Have You Suffered A
Sprained Ankle?

A twisted or sprained ankle is the most common ankle injury. What exactly is a sprained ankle? How long will it take to heal? And finally, what can you do to get back on track more quickly?



Ankle Anatomy

The ankle joint is comprised of a number of bones and ligaments. The talus, located on the inner aspect of the ankle joint, is the weight bearing bone. The fibula, located on the outside, is a non weight bearing bone. It functions to help complete the ankle joint as well as serves as the attachment for both ligaments and muscles. Located at the bottom of each bone is the malleoli. The medial malleoli is located on the bottom of the tibia and the lateral malleoli on the fibula. Between the malleoli is a bone called the talus. Together these three bones form what is commonly referred to as the ankle joint.


Ankle ligaments

The bones of the ankle joint are supported by a number of ligaments. Ligaments are soft tissue structures that connect bone to bone, adding stability to a joint. On the inside or medial aspect of the ankle joint is a broad ligament called the deltoid ligament. On the outside or lateral aspect of the ankle is a series of ligaments named based on where they attach: the ATFL (anterior talofibular ligament), the CFL (calcaneofibular ligament), and the PTFL (posterior talofibular ligament). In addition there are ligaments that connect the tibia and fibula including the AITFL (anterior inferior tibiofibular) and the PITFL (posterior tibiofibular) ligaments.


What is a Sprained Ankle?

A sprain is simply an injury to a ligament. Thus, a sprained ankle involves injuring one or more of the ankle ligaments. Sometimes a strain is confused with a sprain. A strain is an injury to a muscle or sometimes a tendon whereas a sprain involves a ligament.

Ligament sprains are classified by the severity of the sprain. A grade I sprain is a minor stretch of the ligament. A grade II sprain is generally termed a partial tear of the ligament. And a grade III sprain is a complete rupture of the ligament.

The most common type of ankle sprain is called an inversion sprain. This type of sprain occurs when the ankle rolls inward, causing the outside ligaments to stretch or tear. The most common ligament that is sprained is the AFTL.


Inversion ankle sprain

What If It’s Not a Sprained Ankle?

If you have injured your ankle and you either you cannot walk on it, or it is slow to heal, it is best to get it evaluated by a doctor. Sometimes you can sustain a small fibula fracture, , often called an avulsion fracture. This type of fracture occurs when a small piece of bone is pulled off by one of the ligaments. The only way to know for sure is to get an x-ray.


What is the Best Treatment for a Sprained Ankle?

Treatment for a sprained ankle is based on the severity of the sprain. Typical progression of treatment includes: immobilization/protection, range of motion and stretching exercises, strength, proprioception/balance activities, and return to functional activities.

Generally a sprained ankle takes between six and eight weeks to heal. As with all acute injuries, follow the RICE method in the early stages: Rest, Ice, Compression, and Elevation.

Generally a grade I, mild stretch, does not require immobilization but can benefit by using a compression wrap to minimize the swelling. A grade II, partial tear, may involve crutches and a rigid brace such as an aircast. When you have sustained a Grade III sprained ankle, a complete rupture, the rest often involves both crutches and an immobilizer.

With all sprains, it is important to utilize crutches or an ankle brace until you can walk without a limp and to continue to utilize ice as long as there is swelling.

No matter how significant the ankle sprain, early, controlled pain free range of motion exercises is encouraged. Doing ankle pumps, writing the alphabet with your foot, or doing ankle circles will encourage normal motion of your ankle. In addition, calf stretching, either in standing or with a towel, can help maintain flexibility of the calf muscle.

When to initiate strengthening exercises as part of the treatment process will vary based on the severity of the sprain. With grade I sprains, strengthening can occur within a couple of weeks. With a complete rupture, protecting the ligament as it heals is of primary importance thus strengthening is generally not initiated until after six weeks.


Ankle strengthening


Strengthening often comes in the form of band exercises that are used to isolate specific ankle movements. Functional exercises such as squats, lateral walking, backward walking, and step ups can also help to increase ankle strength.

Balance, also called proprioception, exercises are extremely important in the ankle rehabilitation process. Simple balance exercises include standing on one foot, standing on one foot while keeping your eyes close, standing on one foot on a pillow, or even standing on one foot while playing catch with someone. Any activity where you are balancing on one foot and challenging yourself either with the surface you are standing on (softer is harder) or adding other body movements will train the muscles of the ankle to react more quickly, an important aspect in protecting the ankle joint.

The final stage of treatment for a sprained ankle is returning to function. If you are a basketball player, soccer player, or even play tennis this means beginning light jogging, cutting, and jumping. Care must be taken to avoid pain and watch if the ankle reacts with increased swelling. If pain or swelling increases you may be doing too much, too soon.

A sprained ankle can be a minor or significant injury. Obtaining proper treatment is necessary in order to ensure a full recovery.


Summary

• A sprained ankle is an injury to one or more ankle ligaments.

• Sprains are categorized by severity; Grade I, II, III.

• Most sprains take 6-8 weeks to heal.

• Early treatment includes rest, ice, compression, and elevation.

• Treatment progression includes reducing swelling, increasing range of motion, restoring strength and balance, and return to functional activities.



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References

Ned Tijdschr Geneeskd. 2011;155(33):A3324.[Guideline for diagnosis and treatment of acute inversion trauma of the ankle in athletes]. Inklaar H, van Beek PA

Sports Med. 2011 Mar 1;41(3):185-97. doi: 10.2165/11584370-000000000-00000.A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types.Kemler E, van de Port I, Backx F, van Dijk CN

Br Med Bull. 2011;97:105-35. Epub 2010 Aug 14.Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence.Seah R, Mani-Babu S