Practice Plus Group MSK and Diagnostics

Ankle sprain

What is ankle sprain?

Ligaments are strong bands of tissue that connect bones together and stop them from moving too far.

The term sprain refers to an injury to your ligaments. This is very common in the ankle.


What causes ankle sprain?

The normal cause of a sprained ankle is when you ‘twist’ it or ‘go over on it’. When you step down, the sole of your foot turns too far inwards or outwards and you overstretch or tear the ligaments on the opposite side of your ankle.

This often happens during sports that involve running, jumping and changing direction suddenly, but it can also happen when you miss a step at home, in the street or on uneven ground.


What are the symptoms of ankle sprain?

The symptoms of ankle sprain will typically come on quickly after the missed step or sports injury that caused them.

In particularly severe cases, you may feel/hear a ‘pop’ when the injury occurs.

Depending on the severity of the sprain, your symptoms could include:

  • Soreness or pain in your ankle, particularly when stepping down.
  • Warmth and tenderness to the touch.
  • Swelling around your ankle.
  • Bruising around your ankle.
  • Stiffness and restricted movement in your ankle.


How is ankle sprain diagnosed?

There are different grades of ankle sprain.

  • Grade 1: The ligament has been overstretched, causing soreness and some swelling, but no significant tearing.
  • Grade 2: A partial tear of the ligament, causing pain, swelling and possible bruising. You may not be able to put your full weight through your ankle.
  • Grade 3: A full tear of the ligament, with 50-100% of the fibres damaged. This will usually be very painful, swollen and bruised, and you will probably be unable to use your ankle/foot.

If you are unable to put any weight through your ankle, you should get checked out at A&E or at your GP, in case the problem is not a sprain but a broken bone.

There is no pressing need to seek an assessment for lesser symptoms, unless they do not improve with time and self-treatment. However, a doctor or physiotherapist will be able to advise you on an exercise/rehabilitation programme which you can pursue yourself.


What are the treatment options for ankle sprain?

Depending on the severity of your injury, it may be advisable to start moving and strengthening your muscles again, as soon as possible, or to avoid putting any weight on your injured ankle (for some Grade 3 injuries, your GP may recommend using a support, brace or cast).

In either case, it is important to manage pain and swelling during the first few days.

Put an ice pack on the ankle area for 10-20 minutes, every 2-3 hours, to relieve pain. (Do not put ice directly next to skin as it may cause ice burn. Wrap it in a damp tea towel. Also, do not lie on the ice. Remove the pack if irritation increases. Allow the area to return to normal temperature before reapplying the ice.)

Compress your ankle with a tubular bandage or neoprene support. This can help to relieve pain and reduce swelling. It should feel tight, but not so tight so that you cannot feel your foot.

As often as possible, use pillows or cushions to elevate your ankle above the level of your heart. This can also help to relieve pain and reduce swelling.

You could try painkillers such as paracetamol, with or without codeine added. Anti-inflammatory painkillers such as Ibuprofen, which also come as creams or gels to rub over the injured area, may also help with pain and swelling. However, you should ask your doctor or pharmacist for advice, as these may slow the healing process during the first 48 hours.

Once the pain and swelling start to improve, you should consider exercises to help your muscles regain their strength. These should be light to start with, such as walking (as tolerated, do not overdo it) and moving your foot up, down, inwards and outwards, gradually progressing to weight-bearing, balance and strengthening exercises (depending on the severity of your injury).

In rare cases, if your injury has been particularly severe, surgery may be necessary.


What is the prognosis (outlook) for ankle sprain?

Recovering from an ankle sprain may take weeks or months, depending on how severe it is and how effective your rehabilitation regime.

A completely torn ligament may take several months to heal and you may be unable to resume training or to play sport during this time.


How can I prevent recurrence of ankle sprain?

If you have had an ankle sprain, you are more likely to have one again, especially during the first 12 months.

You can reduce the chance of a sprain reoccurring by performing regular balance and strength exercises and by warming up properly before strenuous exercise or sport.

Try to make sure that your ankle is fully rehabilitated before resuming sports.

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