Sprained Ankle: Symptoms and Treatment

Sprained Ankle Overview

The ankle is considered to be a very complex joint, held together by set of ligaments called the medial and lateral collateral ligaments.  These ligaments secure the ankle joint and protect the joint from abnormal movements, especially twisting, turning and rolling of the joint.

Medial collateral ligaments are located inside of the ankle joint and are considered to be the strongest and protect the ankle from abnormal eversion (rolling-out) of the ankle joint.

Lateral collateral ligaments are located outside of the ankle joint and are considered to be the weakest and protect the ankle from abnormal inversion (rolling-in) of the ankle joint.

Inversion ankle sprain (ankle rolling-in) is the most common type and with an ankle sprain (inversion or eversion) these ligaments can stretch and if severe enough the ligaments can tear leading to pain, swelling and bruising.

In case of severe ankle sprains, a “pop” can be heard or felt.

The amount of force with which the ankle was twisted along with clinical findings, determines that grade of ankle sprain.

  • Grade 1 sprain (Mild): Slight stretching and some damage to the ligaments.
  • Grade 2 sprain (Moderate): Partial tearing of the ligaments.
  • Grade 3 sprain (Severe): Complete tear of the ligament, which leads to gross instability of the ankle joint on physical exam. A severe ankle sprain can cause damage to the ankle joint surface (cartilage) leading to arthritis and chronic pain.
[table cols=”Severity, Grade – 1″ data=”Physical Examination Findings, Minimal tenderness and swelling, Impairment, Minimal, Pathophysiology, Stretched ligaments, Typical Treatment*, Weight bearing as toleratedNo splinting/casting Isometric exercises
Full range-of-motion and stretching/ strengthening exercises as tolerated”] [table cols=”Severity, Grade – 2″ data=”Physical Examination Findings, Moderated tenderness and swellingDecreased range of motion Possible instability, Impairment, Moderated, Pathophysiology, Complete tears of some but not all collagen fibers in the ligament, Typical Treatment*, Immobilization with walking boot for 6 weeksPhysical therapy with range-of-motion and stretching/strengthening exercises”] [table cols=”Severity, Grade – 3″ data=”Physical Examination Findings, Significant swelling tenderness andInstability, Impairment, Severe, Pathophysiology, Complete tear/rupture of ligament, Typical Treatment*, Immobilization for 6 weeks or morePhysical therapy similar to that for grade 2 sprains but over a longer period Possible surgical reconstruction in ankle joint instability noted after conservative treatment”]

X-ray: Since an ankle fracture can have similar symptoms of pain, swelling and bruising, an X-ray may be needed to make sure you do not have a ankle or foot fracture.

MRI: In case of severe ankle sprains, your doctor may need to order anMRI (Magnetic Resonance Imaging) to evaluate the extent of damage to the ligaments.  Most often, this can be helpful in peri-operative planning.

What are Symptoms of a Sprained Ankle

  • Pain
  • Swelling
  • Bruising
  • Inability to apply pressure on foot or ankle


Conservative Treatments of a Sprained Ankle

  • Rest (Grade 1,2,3)
  • Ice (Grade 1,2,3)  (10-15 minute every 1 hour. You can ice over wrapping to decrease discomfort)
  • Elevation (Grade 1,2,3)
  • Compression (Grade 1,2,3) (wrap with Ace bandage to reduce swelling) Abductor hallucis muscle strain
  • Immobilization with cam-walker (Grade 2,3) (Allows the ligaments and surrounding tissue to heal themselves) Abductor hallucis muscle strain
  • Ankle brace (for preventative purposes) Abductor hallucis muscle strain
  • Taping before Activity Abductor hallucis muscle strain
  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to control pain and inflammation
  • Topical pain relieving gel Abductor hallucis muscle strain


Surgical Treatment of a Sprained Ankle

Surgical treatment for acute ankle sprain is rare and is usually reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.