With around 2 million ankle sprains each year in the United States, this injury is one of the most common musculoskeletal injuries there is. Not only can a sprained ankle be painful, but it can also stop you from participating in normal activities for weeks at a time and, if they aren’t treated properly, much longer. Working with orthopedic doctors to find the right diagnosis and rehabilitation program can ensure that a sprained ankle heals quickly and does not cause long-term issues.
What Is a Sprained Ankle?
While ankle sprains are very common, the term itself is often used erroneously to refer to any injury to the ankle. The ankle is a complex joint that can be injured in many ways, even from the same type of accident, so it is important to know a sprain from other problems.
An ankle sprain is specifically an injury to the ligaments, or tough bands of tissue that surround and connect the bones of the leg to the foot. When the ankle is twisted or turned in an unusual way, it can stretch and tear these ligaments, making them less able to hold the bones and joints together properly.
Each ligament has a specific range of motion and boundary to that range which is what keeps the joint stabilized during movement. When the ligaments are pushed past these boundaries, a sprain occurs. This is usually seen in the ligaments on the outside of the ankle, though it can occur in any ligaments in the area.
The most common causes of sprained ankles are physical activities like sports or other circumstances that can cause a loss of balance. Another cause could be car accidents where joints are overstretched and torn. Any time the ankle twists inward as a result of sudden or unexpected movement, it can cause the ligaments to stretch and tear, becoming sprained. This can happen to anyone at any age, though athletes and older individuals are often at higher risk.
Sprained ankles are separated into three degrees or grades when it comes to medical ankle pain treatment.
A first-degree or grade 1 sprain is a mild tear of the ligament, which causes some pain and swelling but generally heals quickly and without much intervention.
A second-degree or grade 2 sprain is slightly more severe, with about 50% of the ligament tearing. These have more pain and swelling, as well as a greater loss of mobility which can take more time to recover.
A third-degree or grade 3 sprain is a complete tear of the ligament, which will take the longest to heal and can cause complete immobility for a time.
Identifying a Sprained Ankle
The most common symptoms of a sprained ankle are:
- Swelling
- Tenderness
- Bruising
- Pain
- Inability to bear weight on the ankle
- Discoloration in the skin
- Stiffness
These symptoms often cross over with other ankle injuries, like a broken bone or a strain. You will not be able to identify the type of sprain on your own, but a doctor can help you understand where you fall in these categories and what that may mean for your treatment and healing time. If you suspect you have a sprained ankle or are experiencing these symptoms, it is important to avoid as much pressure as possible on the ankle and to seek treatment quickly.
When you see a doctor, they will first perform a physical examination of the ankle to determine which ligaments may have been affected. The exam may also include moving the ankle joint in various ways to check the range of motion. These tests, along with a discussion of your symptoms and medical history, are usually enough for a diagnosis of a sprained ankle.
Imaging tests, like x-rays, may be used to rule out bone fractures and other related injuries, but they are usually not needed to diagnose a sprain itself. If your doctor suspects a serious injury to the ligaments beyond a sprain or damage to the surface of an ankle joint, you may be sent for an MRI in order to obtain detailed imaging that the doctor can use during diagnosis.
Treating a Sprained Ankle
While some sprains are very minor and will improve over time, simple home remedies are always important to avoid further injury. In most cases, these remedies will be combined with treatment from an orthopedic doctor in order to ensure you maintain strength and flexibility in the ankle moving forward.
In cases where surgery is not needed, the healing process will generally consist of some initial home care and a period of recovery, followed by rehabilitation.
Home Care
Even the most minor sprain to the ankle will have symptoms that need to be addressed. Pain can be managed with over-the-counter medications, especially NSAIDs which contain anti-inflammatory properties to help with swelling. In addition to pain management, the most common recommendation is to follow the RICE method.
- Rest the ankle: As much as possible, avoid putting weight onto the injured ankle. This may be accomplished by redistributing your weight while walking or may require crutches.
- Ice: Use an ice pack to reduce swelling and pain in the ankle. Ice can be used for 20 minutes, three to four times per day. Be sure the ice pack is wrapped in a towel and not making direct contact with the skin.
- Compress: If necessary, light compression can help the ankle remain more stable. A compression sock can be helpful in this case.
- Elevate: Whenever you can, keep the foot elevated so that it is above your heart.
RICE may continue to be important throughout the recovery process, but it is most critical in the first days after an injury.
Recovery
The first two weeks following a sprained ankle are critical, as it is common to see a fast decrease in pain and improvement in functionality. Many people believe this means they are recovered and will return to normal activities within 1-3 weeks of the injury. In grade 1 sprains, this is often sufficient, but you should be cautious about returning to regular life without full approval. Symptoms may resolve while there is still damage to the ligaments present, causing future injury or damage that does not resolve.
