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Ankle Sprains

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Condition Awareness Page from R3 Stem Cell – Ankle Sprains and Injuries

 

What is it?

A sprained ankle is an injury that causes the ankle’s ligaments to stretch or tear. Ligaments are tough bands of tissue that help connect the bones of the foot to the bones of the leg and hold the ankle joints together. Ligaments prevent the joints from moving excessively, stabilizing them.

When a sudden movement twists, turns or rolls the ankle, the ligaments outside of the ankle may get injured due to overstretching. Moreover, a sprained ankle can be a result of a fall that makes your ankle to twist when you land awkwardly on your own foot after a jump or turn.

Once an ankle is sprained, it may get worse if proper healing time is not been given to allow the ligament to heal. The ankle should be relaxed without any stress or strain being applied to it while it mends. This can be more difficult than you expect as in many cases, it is hard to determine whether the ankle has healed or not. This is because the ankle can still remain functional even with a tear as the overlying tendons help in maintaining stability and motion.

Incomplete healing or repeated sprains can lead to long term muscle weakness and eventually to a condition called a chronic ankle sprain. Chronic sprains may be the case if the pain continues for over four to six weeks. Other complications that may develop are chronic ankle joint instability or arthritis in the ankle joints.

How common is it and who is at risk?

Sprained ankles are the most common of all ankle related injuries. Torn ligaments account for almost a quarter of all sports injuries, with volleyball, football and basketball players being most frequently affected. Athletes of all forms suffer from ankle sprains.

Other people at risk of spraining their ankles are those with a delicate physical condition, low flexibility in the joints and weak ligaments, making them more susceptible to tearing. Uneven surfaces can increase chances of awkward falls, thereby increasing the risk of ankle sprains. The same is the case for those who wear improper footwear for walking or running or wear high heels in general, making the body unbalanced and unstable.

Additionally, those with prior ankle injuries are more likely to get ankle sprains from accidents or falls as their ligaments are weak.

What are the symptoms?

Symptoms of sprained ankles may vary depending on the severity of the injury. The most basic of these symptoms is a painful sensation in the affected area, particularly when weight is applied to the foot. There may be tenderness around the ankle and general swelling. In some cases, the ankle may bruise, get stiff and exhibit skin discoloration around itself.

All these symptoms can contribute to a restricted range of motion in the leg or foot. If symptoms are particularly severe, it could be indicative of considerable damage to the ligament or even a broken bone. A sign that the injury is a severely sprained ankle is a popping feeling or sound experienced at the time of the injury by the ankle.

How is it diagnosed?

The diagnosis of a sprained ankle can allow the doctor to classify it in one of three categories based on the severity of the injury to the ligament. This classification is as follows:

Grade 1 Sprain – Mild

This injury is characterized by slight stretching and microscopic tearing of the fibers in the ligament. Only mild swelling and tenderness are observed.

Grade 2 Sprain – Moderate

This injury involves partial tearing of the ligament and is identifiable by moderate swelling, tenderness around the ankle and an unusual looseness experienced in the ankle joints.

Grade 3 Sprain – Severe

A severe sprain is caused by the complete tear of the ligament with substantial tenderness and swelling felt in the area around the ankle. Significant instability and looseness of the joints can also be observed when the ankle is moved at certain angles.

Diagnosis is started with a physical examination. The doctor observes the physical condition of the foot and ankle and the condition of the joints by performing some tests. The doctor might press down on different points around the ankle to ascertain which of the ligaments is injured. The ankle will also be moved in various directions to determine the extent of the range of motion it is able to withstand.

Imaging tests may also be conducted to get a clearer view of the state of the ankle before a diagnosis is made in more severe cases. X-ray images of the ankle bone may be taken to rule out a broken bone or fracture in the foot that could produce the same symptoms of swelling and pain. Stress X-rays may also be used to visualize the ankle’s internal structure when it is moved in different directions.

Magnetic resonance imaging or MRI scans can be used if severe damage to the ligaments, cartilage or bone is anticipated. Additionally, ultrasound imaging can be utilized to view the relative stability of the ligaments in accordance with ankle movements in real time. These scans can help the doctor diagnose the strain and its severity grade.

What are the treatment options available?

Treatment options for sprained ankles are based on the severity of the condition. Grade 1 sprains can most likely be treated by basic home care and rest, however, a grade 3 sprain could possibly require referral to a specialist like an orthopedic surgeon or a physical therapist.

For self – care, the R.I.C.E. approach is recommended initially. This approach is explained as follows:

  • Rest: Activities that may cause strain or discomfort to the ankle are to be avoided.
  • Ice: An ice pack or other forms of ice is to be applied to the affected ankle for 15 minutes every few hours to bring the inflammation down and relax the ankle.
  • Compression: Compression is to be provided to the ankle by means of an elastic bandage until the swelling subsides. Compression should not be tight enough to affect circulation.
  • Elevation: The ankle is to be kept elevated to the level of the heart, particularly at night.

Pain relieving medications such as ibuprofen are enough to manage pain caused by the sprain. Additionally, ankle support braces or elastic bandages or in more extreme cases, a cast can help in stabilizing the ankle while the tendons heal. Crutches are also used to assist in walking while the sprain is still painful.

Once the swelling has died down, doctor-assisted exercise can be started to restore the ankle’s flexibility and range of motion. Balance and stability training is also vital is restoring proper function to the foot and ankle. This includes activities to restore balance such as standing on one leg.

In the most severe circumstances, surgery is performed when the injury does not heal even after a long period of rest, therapy and rehabilitation. These surgical procedures may include repairing the ligament or completely reconstructing the affected ligament.

References

https://www.healthline.com/health/ankle-sprain#symptoms

https://www.foothealthfacts.org/conditions/chronic-ankle-instability

https://www.massgeneral.org/ortho-childrens/conditions-treatments/ankle_sprains.aspx

https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

 

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