Sprained Ankle

A sprained ankle is a common injury that arises after an ankle twist, roll, or fall and affects the tissues connecting the ankle bone and the ligaments of the ankle, which get stretched beyond limits or are torn. The severity of the sprained ankle depends on the number of torn ligaments. In most cases, the sprained ankle heals after treatment with ice packs, over-the-counter medicines, elevated leg, and minimal exercises. Still, if the ankle is painful or swollen for a few weeks, you must consult a doctor and get evaluated.

The symptoms of a sprained ankle are:

1. Swelling in the ankle
2. Pain when putting weight on the ankle or while resting
3. Bruising in the area of the ankle
4. Tenderness in the ankle area
5. Difficulty in walking
6. Ankle instability
7. Restricted range of motion
8. Popping sound at the time of injury

Twisting and rolling of the ankle cause ankle sprain. Some of the incidences that cause ankle sprain are:

1. Landing inappropriately after a jump
2. Tripping or falling on bumpy surfaces
3. Sports involving twisting or rolling your foot, such as football, soccer, tennis, and basketball
4. Losing balance

Risk Factors

Some of the risk factors of getting an ankle sprain include:

1. Uneven surface
2. The weak muscles around the ankle
3. Improper footwear or poor-fitting shoes

The doctor will conduct:

Physical examination:

In this, the doctor will:

1. Diagnose the ankle by asking questions to you
2. Observe the injured ankle and compare it to the other leg’s ankle
3. Press the area around the ankle to check if the ligament is torn/injured
4. Check the range of motion
5. Check the stability of the joint by pulling the ankle in several directions

Imaging tests:

The doctor may:

1. Conduct an X-ray examination to evaluate the foot and ankle bones.
2. Do stress X-rays in which the ankle is pushed in different directions to check the stability of the ankle.
3. Conduct a magnetic resonance imaging (MRI) scan to check other structures like the tendon and cartilage surrounding the ankle, signs of high ankle sprain (injury to the ligament of the lower leg area), and injury after six to eight weeks of persistent pain even after the conservative treatment.

1. Medication: Pain-relieving medicine such as naproxen and ibuprofen will be recommended to you to control swelling and pain. This is a good option for mild ankle sprain.
2. Physical therapy: Physical therapy builds strength and enhances flexibility and balance. The physical therapist or doctor will recommend the following:
   1. Early motion: They will recommend specific exercises to prevent stiffness.
   2. Balance training: Poor balance can cause repeated ankle instability and sprain. They will suggest balancing exercises like standing on the injured leg and lifting the other leg with eyes closed. Mainly, balancing boards are used to build balance.
   3. Strengthening exercises: As the pain and swelling improve, the doctor will add other exercises to strengthen the muscles and tendons of the ankle and leg. For example, if weight-bearing strengthening exercises like toe-raising are painful, the doctor suggests water exercise. Even exercise with resistance can be used if it's not painful. 
   4. Endurance and agility exercise: The doctor may suggest activities such as agility drills as the pain goes away completely. You will be told to run in progressively smaller figures of eight. This is good for agility and ankle and calf strength and enhances the range of motion with time.
3. Surgical treatment: For ankle sprain, surgical treatment is rare. However, the surgery is recommended when:
   1. The injury fails to respond to the non-surgical treatment.
   2. Surgery is indicated for patients who feel pain and persistent ankle instability after trying non-surgical treatment and rehabilitation. 
   3. There is a high sprained ankle with the instability of the ankle syndesmosis (a fibrous joint that holds the ligament together)
   4. An ankle sprain is severe and has other injuries such as tendon rupture or ankle cartilage injury.
4. Types of surgery: 
   1. Reconstruction/repair: The doctor repairs a torn ligament with stitches. They may also reconstruct the injured ligament by replacing it with a tissue graft from other tendons and/or ligaments around the ankle or the foot.
   2. Arthroscopy: The doctor uses an arthroscope (tiny camera) to see inside the ankle joint. They use small instruments to remove any loose fragments of cartilage or bone, or ligaments stuck in the joint.

If not treated in time, the ankle sprain may become long-lasting (chronic) and can:

1. Continue to be more swollen and painful
2. Become weak
3. Cause inability to walk
4. Lead to arthritis

Disease Progression

There are three grades of sprained ankle based on the severity of ligament damage:

Grade I (Mild): A tiny tear in the ligament fibres or the ligament is stretched slightly. There will be minor swelling and tenderness to the touch.

Grade II (Moderate): The ligament is torn but not entirely. There is swelling over the injury and pain while moving.

Grade III (Severe): The ligament is entirely torn. Walking is difficult, the swelling is more, and the injury is painful.