Ankle Sprains: Diagnosis and Treatment

Ankle sprains generally occur when the foot rolls inward (aka inversion injuries). Getty Images /

An ankle sprain is a common orthopedic injury estimated to occur in approximately 3 million people each year.  They are usually the result of a misstep or athletic injury where the foot rolls inward, injuring the stabilizing ankle ligaments.  A minor sprain can last a few days, whereas a severe sprain may take upwards of 2-3 months to heal.  Ankle sprains are not treated with surgery bone breaks are treated by ankle fracture surgery.

Ankle Sprain Severity & Symptoms

Ankle sprains generally affect the outer ligaments of the ankle.  There are 3 stabilizing ligaments that can be ruptured: anterior talofibular (ATFL), calcaneofibular (CFL) and/or the posterior talofibular ligament (PTFL).  The ATFL is the most commonly injured, followed by the CFL, and lastly the PTFL.  

The severity of ankle sprains are usually graded based on extent of damage along with structural integrity.  They are Graded 1 through 3, with grade one being the least injured and grade three being the most injured.  

Grade 1 - Mild ankle sprain:  Here the ankle ligaments are slightly injured and/or overstretched.  The symptoms are also mild in that there is minimal pain, tenderness and swelling.  Usually people can still walk despite the symptoms.  The ankle stability is intact.   

Grade 2 - Moderate ankle sprain:  A partial or incomplete tear of one or all of the ankle ligaments resulting in moderate pain.

 The outer ankle is usually swollen, sometimes with redness and hurts to touch.  Walking is difficult and often requires some support.  The stability of the ankle is questionable.  

Grade 3 - Severe ankle sprain:  A complete tear of the outer ankle ligaments.  These injuries usually appear dramatic with lots of swelling and bruising.

 There is often intense pain when touched.  Because the ankle ligaments are completely ruptured, the ankle is unstable and walking is not usually possible.  

Ankle Sprain Treatments

Ankle sprains are generally treated conservatively, which means without surgery.  Depending on the severity of the ankle sprain, the treatment can vary.  Grade 1 (minor) ankle sprains can involve relatively simple short-lived treatments whereas grade 3 (severe) ankle sprains often involve a prolonged recovery and ankle immobilization.  Nonetheless, the following treatment modalities are used to treat ankle sprains of varying degrees:

  1. Immediate Immobilization.   After an ankle injury, it’s important to immobilize the extremity to avoid additional damage until the extent of the injury is determined.  

  2. Rest, Ice, Compression and Elevate.  All orthopedic injuries adhere to this recipe of rest, ice, compression and elevate - also known as the acronym RICE.  Rest, prevents additional injury and also allows the body to heal.  Applying ice can help reduce inflammation and alleviate pain.  Compression (often with an ace wrap) of the area prevents/limits additional swelling.  Elevation of the extremity, above the level of the heart, also prevents/limits additional swelling and can decrease pain.  

  1. Anti-inflammatory Medication.  Inflammation is associated with nearly every injury and increases with severity of the injury.  Taking anti-inflammatory medication (NSAIDs) helps decrease inflammation and also acts a pain reliever.  Of course, taking anti-inflammatories should be monitored by your doctors as it has effects on the kidneys.  

  2. Ankle Brace.  There are various types of ankle braces that can be used to support the ankle during healing - some soft and others rigid.  Ankle braces are best used for grade 1 sprains and some grade 2 sprains.  It’s important to stabilize the ankle during healing so the ligament heals properly.  

  1. Casting.  Placing a cast on the lower leg usually recommended for severe ankle sprains (grade 3 sprains).  The purpose of the cast is keep the ankle in a neutral position for approximately 6 weeks to allow the ankle ligaments to heal properly, and not in an over lengthened position.   Crutches and non-weightbearing are commonly employed.  In some grade 2 (moderate ankle sprains) casting may be used as well, or alternatively a removable boot.

  2. Physical therapy.  Ligaments take 6-8 weeks to mend.  Depending on the severity of the sprain some foot health providers may institute physical therapy early.  Generally speaking, grade 1 sprains start early physical therapy whereas grade 3 often wait until the ligament is mended.  

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