Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the joint. There are two sets of ligaments that help to stabilize the ankle. The outside(lateral) ones are the Anterior talofibular ligament (ATFL), calcaneofibular ligament and the posterior talofibular ligament. The inner ones are grouped together called the deltoid ligament.
An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Most sprained ankles occur in the lateral ligaments on the outside of the ankle. Sprains can range from tiny tears in the fibers that make up the ligament to complete tears through the tissue. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.
Lateral ankle sprains are the most common injury in sports, but they can easily occur from a misstep. The ATFL is the most commonly injured ligament in an ankle sprain becomes of the mechanism of injury of an ankle-inverting motion with the foot in plantar flexion.
Your foot can twist unexpectedly during many different activities. Most ankle sprains occur when the foot twists or rolls to the side with enough force to cause injury to the ligament.
- Bruising and swelling are common signs of a sprained ankle.
- Pain/tenderness to the touch and with motion
- Instability of the ankle (feeling like your ankle wants to give way)
- Pain on weight bearing
Grades of Ankle Sprains
Grades of Ankle Sprains
Grade 1 Sprain (Mild)
- Slight stretching and microscopic tearing of the ligament fibers
- Mild tenderness and swelling around the ankle
Grade 2 Sprain (Moderate)
- Partial tearing of the ligament
- Moderate tenderness and swelling around the ankle
- Instability of the ankle when tested by your doctor
Grade 3 Sprain (Severe)
- Complete tearing of the ligament
- Significant tenderness and swelling around the ankle
- Substantial instability of the ankle when tested by your doctor
Chronic Ankle Sprains
Once you have sprained your ankle, you may continue to sprain it if the ligaments do not have time to completely heal. It can be hard for patients to tell if a sprain has healed because even an ankle with a chronic tear can be highly functional because overlying tendons help with stability and motion.
If pain continues for more than 4 to 6 weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces and participating in sports that require cutting actions or rolling and twisting of the foot.
Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately
- A three-phase program guides treatment for all ankle sprains—from mild to severe:
- Phase 1 – includes resting, protecting the ankle and reducing the swelling
- Phase 2 – includes restoring range of motion, strength and flexibility
- Phase 3 – includes maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle.
- Eventual return to activities that require sharp, sudden turns (cutting activities) such as sports
- This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6-12 weeks for more severe injuries
Your doctor may recommend many of the following treatments both during your recovery process and long term depending on residual symptoms once the ligaments have healed.
- Rest. Avoiding movements that exacerbate your pain.
- Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
- FS6 Compression sleeve
- Air cast boot – Temporary use of an aircast boot for walking for 2-4 weeks can allow the tendon to rest
- Crutches – in addition to the air cast for ultimate rest
- Custom soft orthotics with lateral support wedge
- To treat this condition, the outside edge of the foot needs to be supported to prevent the foot from rolling. This decreases the strain and workload on the lateral ligaments long term.
- Early motion
- Strengthening exercises
- Proprioception (balance) training
- Shockwave therapy
- Endurance and agility exercises
- Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
- Topical anti-inflammatories
- Compound Topical Creams
- Steroid (Depo-Medrol, Kenalog, Decadron)
- Blood (PRP – Platelet Rich Plasma)
Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.
Surgical options may include:
- The surgeon uses a small camera, called an arthroscope, to view inside the ankle. From this camera, small tools and instruments can be used to manipulate the joint.
- Repair of the ligament with stitches or sutures
After surgery considerations:
- Immobilization. There is typically a period of immobilization following surgery for an ankle sprain. Your doctor may apply a cast or protective boot to protect the repaired or reconstructed ligament. Be sure to follow your doctor’s instructions about how long to wear the protective device; if you remove it too soon, a simple misstep can re-tear the fixed ligament.
- Rehabilitation. Rehabilitation after surgery involves time and attention to restore strength and range of motion so you can return to pre-injury function. The length of time you can expect to spend recovering depends upon the extent of injury and the amount of surgery that was done. Rehabilitation may take from weeks to months.