Ankle sprain is one of the most common musculoskeletal injuries seen by primary care doctors. Most people have twisted an ankle at some point in their life. Although many sprains are considered minor injuries, some can be serious and result in serious complications if not treated correctly. Treating a sprained ankle can help prevent ongoing ankle problems.
What is an ankle sprain?
The ankle joint consists of tree bones held together by ligaments. Ankle sprains are common sport injuries but can occur in everyday life experiences. An ankle sprain happens when you make a rapid shifting movement with your foot planted, such as when playing football. Often the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle.
An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel “wobbly.” You cannot walk, because the ankle gives out and may be very painful.
Symptoms of ankle sprains
One of the most common symptoms of an ankle sprain is acute pain at the site of the injury. Often the ankle starts to swell and might be bruised. The ankle area is usually tender to touch, and it hurts to move it.
In more severe sprains, you may hear and/or feel something tear, along with a pop or snap. You will probably have extreme pain at first and will not be able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal.
Making the diagnosis
When evaluating the ankle injury your healthcare provider would take a clinical history and carry out a complete physical examination to make sure there are no other injuries. Your doctor will ask you how the injury occurred and if you have hurt your ankle before.
In some cases, the doctor may order X-rays to be sure there is not a broken bone in the ankle or the foot. Other investigations and tests might be done if required.
Treatment
Immediate treatment is important, and in some cases such treatment can be started at home or at the place of injury. Remember the RICE approach.
In many cases you can first use the RICE approach to treat your ankle:
• Rest. You may need to use crutches until you can walk without pain.
• Ice. For at least the first 24 to 72 hours, or until the swelling goes down, apply an ice pack for 10 to 20 minutes every hour or two during the day. Always keep a thin cloth between the ice and your skin, and press the ice pack firmly against all the curves of the affected area.
• Compression. An elastic compression wrap, such as an ACE bandage, will help reduce swelling. You wear it for the first 24 to 36 hours. Compression wraps do not offer protection. So you also need a brace to protect your ankle if you try to put weight on it.
• Elevation. Raise your ankle above the level of your heart for 2 to 3 hours a day if possible. This helps to reduce swelling and bruising.
If you are not taking any prescription pain relievers, you may want to take an over-the-counter pain reliever, such as ibuprofen or naproxen, to reduce pain and swelling.
Proper treatment and rehabilitation (rehab) exercises, under the guidance of a trained physiotherapist, are very important for ankle sprains. If an ankle sprain does not heal right, the joint may become unstable and may develop chronic pain. This can make your ankle weak and more likely to be reinjured. Before you return to sports and other activities that put stress on your ankle, it is a good idea to wait until you can hop on your ankle with no pain. Taping your ankle or wearing a brace during exercise can help protect your ankle. Wearing hiking boots or other high-top, lace-up shoes for support may also help. But use caution. Do not force your foot into a boot if you feel a lot of pain or discomfort.
If your ankle is still unstable after rehab, or if the ligament damage is severe, your doctor may recommend surgery to repair the torn ligaments.
Complications
A sprained ankle left untreated, engaging in activities too soon after spraining your ankle, or spraining your ankle repeatedly, might lead to complications like chronic pain, chronic ankle instability and early-onset arthritis in the ankle joint.
Preventing ankle sprains
There are a few things that individuals can do to prevent ankle sprains. These include the following:
• Warm up before you exercise or play sports.
• Be careful when walking, running or working on an uneven surface.
• Wear shoes that fit well and are made for your activity.
• For women, do not wear high-heeled shoes.
• Do not play sports or participate in activities for which you are not conditioned.
• Maintain good muscle strength and flexibility.
• Practice stability training, including balance exercises.
Conclusion
A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you have sprained your ankle and to put you on the path to recovery.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
