Written by Dr Gowreeson Thevendran, MBChB (Bristol), MRCS.Ed, Dip. Sports Med.Ed, FRCS.Ed (Trauma & Ortho. ), FAMS (Singapore)
What is a Sprained Ankle?
A sprained ankle, also known as a twisted ankle or a rolled ankle, is an injury to the ligaments in your ankle. You might find that putting weight on your ankle causes pain. Your ankle might also be swollen, bruised or tender to the touch. Conversely, it may also feel numb on occasion. A sprained ankle and a fractured ankle are often confused, but there is a clear difference between both foot injuries and require different treatments.
Sprains are categorised into three degrees. A Grade I sprain is considered the least severe, with small tears occurring in the stretched ankle ligament. Grade II sprains are moderate, involving partial ligament tears, while a Grade III sprain is the most severe with a complete tear of the ligament.
Causes of Sprained Ankle
A sprained ankle is caused by the stretching or tearing of the ligaments that connect the bones in the ankle joint. This typically occurs when the ankle joint is forced beyond its normal range of motion due to sudden twisting or turning movements of the foot. This can happen during sports activities that involve jumping, running, or quick changes in direction, or when walking or running on uneven surfaces. A sprain can also occur as a result of falls or collisions that cause the ankle to twist or turn awkwardly. For a better understanding of the causes, it is advisable to consult a doctor.
Here's a closer look at the common causes across different age groups and activities as well as symptoms that might indicate a sprained ankle, to ensure you get the appropriate treatment.
Children and Adolescents
- Playing sports without proper footwear or protective gear.
- Jumping or making rapid directional changes in sports like basketball, soccer, or football.
- Use of trampolines without safety precautions.
- Jogging or running on uneven terrains.
- Stepping on objects while walking.
- Missteps in high heels or other unstable footwear.
- Activities like dancing or certain gym exercises which involve rapid foot movement.
- Falls due to decreased balance or coordination.
- Walking on slippery surfaces.
- Reduced muscle strength and proprioception, making them susceptible to minor twists and turns, leading to sprains.
A sprained ankle is often characterised by immediate pain at the site of injury, accompanied by swelling and tenderness. Difficulty in moving the ankle or bearing weight, along with possible bruising, can also be indicative signs of a sprain. If you experience any of these symptoms, you can consult a doctor for proper evaluation and treatment.
How an Ankle is Sprained
Understanding the intricate anatomy of the ankle is essential to grasp how sprains occur and ensure proper treatment. A sprained ankle is not just a minor injury; it involves the stretching or tearing of the ligaments that support the ankle. Let's delve into the anatomy, ligaments involved, and the specific mechanisms that result in different types of ankle sprains.
Anatomy of the Ankle
The ankle is a complex joint made up of three main bones:
- Tibia: The shin bone.
- Fibula: The smaller bone of the lower leg also known as calf bone.
- Talus: A small bone that sits between the heel bone and the tibia and fibula.
These bones form the ankle joint and are held together and stabilised by three ligamentous systems: the lateral ligament complex, the medial deltoid ligament, and the syndesmotic ligaments, which are tough bands of fibrous tissue.
Main Ligaments Involved in Ankle Sprains
Before seeking treatment for your sprained ankle, you must be aware of the main ligaments involved. A sprained ankle predominantly stresses the lateral ligament complex, leading to the most common form of ankle injury. Composing this complex are three cruciate ligaments: the anterior talofibular (ATFL), the calcaneofibular (CFL), and the posterior talofibular (PTFL).
In the usual sequence of injury, the ATFL is the first to be compromised, largely due to its weaker constitution within the lateral ligament complex. The CFL, on the other hand, faces heightened vulnerability during dorsiflexion (upward movement) paired with inversion. Meanwhile, the PTFL, recognised as the sturdiest member of this trio, is least frequently subjected to injury.
Types of Ankle Sprains
Ankle sprains can be categorised into inversion, eversion, and high-ankle based on the injury’s direction and location:
1. Inversion Sprains
Ligament Complex Involved: Lateral Ligament Complex
Inversion sprains predominantly target the lateral ligament complex of the ankle. This complex comprises three primary ligaments, each with its distinct susceptibility to injury. The Anterior Talofibular Ligament (ATFL) stands out as the most frequently injured, being the weakest of the trio. Around 70% of sprained ankle cases are attributed to ATFL injuries, which commonly occur when the foot undergoes plantar flexion, a downward movement, coupled with inversion, where the sole turns inward, often requiring treatment. Another component of this complex, the Calcaneofibular Ligament (CFL), is particularly prone to injury during dorsiflexion, an upward movement of the foot when combined with inversion. Contrarily, the Posterior Talofibular Ligament (PTFL), acknowledged as the strongest member of the lateral ligament complex, experiences injuries less frequently.
