Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.
Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.
Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.
To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercise and stretching, and wearing well-fitted shoes.
Chronic Lateral Ankle Sprain
Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.
Signs and symptoms include:
• Ankle instability.
• Difficulty walking on uneven ground or in high heels.
• Pain, sometimes intense, on the outer side of the ankle.
• Repeated ankle sprains.
Although ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include:
• A fracture in one of the bones that make up the ankle joint.
• Arthritis of the ankle joint.
• Inflammation of the joint lining.
• Injury to the nerves that pass through the ankle. In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure.
• Scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments.
• Torn or inflamed tendon.
Treatments for chronic lateral ankle pain include:
• Over the counter or prescription anti-inflammatory medications to reduce swelling. Note: Please consult your physician before taking any medications.
• Physical therapy, including tilt-board exercises that focus on strengthening the muscles, restoring range of motion, and increasing your perception of joint position.
• Ankle braces or other supports.
• Steroid medication.
• Immobilization to allow the bone to heal (in cases of fractures).
Osteochondritis is a lesion that usually causes pain and stiffness of the ankle joint and affects all age groups. Osteochondritis is caused by a twisting-type injury to the ankle. Symptoms include swelling and ankle pain.
Immobilization of the foot and ankle for a period of time usually resolves the problem. In more severe cases, however, surgery may be prescribed. During the surgery, loose fragments of cartilage and bone are removed from the ankle joint and, in some cases, small drill holes are made in the defect to stimulate new blood vessels and help form scar tissue that will fill the defect.
A sprain is an injury to a ligament. PRICE (Protection, Rest, Ice, Compression, and Elevation) and avoiding HARM (Heat, Alcohol, Running, and Massage) are commonly advised for the first 48-72 hours after a sprained ankle. Painkillers may be needed. Most sprains heal within a few weeks. Physiotherapy may help. For severe sprains where the ligament ruptures (tears badly), a brace or plaster cast may be helpful. In some cases, surgery may be advised for a severe sprain.
What is a sprain?
A sprain is an injury to a ligament. Ligaments are strong tissues around joints which attach bones together. They give support to joints. A ligament can be injured, usually by being stretched during a sudden pull. The ligaments at the side of the ankle are the ones most commonly sprained.
A damaged ligament causes inflammation, swelling, and bleeding (bruising) around the affected joint. Movement of the ankle joint is painful when you have a sprained ankle. The picture shows a badly sprained ankle with fairly extensive bruising.
The severity of a sprain is graded into:
- Grade I – mild stretching of the ligament without joint instability.
- Grade II – partial rupture (tear) of the ligament but without causing joint instability (or with mild instability of the joint).
- Grade III – complete rupture (tear) of the ligament with instability of the joint. Sometimes this is simply called a severe ankle sprain.
A high ankle sprain is a sprained ankle in which the ligament above the ankle joint is torn. This ligament links the two bones of the lower leg (the tibia and fibula). It may get torn during certain types of ankle injuries, such as skiing or football injuries. A high ankle sprain takes longer to heal compared to the usual type of ankle sprain, where the ligaments at the side of the joint are injured. A high ankle sprain may be suspected if the joint is still painful more than six weeks after the original injury. Another name for this type of sprain is syndesmosis sprain, because the ligament involved is also called a syndesmosis.
What is the aim of treatment?
Usually, the damaged ligament heals by itself over time. Some scar tissue may be produced where there has been a tearing of tissues.
The main aims of treatment are to keep inflammation, swelling, and pain to a minimum, and to be able to use the ankle joint normally again as quickly as possible.
You can help to prevent ankle sprains by wearing boots that give ankle support rather than shoes when hiking across country or rambling over hills and uneven ground. Boots are often best for manual labourers too.
Also, exercises to build up the muscles around the ankle and to improve proprioception (described earlier) help to prevent ankle sprains. A physiotherapist can advise on these exercises.