Ankle sprains are common injuries that occur from overstretching or tearing of the ligaments that support the ankle. The ankle is composed of the talus, tibia and fibula bones forming the joint, and the ligaments, which are responsible for holding these bones in their proper place. Ligaments and other soft tissues function to prevent abnormal movement such as twisting, turning and rolling of the foot beyond the normal range.
Ankle sprains occur due to sudden inward or inverted movement of the foot during sports activities, or while walking and running on uneven surfaces. An ankle sprain can occur from falling or sudden force on the ankle, which twists the joint beyond its normal range, resulting in damage to the ligament. Ankle sprains can occur at any age, and although commonly seen as a sports injury, ankle sprains can occur to non-athletes as well.
Ankle sprains result in pain, swelling, bruising and stiffness of the ankle region. Mobility, range-of-motion and weight-bearing are adversely affected. The severity of the ankle sprain depends on the condition of the torn ligament.
Grades of ankle sprain
Based on the severity of the ligament’s condition, ankle sprains are categorized as:
- Grade 1: a mild sprain with some damage to the ligament fibers.
- Grade 2: a moderate sprain with partial tearing of the ligament.
- Grade 3: a severe sprain with complete tearing of the ligament.
The diagnosis of ankle sprain starts with a physical examination, which is painful as the ankle is bent in various directions to assess which ligament is injured. Then, X-rays are taken to confirm whether any fracture is present, as the symptoms of a sprain are similar to a broken bone. The doctor grades the ankle sprain by looking at the amount of swelling and bruising of the ankle. In complex cases, an MRI scan is ordered to analyze the injured ligament.
Treatment and healing time of an ankle sprain will depend on the grade of the sprain. All sprains will be treated with the R.I.C.E. method: Rest, Ice, Compression and Elevation.
Your physician may also order the following treatment measures if the sprain is grade 2 or 3:
- Immobilization: A splint, short leg cast or boot may be used to immobilize the ankle and allow healing to take place with a grade 2 or 3 sprain.
- Medications: Medications such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for your comfort and to minimize swelling.
- Physical therapy: Strengthening and range-of-motion exercises may be prescribed by a therapist to regain normal function of the ankle and prevent chronic ankle problems. Your therapist may utilize ultrasound and electrical stimulation to decrease pain and swelling and instruct you on taping the ankle for support while it heals.
Surgery for ankle sprains is rarely needed, but may be necessary if the sprain is a grade 3 with complete tearing of the ligament, and the patient does not improve with conservative treatment measures and months of adequate healing time.
Your surgeon will perform ankle arthroscopy surgery to evaluate and repair the torn ligament. Arthroscopy is a surgical procedure in which an arthroscope, a small soft flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat various conditions. Your surgeon will look for any loose fragments of bone or ligament inside the joint with the help of an arthroscope through a small incision. The torn ligament is repaired by stitching it back together with sutures, or by using the surrounding ligaments or tendons to repair the damaged ligament.
The benefits of arthroscopy compared to the alternative, open ankle surgery, include:
- Smaller incisions.
- Minimal soft tissue trauma.
- Less pain.
- Faster healing time.
- Lower infection rate.
- Less scarring.
- Earlier mobilization.
- Usually performed as outpatient day surgery.