2. Eversion Sprains
Ligament Involved: Medial Deltoid Ligament
The medial deltoid ligament, known for its robust nature, is particularly susceptible to injury when the ankle experiences eversion, causing the sole of the foot to turn outward. This ligament has two main components. Firstly, the Superficial Deltoid Complex plays a crucial role in limiting the abduction movements of the talus, essentially preventing the top of the foot from moving outward excessively. The second component, the Deep Deltoid Complex, is designed to prevent the talus from undergoing excessive external rotation on the distal tibia. Notably, while the medial deltoid ligament is vital for ankle stability, isolated injuries to it remain a rarity. If you experience an injury to the medial deltoid ligament, it's advisable to seek advice from a sprained ankle specialist to evaluate treatment options.
3. High Ankle Sprains
Ligament Complex Involved: Distal Tibiofibular Syndesmotic Ligaments
These ligaments play a crucial role in stabilising the distal (lower) parts of the tibia and fibula together. Referred to as “high ankle sprains,” syndesmotic injuries are less prevalent than typical ankle sprains. Due to the substantial force required to damage this complex, such sprains are infrequent in the general population but are more commonplace in competitive athletes. The predominant mechanism causing these injuries includes external rotation or dorsiflexion (upward bending) of the ankle. If you suspect a syndesmotic injury, you can consult a foot and ankle doctor to seek appropriate treatment for your sprained ankle.
Mechanism of Injury and Ligamentous Structures
Ankle sprains can be categorised based on their severity and the degree of damage to the ligaments:
1. Grade I Ankle Sprains
These sprains involve stretching or microscopic tearing of the stabilising ligaments, like the ATFL and CFL. They are often a result of low-energy injuries, where the force applied to the ankle is relatively mild. This mild injury is characterised by symptoms such as mild pain, swelling, and tenderness. Notably, joint instability is absent, and individuals do not face challenges in bearing weight. However, proper treatment and care are still essential to help manage a sprained ankle.
2. Grade II Ankle Sprains
Moving up the scale of severity to Grade 2 ankle sprains, the ligaments sustain a partial tear. Moderate pain, swelling, and tenderness are common symptoms experienced by individuals at this stage. Furthermore, there might be mild to moderate joint instability, along with some loss of both range of motion and functional ability. Pain is often noticeable in the sprained ankle when bearing weight and walking, requiring appropriate treatment measures.
3. Grade III Ankle Sprains
This is a severe form of ankle sprain. This type of sprained ankle affects the syndesmotic structures, which are the ligaments that connect the two bones of the lower leg, the tibia, and the fibula. As per doctors, this type of sprain can occur due to high-energy injuries, where there's significant force applied to the ankle. Individuals with this type of sprain encounter severe pain, swelling, tenderness, and often, bruising. The instability of the joint is considerable, leading to significant loss of both function and range of motion.
Statistics and Research on Common Activities Leading to Sprained Ankles
- Over two million sprained ankle treatments are done annually in emergency departments in the United States (US) and United Kingdom (UK).
- Ankle sprains rank as the topmost injury in sports.
- The incidence rate of ankle sprains varies between male and female athletes, depending on the specific sport.
- A significant number of studies emphasise the high recurrence of injuries and ongoing instability after a single primary ankle sprain.
- Up to 40% of patients who sustain a lateral ankle sprain experience persistent symptoms, recurrent sprains, and chronic lateral ankle instability.
Symptoms of a Sprained Ankle
A sprained ankle is an injury to one or more ligaments in the ankle, which are the fibrous bands connecting bones to bones. While the intensity and symptoms of the sprain can vary based on the severity, there are common manifestations that patients should be aware of. Recognising these symptoms early can lead to timely treatment:
- Pain: Almost immediately after the injury, you may experience pain, particularly when trying to bear weight on the affected foot. This pain can vary from mild to intense, depending on the severity of the sprain.
- Swelling: Swelling often accompanies a sprain, caused by the accumulation of fluid around the injured area. This swelling can become more pronounced in the hours following the injury.
- Bruising: You might observe discolouration around the ankle, a result of broken blood vessels.
- Tenderness: The area around the injury will likely be sensitive to touch.
