Ankle Sprain

ANKLE SPRAIN

Sprains are caused by overstretching and tearing of one or more ligaments. Sprains involving two or more ligaments are worse than single-ligament sprains. Sprains are classified into three grades:

First-degree sprain: ligament is painful but normal length. Average healing time 2 to 6 weeks
Second-degree sprain: ligament is stretched or partially ruptured. Average healing time 8 to 12 weeks
Third-degree sprain: ligament is completely torn and does not function. Average healing time 12 to 16 weeks

If the sprain is a first-time injury, proper care and sufficient healing time before resuming activity can prevent permanent disability. Ligaments have poor blood supply and require more healing time than simple muscle strains.

Lateral ankle sprains are the most common type of ankle sprain. There are three ligaments of the outer (lateral) ankle that may be damaged by an lateral ankle sprain
Medial ankle sprains are much less common accounting for < 15% of all ankle sprains. The large triangular ligament of the inner (medial) ankle is stronger and more compact than the outer ligaments and thus, is less likely to be injured.

Syndesmosis (“high ankle”) sprains involve the ligament that connects the fibula and tibia. This type of ankle sprain can take a long time to heal. Frequent recurrence of symptoms can result in a chronic problem.

Signs and Symptoms

Pain, tenderness, and swelling in the ankle that may progress to involve the whole ankle and foot
Popping or cracking sensation at the time of injury
Bruising of the ankle
Impaired ability to walk soon after injury

Risks

Previous ankle sprain
Activities in which the foot may land unevenly like basketball, volleyball, and soccer
Walking or running on uneven or rough surfaces
Contact sports
Shoes with inadequate support to prevent sideways motion
Poor balance skills

Treatment

Appropriately addressing the problem the first time decreases the frequency of recurrence and optimizes healing time. Severity of initial sprain does not predict the likelihood of later instability. Injury to other structures (bone, cartilage, or tendon) and a chronically unstable or arthritic ankle joint are possible with repeated sprains.
If the patient is unable to walk immediately after the injury or if there is pain along either malleolus or the outer edge of foot, xrays are indicated. In the absence of these criteria, xrays usually provide little diagnostic value.
Initial treatment consists of relative rest, ice, elevation, medication, and a compressive elastic bandage to help reduce swelling and discomfort. Many believe that non-steroidal anti-inflammatory medications (NSAIDS) help reduce pain and inflammation. However, there is some evidence that certain subtypes of NSAIDS can impair ligament healing. Because of this, some experts will prescribe only certain NSAIDS or even simple analgesics like acetaminophen. Some will avoid all NSAIDS when treating a ligament injury.
The initial phase of rest, ice, and elevation usually lasts 72 hours and is followed by a graduated program of stretching and strengthening. It is especially important to concentrate on increasing the endurance of the injured area muscles and supporting muscles to help prevent future injury. One often neglected part of rehabilitation involves re-training proprioception in the injured area. This has also been shown to help reduce the incidence of re-injury.

Topical ointments or liniments may be beneficial. Injections of corticosteroids may be given to reduce inflammation and pain.

A walking cast, boot, or brace may be needed for support when walking with crutches for varying lengths of time, depending on the severity of injury. Surgical treatment is rarely necessary. After the inflammation and pain are reduced, regaining motion, strength, balance, and proprioception are the key elements in regaining function of the ankle.