Anatomy of the Ankle
There are several ligaments in the ankle that hold the bones and joints in position. The ligaments of the ankle are comprised mainly of the collateral ligaments, both and lateral (outer) medial (inner). These are extremely important in the stability of the ankle itself:
- Lateral Collateral Ligaments - The lateral collateral ligaments prevent excessive inversion. They are considerably weaker than the larger medial ligament and thus sprains to the lateral ligaments are much more common. There are 3 individual bands:
- Anterior talofibular ligament (AFTL) - passes from the fibula to the front of the talus bone
- Calcaneofibular ligament (CFL) - connects the calcaneus and the fibula
- Posterior talofibular Ligament (PTFL) - passes from the back of the fibula to the rear surface of the talus
- Medial Collateral Ligament – The medial ligament, also known as the deltoid ligament, is considerably thicker than the lateral ligaments and spreads out in a fan shape to cover the distal (bottom) end of the tibia and the inner surfaces of the talus, navicular, and calcaneus.
Sprains are graded on a scale:
- Grade 1 sprains involve slight stretching and a small amount of damage to the fibers of the ligament. Grade 1 sprains are generally accompanied by mild tenderness and swelling.
- Grade 2 sprains include a partial tearing of the ligament, and a small amount of abnormal looseness of the ankle joint may occur. Grade 2 sprains are characterized by moderate tenderness, swelling, bruising, decreased range of motion, and possibly some instability.
- Grade 3 sprains are a complete tear of a ligament and can result in instability of the ankle along with significant pain, swelling, and bruising.
- “High” ankle sprains – these sprains involve the ligaments that hold the distal tibia and fibula together. They can occur in combination with other sprains or in isolation. The pain is usually felt higher than other ankle sprains and may extend into the lower leg. These sprains can take significantly longer to heal.
Causes of Ankle Sprains
Ankle sprains are a very common injury and can happen to nearly anyone. While some sprains are a result of injury during athletics, many happen during normal daily activity. Anything that causes the foot to twist, roll, or turn beyond its normal range of motion can cause a sprain, from an awkward jump landing to simply stepping on uneven ground. These motions cause the ligaments to stretch beyond their normal capacity, resulting in mild to significant damage.
Symptoms of Ankle Sprains
Symptoms depend on the grade of the sprain. These symptoms include:
- Tenderness/Pain – tenderness can range from minimal for Grade 1 sprains to severe in Grade 3 sprains
- Swelling – like pain, swelling can range from minimal to severe
- Bruising – can be quite severe in higher grade sprains and can cover the entire ankle, top of the foot, and may extend into the lower leg
- Instability – occurs in Grade 3 sprains as well as some Grade 2 sprains.
- Dislocation – occurs in some Grade 3 sprains
Immediate Treatment of Ankle Sprains
If you suspect you have sprained your ankle, you should rest it as much as possible and apply ice for 20 minutes at a time until you can see your doctor. Elevation of the ankle above the level of the heart is important to help reduce swelling.
Diagnosis of Ankle Sprains
Your doctor will conduct a physical exam by feeling the ankle and moving it in different ways. Because sprains and fractures often exhibit similar symptoms, the doctor will probably order an x-ray to rule out fractures. If the injury seems very severe, an MRI may be ordered to assess severity and to rule out other problems.
Non-Surgical Treatment of Ankle Sprains
Most ankle sprains are treated non-surgically. The RICE guidelines are usually followed:
- Rest the ankle
- Ice the ankle for 20 minutes at a time several times a day until swelling subsides
- Compression dressings such as ACE wraps may be recommended
- Elevate your ankle above your heart when possible to reduce swelling
Anti-inflammatories may also be used to alleviate swelling and pain. After an initial period of protection, rehabilitation may be necessary for some sprains. Return to normal activities should be gradual. Depending on severity, it may take several months to return to athletic activities.
Surgical Treatment of Ankle Sprains
Surgery for ankle sprains is rare, and is usually resorted to only if non-surgical treatment has failed. Occasionally a cartilage injury to the talus may occur with a severe sprain. If the lesion is large or forms a loose fragment inside the joint, surgery may be indicated. This can be diagnosed with MRI. The surgeon may use an arthroscope to look inside the ankle for any loose fragments of bone or cartilage, or to see if the part of the ligament is caught in the joint.
If severe instability develops after a sprain, sometimes the torn ligaments can be repaired. In rare cases, reconstruction may be necessary in which a piece of tissue from another tendon is used to repair the damage.
Rehabilitation will focus on restoring strength and range of motion in order to return to pre-injury activities. The length of time spent on rehabilitation will depend on the severity of the sprain and the type of surgery performed.
- How can I prevent ankle sprains?
Maintaining strength, balance, and flexibility is important in preventing ankle sprains. Always warm up before beginning vigorous activity, and wear proper shoes. Pay attention to the surface you are walking or running on to avoid an awkward step. Ankle braces may be useful in preventing sprains, especially in people who have a history of previous ankle sprains and have developed some laxity in the ligaments. Ankle taping, when done properly by an athletic trainer, can also be helpful for preventing sprains in athletes.
- How long will an ankle sprain keep me out of sports?
Recovery time for ankle sprains depends mostly on the severity/grade of the sprain. It may take anywhere from a few days for a mild sprain to 8 weeks after a severe sprain. In general, high ankle sprains have a longer recovery period. The return to sports is usually based on when the pain level decreases to tolerable levels.
If you have more questions, please call my office at 502-394-6341.