- Limited Range of Motion: You may find it challenging to move the ankle, especially in certain directions, due to pain and swelling.
- Instability: In more severe sprains, you might feel that your ankle is unstable or wobbly when trying to stand or walk.
- Popping Sensation or Sound: Some individuals report hearing or feeling a pop at the time of injury, which can suggest a complete ligament tear.
If you experience intense pain, swelling that doesn't subside within a few hours, or any other symptom that concerns you, it's crucial to seek medical help.
Diagnosing Sprained Ankle
Diagnosing a sprained ankle involves a thorough evaluation of the severity of the injury to ensure proper treatment and to rule out the presence of fractures or other potential injuries. Different diagnostic tests and imaging techniques can play a crucial role in confirming the diagnosis and guiding the treatment plan, some common options include:
X-rays: X-ray imaging can help identify any potential fractures or dislocations that might accompany the sprained ankle. It is particularly done by doctors to rule out bone-related injuries.
Magnetic Resonance Imaging (MRI): MRI provides detailed images of soft tissues, such as ligaments and tendons. It can reveal the extent of ligament damage and help determine the appropriate treatment plan for your sprained ankle. MRI is especially valuable for assessing grade 2 and 3 sprains.
What Happens If Ankle Sprains Are Left Untreated?
Neglecting proper treatment for a sprained ankle can have dire consequences, leading to a range of complications that extend far beyond the initial injury. An untreated ankle sprain can result in chronic pain, as the injury fails to heal properly, making daily activities and physical exertion difficult. Furthermore, the lack of adequate healing can contribute to instability in the ankle joint, rendering it susceptible to further sprains and injuries.
Seeking medical attention promptly is crucial, as a delay can worsen the prognosis and prolong recovery times. Incorrect self-treatment methods also pose a risk, potentially worsening the damage and complicating the healing process. In essence, untreated sprained ankles can set the stage for a cycle of pain, instability, and recurrent injuries, emphasising the necessity of timely medical intervention.
Treatments Available For Sprained Ankle
When it comes to sprained ankles, taking immediate steps to safeguard the injured area and initiate proper management can significantly prevent exacerbation of the injury. Begin by immediately stopping any activity that caused the sprain and resting the affected foot. These initial precautions not only manage discomfort but also lay the foundation for a smoother treatment. This can be followed up with:
1. RICE Protocol
Sprained ankle treatments depend on the severity of the condition. In general, the RICE protocol - rest, ice, compression, and elevation is recommended by the doctor for all types of sprains to reduce pain and swelling.
Before any treatment, giving rest to the sprained ankle allows the injured tissues to begin healing without further strain. Ice, when applied promptly and intermittently, constricts blood vessels, curbing inflammation and providing localised relief. Compression with a bandage supports the injured area, minimising swelling and promoting stability. Elevation leverages gravity to encourage fluid drainage away from the injured site, further reducing swelling.
However, it is vital to acknowledge the limitations of this treatment. While rest is essential for healing, extended immobilisation can lead to joint stiffness and muscle atrophy if not balanced with controlled movement and rehabilitation exercises. Excessive cold exposure to the sprained ankle can lead to skin damage, emphasising the importance of using a cloth barrier. Compression should be snug but not too tight to avoid impairing blood circulation. Elevation can be limited by practical constraints and might not always be feasible, particularly during daily activities.
2. Treatment For Mildly Sprained Ankle
For mild sprains, rest, and home care may be sufficient. While rest allows the body to initiate the healing process, there are additional steps you can take at home to facilitate recovery of your sprained ankle without getting any surgical treatment. Applying ice to the affected area at regular intervals during the initial 48 hours can effectively reduce inflammation and discomfort. Over-the-counter pain relievers can assist in managing pain and inflammation, whereas elevating the ankle when resting can aid in minimising swelling. Mild, low-grade ankle sprains usually heal in one to three weeks with proper rest and non-surgical care.
3. Treatment For Moderately Sprained Ankle
For moderate sprains, the doctor may propose immobilisation with a brace, splint, or walking boot to provide stability and prevent further injury. This external support aids in preventing further injury by limiting the range of motion and providing stability during the crucial early healing stages. With proper care and support, a moderately sprained ankle may take between three and four weeks to heal.
Additionally, physical therapy may also be recommended to restore the range of motion, strength, and flexibility of the sprained ankle. Skilled doctors design tailored exercise programs to help with the sprained ankle's range of motion, strength, and flexibility. This phase is essential for preventing joint stiffness, muscle atrophy, and chronic instability.
