An ankle sprain is the most common sprain in the body. It occurs when there is an injury to the ligament on the outside of the ankle. Ligaments are tough elastic bands of fibrous tissue that stabilize bones, connect one bone to another at a joint, and prevent excess movement. When ligaments are stretched beyond their normal range, that over-extension can cause a sprain.

A simple movement like a twist, turn, or roll in a slightly awkward way can make a ligament stretch or tear, causing a sprain. With ankle sprains, this often occurs when someone lands awkwardly on their foot after jumping. Ankle sprains frequently happen during sports activities or when walking or running on uneven surfaces.

• Visible swelling

• Pain or tenderness

• Bruising

• Coldness or numbness in the foot

• Difficulty walking or bearing weight on the affected joint

• Stiffness

Pain is usually mild, if the sprain is not severe. In case of a severe sprain, swelling and severe pain usually accompany it. In both cases, the movement of the ankle may be restricted.

Most of the time, the doctor can diagnose an ankle sprain simply by asking questions about the injury while examining the ankle. The doctor may also take an X-ray in order to capture images of the internal structure of the ankle and confirm that the bones are not broken (fractured). An X-ray can help find a fracture, but it is less effective for finding tiny cracks, stress fractures, and soft tissue injuries such as a ligament tear.

A better procedure for these types of injuries is a bone scan, which is the injection of a radioactive substance into the bone. This substance is attracted to damaged or inflamed bones and makes the injured area appear as a bright spot or spots.

Finally, if the sprain is causing the patient discomfort for more than six weeks, the doctor may perform a magnetic resonance imaging, or MRI, scan using a magnetic field to produce detailed images of the ankle’s internal structure. An MRI is incredibly helpful when examining soft tissue injuries and can detect more serious ankle sprains. For example, an injury to the tibiofibular syndesmosis ligaments, which bind together the distal ends of the tibia and fibula, is called a high ankle sprain. This injury accounts for only about 10 percent of ankle sprains, and it requires much different treatment than common ankle sprains. An MRI helps determine if it is a common sprain versus a more serious sprain.

Similarly, if the injury is causing problems for more than six weeks, a computerized tomography, or CT, scan is performed to get cross sectional X-ray images of the ankle. The CT scan allows for more detail about the specific joint and soft tissues that surround it.

For the initial management of a sprain, doctors may suggest the “RICE” approach: rest, ice, compression, elevation.

• REST the ankle sufficiently and use crutches, if needed

• ICE packs should be applied for at least one to two days after injury in order to decrease swelling, muscle spasms, bruising, and pain

• COMPRESSION of the ankle with an ankle wrap for one to two days after the injury diminishes and prevents further bruising and swelling

• ELEVATION of the ankle above heart level. Keep it elevated for two to three hours every day to reduce bruising and prevent swelling from becoming worse

Do not place the ice pack on the affected part of the ankle for more than 20 minutes at a time. Ice should be used once every two to four hours for the first two days after the sprain. If at any point the person feels numbness, the ice should be removed from the injury site.

When compressing the injury, an elastic bandage (such as an ACE bandage) is wrapped around the foot in a figure-eight pattern. Make sure that the ankle is not wrapped so tightly that the blood flow is stopped; a finger inserted between the wrap and the skin should be snug but not overly tight. Also, the toes may appear pale and “white” if the elastic bandage is wrapped too tightly. Secure the end of the elastic bandage with strips of bandaging tape and the ankle wrap can be worn for up to a week. It should be removed daily during bathing and replaced after drying the area well.

Over-the-counter medications recommended for reducing pain associated with ankle sprains include acetaminophen, ibuprofen, and naproxen. The latter two drugs (also called NSAIDs) will help to reduce the inflammation associated with these injuries and thus are often more effective in treating the pain and swelling. Sometimes physical therapy may be needed to increase balance, flexibility, motion, and strength of the affected ankle. If your physician is a Doctor of Osteopathic Medicine (DO), they may also utilize osteopathic manipulative treatment, which can speed up the healing process by improving circulation to the area and help the body heal itself. In cases of severe sprains where significant tearing has occurred, a cast, walking boot, and/or crutches may be necessary for proper healing. Rarely, surgery is needed in the case of a partial or complete ligament tear.

To prevent re-injury, the patient must exercise the ankle to strengthen the muscles. Sometimes patients need to wear a semi-rigid brace on the ankle to prevent further sprains for one to two months. Periodically, the patient should take off the brace and practice the following exercises:

• Make 5 to 10 ankle circles, three times a day, while sitting on the floor with the legs stretched

• Move the ankle up and down and side to side

• Write the alphabet in the air with the toe

• Pull toes toward the body then point them away, holding the position for 15 seconds around 10 times a day

• Stand on the injured leg three times a day for 30 seconds at a time to improve balance. Increase the amount of time on the ankle as it gets stronger and place a chair in front to provide support

Returning to Activity

Returning to sports activities depends on the severity of the injury. For activities like swimming and bicycling, if there is no pain, someone can return to them immediately. When participating in other sports, the patient should always wear an ankle brace support.

To avoid an ankle sprain, one recommendation is to wear shoes that fit properly. It is important to warm up before any sports activity and take care not to exercise on uneven ground.