Ankle sprain

Overview of ankle sprain

Overuse injuries are common among athletes. An ankle sprain is the most common sports injury belonging to this category. Normal people may also experience similar conditions due to accidental injuries. The current global incidence rate of ankle sprain is quite high. As per the statistics of the Cleveland Clinic, ankle sprain accounts for nearly 15% of the athletic injuries. People who undergo strenuous physical activities on a daily basis may also suffer from an ankle sprain. Proper diagnosis and treatment are mandatory in all such cases. Failure to do so may result in permanent damage and instability of the ankle.

What is ankle sprain?

An ankle sprain is defined as the ankle injury that occurs due to stretching and tearing of the ligaments attached to the exterior or the interior portion of the ankle. It mainly results from an accidental turning in of the foot. The severity of the sprain depends on how many ligaments are affected. The pain and intensity of the condition vary, based on whether the ligament is stretched, partially torn or completely torn. These sprains are common in activities that require an exertion of the entire body weight on the ankles in the course of full range motions like running, jumping and landing. In most cases, the lateral ankle ligament is more affected than the medial ankle ligament, since the former is much thinner and weaker than the latter.

It needs to be mentioned that ankle sprain and ankle strain are two completely different phenomena. While sprain involves only the ligaments, ankle strain entails a severe damage to the muscles and tendons in the vicinity of the injured site.

What are the symptoms of an ankle sprain?

The symptoms of ankle sprain vary according to the degree of damage. The following signs are common-

• Sharp throbbing pain at the site of injury
• Swelling of the affected region
• Reddish, bluish or purple discoloration of the injured foot
• Temporary immobility of the affected ankle
• Pain may radiate from the site of injury to the adjoining regions
• The appearance of irregular bulges
• Occasional bruising
• Stiffness and inflammation of the affected joint(s)
• Bleeding underneath the skin (ecchymosis)
• Extreme tenderness

What are the different types of ankle sprain?

Based on the severity of the symptoms, ankle sprain is classified into three types-

Grade I: Mild stretching of the ligament fibers occurs, that results in mild and short-termed pain. The anterior talofibular ligament (ATFL) is stretched and a few ligament fibers may be torn. Swelling of the affected ankle and discoloration of the overlying skin generally occurs. The patient experiences mild to moderate difficulty in walking.

Grade II: Grade II sprains are relatively serious than Grade I sprains. Stretching and tearing of the ligament fibers occur in this case. A complete tear of the anterior talofibular ligament and a partial tear of the Calcaneofibular ligament (CFL) take place. Hemorrhage, tenderness, and swelling of the affected ankle occur. The patient may be advised to avoid movement of the ankle for a few days.

Grade III: These are the most severe ones. A complete tearing of one or more ligaments may occur in this case. Capsular tear and Posterior talofibular Ligament (PTFL) tear may occur along with a severe damage to the ATFL and CFL. The patients may experience-

• Diffuse swelling
• Hemorrhage of the sides of the ankle and heel
• Tenderness over the anterolateral capsule, ATFL, and CFL

Based on the site affected, an ankle sprain is classified into the following types-

• Lateral ankle sprain: Around 70-85% of the ankle sprains belong to this category. It is also known as inversion ankle sprain and mainly affects the lateral side of the foot. It results from over-inversion of the foot and overstretching of the lateral or the outer ligaments. The ATFL and the CFL ligaments are damaged in this case.
• Medial ankle sprain: It is also called “eversion injury” and affects mainly the medial side of the foot. This happens when the foot accidentally rolls on the exterior side. Overstretching and overexertion of the medial or the deltoid ligament occurs in this case.
• High ankle sprain: An injury to the large ligaments above the ankles occurs in this case. These ligaments connect the two long bones of the lower leg known as tibia and fibula. It results from a sudden outward twisting of the foot during certain sports activities such as football, basketball, badminton, and horse-riding.

What are the necessary diagnostic tests?

The diagnosis of ankle sprain should be proper and accurate, to prevent the conditions from worsening. The following tests are usually carried out by the doctors-

• Medical history of the patient to look for instances of bone and ligament injury in the past
• Differential diagnosis (to exclude the possibilities of bone fractures or strains)
• X-ray radiography (to rule out fractures)
• Ottawa ankle rule (to differentiate between the different types of ankle injuries)

How do you treat ankle sprain?

The treatment of ankle sprain is a long-term and systematic process and is popularly known as RICE (Rest, Icing, Compression, Elevation). This method is effective for the treatment of sprained ankles and soft tissue damage. It is elaborated below-

• Rest: The patient is advised to rest the ankle for at least one week in order to avoid further stress or exertion. Certain unavoidable movements should be carried out only with the aid of crutches. A below-knee cast or an air cast helps speed up the recovery process.
• Ice: Wrap frozen peas or ice in a damp towel and press on the injured area for 15-20 minutes when you are awake. Do not apply the ice directly to the skin.
• Compression: Tie a tight bandage that covers the toes and the ankles in a manner that allows a smooth flow of blood.
• Elevation: Raise your foot and rest it on an elevated support.

Cryotherapy is the first line of treatment. Ice packs or ice slush bath should be used for a duration of 15 to 20 minutes. This should be repeated after every 2 to 3 hours. Individuals with conditions like diabetes, vascular disease, neuropathies etc. should consult a doctor prior frequent use of ice packs.

Medications such as over-the-counter pain relievers can be administered. Some of the medicines are ibuprofen, naproxen sodium, and acetaminophen. Rehabilitative exercises and physical therapies can help in regaining the strength and function of the injured ligament. Surgery may be required in chronic cases where repair or reconstruction of the ligament is required. Wearing comfortable footwear can help in preventing an ankle sprain. Regular exercise and physical activity strengthens the ligaments, tendons, and muscles and thereby prevent the spraining of the ankle.

Physical activity or any form of a sport should be avoided when tired, worn out or in the state of less consciousness. Walking on uneven surfaces should be avoided. In some serious cases of an ankle sprain, surgical intervention becomes necessary in order to restore the original condition of the ligaments. Sufficient care and attention is required in such cases in order to prevent post-operative complications.

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