4. Treatment For Severely Sprained Ankle
In cases of severe sprains or complete tears of the ligaments, surgery may be necessary to repair the damaged tissue. This is typically only recommended if the injury is severe and other treatment options have been unsuccessful. Surgery involves repairing the damaged ligaments to restore stability and function to the ankle joint. Post-surgery, a structured rehabilitation program is crucial to regain strength and mobility of the sprained ankle, and the sprain may take between three and six months to completely heal.
While surgery presents a more complex and demanding treatment path, it is a viable option for those with severe injuries that significantly compromise daily activities and quality of life. The decision for surgery is often made in consultation with a healthcare professional, weighing the potential benefits against the risks and considering the individual's overall health and lifestyle factors.
Follow-Up Appointments After Sprained Ankle Treatment
After undergoing treatment for your sprained ankle, follow-up appointments play a crucial role in monitoring the healing progress and adjusting the rehabilitation plan as needed. Additionally, a well-structured rehabilitation program involving specific exercises is essential for promoting a successful recovery:.
- Range-of-Motion Exercises: Early in the rehabilitation process, range-of-motion exercises help prevent joint stiffness after getting the treatment and maintain the proper alignment of healing tissues.
- Isometric and Isotonic Strength Training: During the early stages of rehabilitation, isometric exercises (muscle contractions without joint movement) are beneficial for maintaining muscle tone and preventing atrophy. After the treatment of your sprained ankle, as healing progresses, isotonic exercises (muscle contractions with joint movement) are introduced to help with muscle strength and power.
- Proprioception-Training Exercises: Proprioception refers to the body's sense of spatial orientation and awareness of movement. Proprioception-training exercises challenge the ankle's ability to maintain stability and balance. These exercises involve various surfaces, such as wobble boards, to improve neuromuscular control and prevent recurrent instability after getting the treatment for sprained ankles.
- Functional and Sport-Specific Activities: As the rehabilitation progresses after the sprained ankle treatment, incorporating exercises that mimic the demands of the individual's daily activities or sports is crucial. These exercises enhance the ankle's ability to handle the specific stresses encountered during those activities, ensuring a smooth return to regular or athletic function.
Recovery Period After Sprained Ankle Treatment
The recovery period for a sprained ankle varies based on the severity of the injury and the individual's response to treatment. Ankle sprains are typically categorised into three grades of severity: Grade 1, Grade 2, and Grade 3. The recovery process involves different stages of rehabilitation to ensure a safe return to sports and physical activities.
1. Acute Stage
In the initial acute stage of sprained ankle rehabilitation, the focus is on promptly addressing pain and managing swelling. This phase involves techniques such as applying external pressure and utilising modalities like cryotherapy. Active range of motion exercises are introduced to manage pain and prevent stiffness after the treatment, laying the foundation for the subsequent phases.
2. Subacute Stage
As the acute phase transitions into the subacute stage, the emphasis shifts towards maintaining proper range of motion and preventing muscle atrophy. Range-of-motion exercises are incorporated to ensure that the sprained ankle retains its flexibility and mobility after the treatment. Gentle strength-building exercises are introduced to safeguard against loss of function.
3. Intermediate Stage
In the intermediate stage of ankle rehabilitation, proprioception takes centre stage. Proprioception-training exercises are introduced to challenge balance, coordination, and joint stability. Given that deficits in postural stability are common after getting your ankle sprained, this phase aims to rectify imbalances and prevent future instability through targeted treatment exercises.
4. Advanced Stage
The advanced stage is characterised by a transition to physical and sport-specific activities, aligning with the specific demands of the individual's chosen activities or competition. Recovery after a sprained ankle treatment is typically swift, particularly if the injury is located on the outer side of the foot. In such cases, most athletes can resume full training within the span of one to three weeks. However, if the ligament damage is extensive, the recovery period may extend, and certain individuals might experience stiffness and discomfort for a prolonged duration.
Over the course of up to 12 weeks, the ligaments gradually achieve complete healing, culminating in a restoration of structural integrity. It is important to note that the prognosis tends to be a bit more deliberate for sprains located on the inner side of the ankle. Athletes should anticipate a more extended period of rehabilitation to avoid aggravation after receiving treatment. Consulting with a doctor may ensure that the rehabilitation process is aligned with the specific requirements of your sprained ankle.
