Ankle Sprain

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. More specifically, the ankle sprain is an injury to the lateral ligamentous complex, comprised of the anterior talofibular ligament and the calcaneofibular ligament. These are the ligaments that support the ankle. Ligaments are bands of tissue (like rubber bands) that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, completely torn, or involves a number of ligaments. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Ankle sprains are graded based on severity, from I to III:

• Grade I sprains – The anterior talofibular ligament is stretched, and there may be microscopic tearing of the ligament fibers.
• Grade II sprains – The anterior talofibular ligament is completely torn.
• Grade III sprains – Both the anterior talofibular ligament and the calcaneofibular ligament are completely torn.

Treatment for an ankle sprain depends on the grade of the sprain and the number of ankle sprains the patient has experienced prior to the injury.

A sprained ankle often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. An ankle sprain commonly occurs while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface.

Sometimes an ankle sprain occurs because a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.

Pain is the first sign of an ankle sprain. Other symptoms may include soreness, swelling, bruising, tenderness, difficulty walking, or stiffness in the joint. If a ligament has completely torn, you may have felt a “pop” when the injury occurred.

These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people who have had previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain–whether it is your first or your fifth–requires prompt medical attention.

There are four key reasons why an ankle sprain should be evaluated promptly by a foot and ankle surgeon like Dr. Neitzel:

1. An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. Weakness in the leg may also develop.
2. A more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications.
3. An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
4. Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

A physical examination is needed to determine the severity of the sprain and what treatment is needed. 

During your examination, Dr. Neitzel will gently press around the ankle to determine which ligaments are injured. She will also move your ankle in different directions, testing your range of motion. Of course, a stiff, swollen ankle usually will not move much, but Dr. Neitzel will be able to tell the severity of your ankle sprain based upon the amount of swelling, pain, and bruising you may have.

Imaging Tests

X-Rays. Dr. Neitzel may order X-rays to rule out a broken bone, as a broken bone can cause similar symptoms of pain and swelling. 

Stress X-rays. If stress x-rays are needed, scans are taken while the ankle is being pushed in different directions. This will give Dr. Neitzel an idea of whether the ankle is moving abnormally because of injured ligaments.

Magnetic Resonance Imaging (MRI). An MRI may be ordered if Dr. Neitzel suspects you have a severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. 

Ultrasound. This imaging scan allows Dr. Neitzel to observe the ligament directly while she moves your ankle, giving her an idea of how much stability the ligament provides.

There are both nonsurgical and surgical treatment options available to treat ankle sprains.

Nonsurgical Treatment Options

When you have an ankle sprain, rehabilitation is crucial and it starts the moment your treatment begins. Dr. Neitzel may recommend one or more of the following nonsurgical treatment options:

• Rest. Stay off the injured ankle. Walking may cause further injury.
• Ice. Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Compression. An elastic wrap may be recommended to control swelling.
• Elevation. The ankle should be raised slightly above the level of your heart to reduce swelling.
• Early physical therapy.  Dr. Neitzel will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.  In some cases, prescription pain medications are needed to provide adequate relief.

Full recovery times can range from a few weeks to a few months, depending on the severity of the sprain.

Surgical Treatment Options 

The majority of ankle sprains resolve uneventfully with conservative treatment. However, a small percentage of patients may have chronic ankle instability if the ligament heals in a stretched position and is unable to hold the ankle in place properly. Recurrent ankle instability is linked to the development of post-traumatic ankle arthritis in the future, so surgical intervention is generally recommended to correct this problem. An MRI is typically performed before surgery to confirm damage to the tissues in the ankle.

During surgery, Dr. Neitzel evaluates the ankle and may remove damaged tissue. The ligaments may also be reconstructed with a suture anchor augmentation device–a procedure that enables patients to return to work and play more quickly and with better results. 

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to schedule follow-up appointments with Dr. Neitzel during this period to ensure that your ankle heals properly and function is restored.

If you have sprained your ankle, please call Peninsula Podiatry at (360) 286-0404 to schedule an appointment with Dr. Neitzel for evaluation and treatment.