Most people have twisted
an ankle at some point in their life. But if your ankle gets swollen and
painful after you twist it, you have most likely sprained it. This means you
have stretched and possibly torn the
ligaments in your ankle.
Even though ankle sprains are common, they are not
always minor injuries. Some people with repeated or severe sprains can develop
long-term joint pain and weakness. Treating a sprained ankle can help prevent
ongoing ankle problems.
Most types of ankle sprains
happen when you make a rapid shifting movement with your foot planted, such as
when you play soccer or get tackled in football. Often the ankle rolls outward
and the foot turns inward. This causes the ligaments on the outside of the
ankle to stretch and tear. Less often, the ankle rolls inward and the foot
turns outward. This damages the ligaments on the inside of the ankle.
An ankle sprain can range from mild to
severe, depending on how badly the ligament is damaged and how many ligaments
are injured. With a mild sprain, the ankle may be tender, swollen, and stiff.
But it usually feels stable, and you can walk with little pain. A more serious
sprain might include bruising and tenderness around the ankle, and walking is
painful. In a severe ankle sprain, the ankle is unstable and may feel "wobbly."
You can't walk, because the ankle gives out and may be very painful.
With most sprains, you
feel pain right away at the site of the tear. Often the ankle starts to
swell immediately and may bruise. The ankle area is usually tender to touch,
and it hurts to move it.
In more severe sprains, you may hear
and/or feel something tear, along with a pop or snap. You will probably have
extreme pain at first and will not be able to walk or even put weight on your
foot. Usually, the more pain and swelling you have, the more severe your ankle
sprain is and the longer it will take to heal.
Your doctor will
ask you how the injury occurred and if you have hurt your ankle before. He or
she will check your foot and ankle, your lower leg, and even your knee to see
if you are hurt anywhere else.
If the sprain is mild, your doctor
may not order
X-rays. But with more severe sprains, you may need
X-rays to rule out a broken bone in the ankle or the foot. It is possible to
break a bone in your foot or ankle at the same time as a sprain.
In most cases, doctors order X-rays in children with symptoms of an ankle
sprain. This is because it is important to find and treat any damage to the
growth plates in bones that support the ankle.
In many cases you can first use
the PRINCE approach to treat your ankle:
Proper treatment and rehabilitation (rehab) exercises are very
important for ankle sprains. If an ankle sprain does not heal right, the joint
may become unstable and may develop
chronic pain. This can make your ankle weak and more
likely to be reinjured. Before you return to sports and other activities that
put stress on your ankle, it's a good idea to wait until you can hop on your
ankle with no pain. Taping your ankle or wearing a brace during exercise can
help protect your ankle. Wearing hiking boots or other high-top, lace-up shoes
for support may also help. But use caution. Don't force your foot into a boot
if you feel a lot of pain or discomfort.
If your ankle is still
unstable after rehab, or if the ligament damage is severe, your doctor may
recommend surgery to repair the torn ligaments.
Rehab exercises can begin soon after the injury. You can try to walk or
put weight on your foot while using crutches if it doesn't hurt too much.
Depending on your pain, you can also begin
range-of-motion exercises while you have ice on your
ankle. These exercises are easy to do—you just trace the alphabet with your
toe. This helps the ankle move in all directions.
Ask your doctor
about other rehab. Stretching, strength training, and balance exercises may
help the ankle heal totally and may prevent further injury.
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Learning about ankle sprains:
ligaments that connect the bones in the foot, ankle,
and lower leg stretch or tear. There are different types of ankle sprains.
An inversion injury, the most
common cause of ankle sprains, occurs when the ankle rolls outward and the foot
turns inward. It results in stretching and tearing of the ligaments on the
outside of the ankle.
In an eversion injury, the ankle rolls
inward and the foot turns outward, damaging the ligaments at the inside of the
In a "high" ankle sprain, a less common type of injury,
ligaments that join the two lower leg bones together above the ankle, called
the syndesmosis, are injured. This usually happens if the foot is forced up, or
if the leg is forcefully twisted while the foot is planted. This injury can
occur either by itself or with an inversion or eversion sprain. If the
ligaments of the syndesmosis are injured, the sprain is more severe and takes
longer to heal.
Damage to the ligament varies from simply
stretched or slightly torn to completely torn. Your doctor will grade your
People usually feel immediate pain at the
site of an
ankle sprain. Often the ankle starts to
swell immediately and may develop bruising. The affected area is usually
tender to touch and may feel "wobbly" or unstable.
In a mild
sprain, swelling usually goes down within a few days.
of your symptoms usually depends on how much tearing has occurred. In more
severe sprains, you are often not able to walk or even put weight on your foot,
and your ankle may feel unstable. You usually have extreme pain at first, but
some people start to feel better fairly soon. You may also hear and/or feel a
tearing sensation and a pop or a snap.
If a sprain does not heal
correctly, your ankle joint may be more likely to be injured again or the pain
may not go away. This often occurs with even a slight trauma, such as stepping
off a curb or walking on uneven pavement. Some people complain of persistent
pain and swelling.
