A sprained ankle injury is potentially the most frequent sports injury but it can occur at any time to anyone by simply slipping and twisting your ankle ligaments on uneven ground far away from the sports field.
The ankle joint is made up of three bones, the tibia (shin bone), the fibula and the talus and strictly consists of two joints being the ankle joint sitting upon the subtalar joint;
The ankle Joint is a hinged joint that allows for an up and down motion of your foot, also referred to as dorsi and plantar flexion.
The Subtalar Joint is situated below the ankle joint and allows for lateral and medial side to side ankle motion.
What is a Sprained Ankle?
A strained or sprained ankle refers to damage to the ligaments and soft tissues that surround and support your ankle joint. The most common type of ankle injury accounting for over 80% of injuries is an inversion ankle injury.
Types of ankle sprains:
This is when your foot rolls inward and your ankle rolls or twists over moving your body weight to the outside aspect of your ankle joint. An inversion sprain will normally involve injury to your anterior talo-fibular ligament (ATFL) and lateral collateral ligaments. Other local soft tissues such as tendons and muscles may also be damaged.
This is a much less common ankle injury but occurs when the opposite movement to an inversion injury occurs causing damage to your medial ankle ligaments also referred to as the deltoid ligament.
High Ankle or Syndesmotic Injury:
A high ankle sprain refers to an injury to the syndesmotic ligaments above the ankle joint that connect the two lower leg bones, the tibia and fibula. They typically occur when the dorsiflexed foot twists outwards as in an eversion type injury but also involve a simultaneous internal movement of the shin (tibia) bone. A high ankle injury usually takes longer to heal than a standard lateral or medial type ligament strain and may require specialist treatment.
When a ligament is subjected to a force it may often be strained and may even tear to varying degrees. However, occasionally small pieces of the bone to which the ligaments attach may be torn away from the bone with the ligament and if this occurs it is referred to as an avulsion fracture.
Classification of ankle sprains:
Depending upon the severity of the injury ankle sprains are graded between 1 and 3:
1) Grade 1 Sprain
There is mild damage to your ligament, usually with less than 10% of the soft tissue fibres being involved. You should expect mild pain with ankle movements and your ankle may be tender to touch. There may be some swelling and bruising, but no associated instability. You can usually walk normally following a grade 1 sprain.
2) Grade 2 Sprain
There is moderate damage to your ligament with a partial tearing. There is usually immediate pain with significant swelling and bruising at the time of your injury due to the bleeding. Movement of your ankle will be reduced. You may find it difficult to walk and your ankle may feel slightly unstable.
3) Grade 3 Sprain
There may often be a popping sounds at the time of the injury and you will have immediate significant pain, swelling and bruising around the ankle and often down into your foot. Your ligament will have ruptured / torn completely. Walking / weight bearing on your injured ankle is often impossible due to the pain and your ankle may feel like it is going to give way and feels unstable.
What are the symptoms of an ankle sprain?
Most ankle sprains are minor accidents where you roll your ankle slightly but the symptoms will depend upon the severity and degree of your sprain and tissue damage. The most frequent symptoms include:
Pain – especially with movement both active and passive
Swelling – usually localised over and surrounding the damaged tissue
Ecchymosis – this is bruising seen under the skin due to bleeding from the damaged soft tissues.
Reduced ankle weight bearing capability
How can I treat my ankle sprain?
Well the majority of ankle sprains are minor Grade 1 type injuries and although the opinion of a medical expert should always be sought minor injuries can be treated with some simple self treatment:
For self help and treatment of an ankle sprain you should follow the guide lines in the acronym PRICE to treat your injury
P - Protect against further injury. The use of different types of ankle supports and braces can help protect your ankle against further injury during your recovery.
R - Rest for the first 48 to 72 hours.
I - Ice the injured muscle for the first 48-72 hours. Take care to ICE correctly by reading my guide to safe icing.
C - Compress the injury to help reduce swelling with a simple elasticated bandage. Take care that the bandage is not too tight, that it does not restrict the blood flow and always remove the bandage prior to going to sleep.
E - Elevate where possible as elevating the injury helps reduce swelling. To correctly elevate your ankle it should be above your heart level.
When should I go to the hospital casualty department?
Simple grade one sprains can normally be managed at home but for severe injuries of the ankle you should always seek professional medical attention. If you have any of the following symptoms then I recommend you seek urgent medical treatment:
- If your foot feels cold – there may be vascular damage
- If your foot feels numb or tingly – there may be nerve damage
- If your ankle/foot looks deformed – it may be broken or fractured
- If the pain is so severe and you are unable to walk on the injured foot/ankle
- If there is any doubt about the injury or your injury is getting worse you should seek medical opinion