Risks & Complications Of Sprained Ankle Treatment
When pursuing treatment for a sprained ankle, it is essential to be aware of the potential risks and side effects associated with different approaches. Depending on the recommended treatment, various complications might arise, warranting vigilance and open communication with your healthcare provider.
1. Casting or Bracing
For those advised by their doctor to wear a cast or brace for their sprained ankle, some discomfort might accompany immobilisation. Itching, sweating, and a sense of confinement around the ankle area are common issues. To manage these, ensure proper hygiene and consider using hypoallergenic padding if the itching becomes troublesome. Gently tapping on the outside of the cast, not inserting objects inside, can help address itching without compromising the cast's integrity.
2. Medication for Pain and Inflammation
Using medications to manage pain or inflammation caused by your sprained ankle, can have its own set of side effects. Upset stomach, dizziness, and drowsiness are potential reactions. Taking medications with food can often help manage stomach discomfort. If dizziness or drowsiness occurs, it's advisable to avoid driving or operating heavy machinery until you know how your body responds to the medication or consult your doctor.
3. Surgical Intervention
In cases where surgery is recommended for the treatment of the sprained ankle, additional complications might emerge. Infections at the surgical site are a possibility, and keeping the area clean and adhering to post-operative care instructions is essential to minimise this risk. Bleeding is another potential issue; if excessive bleeding occurs, promptly contact your healthcare provider.
Why Choose OrthofootMD for Sprained Ankle Treatment?
If you are seeking treatment for a sprained ankle, OrthofootMD has got you covered. Dr Gowreeson is an orthopaedic doctor with expertise in treating sprained ankles using minimally invasive surgical techniques.
OrthofootMD is committed to delivering care and compassion to its patients. Our methodology is rooted in evidence-based orthopaedic practice, integrating various technologies and expertise in orthopaedic surgery. We recognise the individuality of each patient, thus adopting a patient-centric approach that emphasises tailored care and treatments to achieve results to help improve the well-being of each patient.
Insurance and Medisave Coverage for Sprained Ankle Treatment
OrthofootMD offers various orthopaedic treatments that are covered by insurance plans and Medisave. However, patients with sprained ankles are recommended to contact the clinic and verify their eligibility for Medisave claims and the extent of coverage under their insurance plan.
Dr Gowreeson Thevendran
MBChB (Bristol), MRCS.Ed, Dip. Sports Med.Ed, FRCS.Ed ( Trauma & Ortho. ), FAMS (Singapore)
- Orthopaedics and Trauma Surgery
- English, Malay, Tamil
Dr Gowreeson Thevendran is an orthopaedic surgeon at Island Orthopaedic, part of the Healthway Medical Group. He specialises in lower limb orthopaedic conditions and has expertise in minimally invasive surgical techniques for foot & ankle, knee, and hip/thigh conditions. Additionally, he has a particular interest in trauma and fracture surgery for both upper and lower limbs. He received his medical education at the University of Bristol and completed his surgical training in London, UK. He further pursued subspecialty fellowship training in foot & ankle surgery at the University of British Columbia, sports surgery at Chelsea & Westminster Hospital, and complex trauma and deformity correction surgery at Royal Liverpool University Hospital.
- Bachelor of Medicine and Surgery, University of Bristol, England
- Fellow of the Royal College of Surgeons, Edinburgh
- Diplomate Faculty of Sports and Exercise Medicine, Royal College of Surgeons Edinburgh
- Fellow of the Academy of Medicine, Singapore
- SICOT PIONEER Founders Award 2020
- 2015 European Foot & Ankle Society ‘Best Podium Presentation’ Award
- 2013 Singapore Orthopaedic Association Junior Travelling Fellowship
- 2012 NHG Critical Talent Special Recognition Award
- 1998 Enid Lindt Prize in Clinical Surgery
- 1995 Public Services Department Full Medical scholarship
Global Contribution and Innovations
Dr. Gowreeson's impact reaches beyond clinical practice. As Chair of the Education Academy of SICOT, he elevates orthopaedic postgraduate education globally. He initiated the use of Magnezix bioreabsorbable screws in Singapore, leading a multicenter trial. His scientific articles, international faculty roles, and contributions to educational initiatives underscore his commitment to advancement.
Frequently Asked Questions About Sprained Ankle Treatment
Yes, with proper rehabilitation, gradual progression, and adequate preventive measures like supportive footwear or ankle taping, patients with a history of ankle sprains can safely participate in high-impact activities while minimising the risk of re-injury. However, it is recommended to consult our sprained ankle doctor to ensure a safe return to high-impact sports.