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Ankle Sprains

Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

An ankle sprain is a partial or complete tear of the ligaments that support the ankle. Ligaments are strong bands of tissue that cross joints and connect bones to each other.

diagram of human ankle

Causes

Ankle sprains may be caused by:

  • Falling
  • Sudden twisting of the ankle, such as:
    • Stepping on an uneven surface or in a hole
    • Taking an awkward step when running, jumping, or stepping up or down
    • Having your ankle "roll over" when playing sports or exercising (called inversion of the foot)

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Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. In this case, these include:

  • Playing sports
  • Having:
    • Poor coordination
    • Poor balance
    • Inadequate strength in muscles and tight ligaments
    • Loose joints

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Symptoms

  • Pain, swelling, and bruising around the ankle
  • Worsening of pain when walking, standing, pressing on the sore area, or moving the ankle inward
  • Inability to move the ankle joint without pain
  • Popping or tearing sound at the time of the injury (possibly)

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Diagnosis

An ankle sprain may not require a visit to the doctor. However, you should call your doctor or visit an emergency room if you have:

  • Inability to move the ankle without significant pain
  • Inability to put any weight on that foot
  • Pain over a bony part of your foot or ankle
  • Pain that interferes significantly with walking
  • Pain not relieved by ice, pain relief medication, and elevation
  • Numbness in the leg, foot, or ankle
  • Pain that does not improve in 5-7 days
  • Uncertainty about the severity of the injury
  • Uncertainty about how to care for this injury

The doctor will:

  • Ask about your symptoms and how the injury occurred
  • Examine your ankle to assess the severity of the injury

Tests may include:

  • X-rays-to make sure that no bones are broken
  • MRI scan-to see if a ligament has torn completely (rarely needed)

Ankle sprains are graded according to the damage to the ligaments. The more ligaments involved, the more severe the injury.

Grade 1

  • Some minor tearing of ligament tissue, but the ankle remains stable

Grade 2

  • Partial tearing of ligament tissue
  • Mild instability of the joint
  • Usually involves damage to two ankle ligaments

Grade 3

  • Complete tearing of two or three of the ligaments
  • Significant instability of the joint

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Treatment

Treatment for a sprained ankle includes:

  • Rest-Avoid putting any pressure on your ankle by not walking on it. Using crutches will allow for partial weight-bearing. This is allowed, early on, except in three ligament tears.
  • Ice-Apply ice or a cold pack to the ankle for 15-20 minutes, four times a day for at least 2-3 days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
  • Compression-Wrap your ankle in an elastic compression bandage (eg, Ace bandage). Wrap from the toes going up toward the knee. This will limit swelling of your ankle and foot.
  • Elevation-Keep your ankle raised above the level of your heart as much as you can for 48 hours. This will help drain fluid and reduce swelling.
  • Oral pain medicine (eg, ibuprofen, naproxen, acetaminophen, aspirin) and topical pain medicines (eg, cream, patches) that are applied to the skin
  • Rehabilitation exercises-Begin exercises to restore flexibility, balance, range of motion, and strength of the muscles around your ankle as recommended by your doctor. You may benefit from working with a physical therapist who can teach you the exercises and make sure that you are performing them correctly.
  • Brace-You may need to wear a brace to immobilize your ankle. In many instances, a brace, which stabilizes and compresses the ankle, will allow for early weight bearing and an earlier return to activity. You will be rehabilitating the ankle as it heals. If you play sports, you may need to wear an ankle brace or tape your ankle when you return to play.
  • Leg cast-A cast is very rarely needed for an ankle sprain. If you have a severe sprain, your doctor may recommend a short leg cast for 2-3 weeks, but this is very rare. In many cases, there are special braces that can be used instead of a cast.
  • Surgery-Surgery is rarely needed to repair an ankle sprain, but it may be necessary to repair a third degree sprain in which all three ligaments are torn.

If you are diagnosed with an ankle sprain, follow your doctor's instructions.

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Prevention

Many ankle sprains cannot be prevented. However, you can reduce your risk of spraining an ankle:

  • Take a break from sports or exercise when you feel tired.
  • Do exercises that strengthen leg and foot muscles.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments and tendons, including those around your ankle.
  • If you have injured your ankle before, you are much more likely to injure it again. You may reduce your risk of repeated sprains by wearing an Air-Cast or other ankle brace.

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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-3940

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