See your doctor immediately if you notice any of the following:
You should see your doctor after an
ankle sprain if you notice any of the
Also be sure to contact your doctor if you have a cast or
splint around your ankle that feels too tight. If the cast hurts, pinches, or
feels like it is digging into your skin, it may be too tight. If your foot
feels numb or your skin feels cool, call your doctor immediately.
If your pain is mild and you are able to put some weight on your foot,
you may follow the recommendations in the Treatment Overview and Home Treatment
sections of this topic. Initial treatment and rehabilitation exercises ensure
that your ankle heals properly. If treatment recommendations are not followed,
your ankle may stay weak and unstable.
For evaluation, diagnosis, or treatment of an
ankle sprain, you may see:
For further treatment, you may be referred to:
Your doctor will ask you when and
ankle sprain occurred and ask about any prior
Next, your doctor will examine your foot, ankle, and
lower leg and even your knee to see if any other injury occurred. He or she
may ask you to move your foot up and down and to take a few steps if possible.
Your doctor will then carefully try moving your foot and ankle to see if the
ligaments are intact and what movements cause pain.
If your sprain
is mild, an
X-ray may not be taken. If your sprain is more severe,
you will need X-rays to evaluate the ankle. X-rays can help your doctor find
out whether you have any ligament tears, broken bones, or bones that have moved
out of their normal positions.
X-rays are usually taken for
children because of potential injury to the bone's
growth plate and possible disruption of normal growth.
Doctors may take X-rays of both ankles so they can compare the injured ankle
with the one that is healthy.
Initial treatment for an
ankle sprain is summarized as the PRINCE
Also, it can help to wear hiking boots or other high-top,
lace-up shoes for support.1 But use caution. Don't
force your foot into a boot if you feel a lot of pain or discomfort.
Your doctor may suggest that you keep some or all of your weight off your
ankle as it heals. If this happens, learn to use your crutches or walker
properly and safely.
Almost all ankle sprains heal on their own with proper home
treatment and rehabilitation (rehab) exercises.
Surgery to repair torn ligaments
is usually only considered when there is a severe ligament tear (or tears) or
if the ankle remains unstable after rehab. Surgery is also a
consideration if you have broken a bone.
Ankle sprains take an average of 6
weeks to heal but can take can up to 4 months, depending on the severity. An
ankle brace, air stirrup, hiking boots, or other form of ankle support should
be worn during this time to protect the ligaments. After the ankle is healed,
wearing an ankle brace or taping the ankle may help prevent reinjury.
For more painful and severe sprains, you may not be able to walk,
although you might be able to bear some weight while using crutches and a
protective brace, such as a brace with a built-in air cushion or other form of
ankle support. If pain is severe, use crutches until your doctor tells you that
you can begin to bear weight. In general, if your pain is bearable, you should
try to walk or bear some weight while using crutches and a protective brace,
because these activities promote healing.
Some people who have
repeated or severe sprains can develop long-term joint pain and weakness.
Treating a sprained ankle can help prevent ongoing ankle problems.
Rehabilitation (rehab) exercises for an
ankle sprain can be done at home to promote proper
healing and prevent chronic pain and instability. When rehab exercises
are not followed after a sprain, the ankle can become weak and unstable.
In the case of a minor sprain, rehab exercises begin
soon after the injury with walking. Wear hiking boots or other high-top,
lace-up shoes for support.1 But use caution. Don't
force your foot into a boot if you feel a lot of pain or discomfort.
Stretching exercises should be continued daily and especially
before and after physical activities to prevent reinjury. Even after your ankle
feels better, continue with muscle-strengthening exercises and balance and
control exercises several times a week to keep your ankles strong.
The timing and type of rehab exercises may vary according to
your doctor's or physical therapist's preferences. You will probably do the following types of exercise.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Foot and Ankle Surgeons provides
information on surgery and shoe selection as well as the care and treatment of
heel, toe, ankle, nerve, tendon, nail, and skin conditions. You can also look up and learn about sports injuries, diabetic foot problems, arthritis, and resources in your local area.
The American Orthopaedic Foot and Ankle Society (AOFAS)
provides information on a variety of topics, including foot care for adults,
children, and people who have diabetes; proper shoe fit; and how to select
children's shoes and sports shoes. Some information is available in several
languages besides English.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Fongemie A, et al. (2006). Health Care Guideline: Ankle Sprain, 7th ed., pp. 1–25. Bloomington, MN: Institute
for Clinical Systems Improvement.
Other Works Consulted
Hertling D, Kessler RM (2006). Ankle sprain section of
Lower leg, ankle, and foot. In Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th
ed., pp. 601–604. Philadelphia: Lippincott Williams and Wilkins.
Krabak BJ, Baima J (2008). Ankle sprain. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 421–425. Philadelphia: Saunders Elsevier.
Mann JA, et al. (2006). Ligamentous injuries about the
ankle joint section of Foot and ankle surgery. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 521–524. New York: McGraw-Hill.
Struijs P, Kerkhoffs G (2010). Ankle sprain, search
date November 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
November 15, 2011
Adam Husney, MD - Family Medicine
& William H. Blahd, Jr., MD, FACEP - Emergency Medicine
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