Early intervention is critical to preventing long-term problems and future injuries. The recovery period can be actively managed in this period to prepare for physical therapy and other follow-up programs.
When a sprain is not fully recovered before activity resumes, it can cause the ligament to heal while slightly stretched, making it more prone to future sprains. Certain bones can become stiff, and the fibula may even move incorrectly in the future. These changes in movement are initially protective, but when they carry on for a long period, they can change walking patterns and cause a limp. With prolonged abnormal stress on the foot and ankle, future injuries are more common as the body is unable to compensate.
Rehabilitation
After the ligament has healed, it is common to require physical therapy in order to return the ankle to full functionality. In some cases, this can also speed up the recovery process. Those who participate in sports and physical activities may also choose to use rehabilitative physical therapy to ensure future injuries do not become a problem.
Each exercise program will be personalized to fit the person’s goals, medical history, and injury. The goal of physical therapy is to increase confidence and strength in the ankle, allowing a smooth return to normal life. Most programs will include goals like:
- Restoring full range of motion
- Rebuilding strength
- Rebuilding balance
- Reintroducing high impact loads
It is also common for physical therapy to include a focus on balance and control, which can prevent falls in the future. Those who are at a higher risk for falls are also at risk for sprained ankles, so this may be an important part of re-injury prevention. It is common for someone to enter physical therapy to rehabilitate a sprained ankle and end up working towards an ankle that is stronger and less prone to sprain than it was before the initial injury.
Surgery
It is rare that a sprained ankle requires surgery, but it is a potential outcome. Surgery is most common in instances where the damage to the ligament is severe and there is evidence of instability or when the injury has not improved with proper non-surgical treatment. If surgery does become necessary, there are two forms it may take:
- Arthroscopy: In this procedure, the surgeon will use a small camera to look inside the ankle joint for any loose fragments of bone or cartilage that may need to be removed.
- Reconstruction: A torn ligament can be repaired using stitches. A surgeon can also use other ligaments and tendons in the surrounding area to repair damaged ligaments.
The type of surgery required can depend on the severity of the sprain and the activity level you hope to return to once healed. Surgery is almost always followed by an extensive rehabilitation program, including physical therapy and regular follow-up appointments with your doctor.
Sprained Ankle Healing Times
Though the recovery period will differ with each person and each injury, there are some general guidelines around healing times for sprained ankles.
- A first-degree or grade 1 sprain is expected to heal in 3 to 5 weeks
- A second-degree or grade 2 sprain is expected to heal in 4 to 6 weeks
- A third-degree or grade 3 sprain is expected to heal in 3 to 6 months
These times will vary depending on severity, history of injury, and if things like surgery are needed. Physical therapy may also extend beyond these time frames as a way to focus on strengthening the ankle further and preventing re-injury.
Most people are able to fully heal from a sprained ankle without any permanent effects as long as they seek treatment promptly and follow all elements of their rehabilitation plan.
Preventing Sprained Ankles
Like any injury, it is always better to avoid a sprained ankle in the first place rather than dealing with treatment and recovery. However, sprained ankles sometimes come out of nowhere and can happen to anybody, no matter how active they are. Risk factors can include participating in sports, any condition that causes poor balance, and walking on uneven surfaces.
Most sprained ankles happen during movements and activities that involve the lower half of the leg, or the foot specifically, experiencing a sudden twisting force or roll. This forces the ankle joint out of the normal position. Most people can identify the exact moment the sprain occurred before it is jarring, though some people may not notice.
Once you have experienced an ankle sprain, you are more likely to experience a sprain again in that same ankle. This is true even if the ligaments have fully healed, but the risk increases more when they have not properly healed.
If you are at risk of sprained ankles or particularly concerned about suffering from one, some things you can do to lower your risk include:
- Wrap your ankles, especially ones that have been injured before, in elastic bandages
- Wear a brace if necessary
- Perform strengthening exercises
- Avoid wearing high heels
- Warm-up before exercising
- Always wear sturdy, high-quality footwear
- Avoid uneven surfaces
- Always pay attention to any surface you are walking on
- Slow or stop activities if you begin to feel fatigued
If you do suspect you have suffered from a sprained ankle, the most important thing you can do to prevent serious effects is contact a doctor quickly. At AICA Tucker, our orthopedic doctors will be ready to examine your ankle and make a personalized treatment plan to help you recover quickly and fully. In addition to these doctors, our offices have pain management specialists, radiologists and imaging labs, and other experts on staff to ensure your plan is integrative. We also offer physical therapy services, allowing you to plan your rehabilitation from the beginning with a team that is all working together. Contact AICA Tucker as soon as you suspect a broken ankle to begin treatment immediately.