretches, the ligaments which hold the ankle together are completely torn.

In a low ankle sprain, the ligaments which hold the fibula to the dome of the ankle (the talus) are stretched or torn. These types of ankle sprains usually are more stable and can be treated with a program of taping and rehabilitation once the initial pain and swelling from the injury subside. Most athletes return back to activities by one to three weeks after injury.

In high ankle sprains, the membrane which connects the two leg bones (the syndomosis) is either stretched or torn. High ankle sprains can be especially problematic for athletes because there is a very poor blood supply to this area of the ankle and it takes a long time to heal. Any type of twisting or turning maneuver results in stretching of this area, which makes it especially difficult to play basketball, soccer, or to skate. Over time, athletes who have a high ankle sprain can often walk and even jog on level ground normally, but cannot push off on their skate edges and are limited in terms of their ability to return to activities. High ankle injuries can take six weeks or longer to heal.

Treatment

In a grade I sprain, there is usually minimal loss of function, minimal pain, minimal swelling and the patient maintains the ability to weight bear. The integrity of the ligament remains intact, and typically x-rays are not needed. Treatment consists of Rest, Ice, Compression, and Elevation (RICE). Nonsteroidal anti-inflammatory medications are helpful to control both pain and swelling.

Grade II sprains produce symptoms including more functional problems such as an increase in pain, moderate swelling, bruising, and more difficulty with weight bearing. A grade II sprain is indicative of a partial tear in the ligament. Treatment consists of using RICE protocol and anti-inflammatory medications. Patients will need an ankle support, and crutches are recommended until walking is pain free. Physical therapy and rehabilitative exercises should be started. It is important to re-strengthen the ankle, since people with a previous grade II ankle sprain are more prone to re-injury and tend to have more laxity in the joint following the injury.

In a grade III sprain, a complete rupture of the ligament is diagnosed. There is a severe loss of function, severe pain, and diffuse swelling, bruising and an inability to bear weight. Treatment of grade III sprains can vary.

Stages of Healing

Most sprains heal in four to sixteen weeks; the time will vary depending on age and the severity of the injury. Your doctor may recommend an ankle brace, cast or boot to help the healing process. Immobilizing the joint in the proper position may be recommended so that the ends of the injured ligaments can heal together. During the immobilized period the body is working to heal the injured tissue. Special cells fill the gap in the ligament fibers left by the injury. The body then replaces the torn, damaged tissue with strong, healthy tissue. There are three phases to the healing process, they are Phase I

Multipurpose cells enter the injured area. They quickly and randomly fill the gap and clean up the wound by removing injured tissue.

Phase II

These cells become fibroblasts (cells that build soft tissue). They line up along the direction of the ligaments fibers, forming a bridge and filling the gap temporarily. They begin to produce collagen, the framework for new ligament.

Phase III

Eventually, the new collagen fibers become interwoven with the old collagen in the ligament. Fibroblasts disappear. Over time the structure is strengthened and refined through rehabilitation exercises.

It is important to know that once an ankle sprain has occurred the joint itself has been weakened and is not as strong as it was before the injury. Continued ankle strengthening exercises are very important. For participation in athletics, it may be necessary to continue to wear a supportive brace. Traditionally, many athletes trying to help protect themselves from injury have used ankle taping. Although taping offers some protection, studies have shown that support breakdown can occur quickly. One study showed that 40 percent of tape support was lost after 10 minutes; therefore, we recommend the use of ankle braces to counter the forces being placed on the ankle.