Ankle > Ankle Sprain

The ligaments on each side of your ankle joint, which attach all the bone structures in your ankle to each other, are commonly injured in an ankle sprain. The bony bumps on the sides of your ankle are connected to each other by ligaments and also attach to the your anklebone (talus) and the heel bone (calcaneous). An ankle sprain is one of the most common sports injuries. When a twisting or rolling force bends your foot too far in any direction, the ligaments that hold the joint in place can be stretched past their normal position and the tissue can be damaged. The ligament can pull off its attachment to the bone, the bone can break, or the middle of the ligament can tear or stretch. The two ankle ligaments most commonly sprained are called the anterior talofibular ligament, which connects your talus to your smaller lower leg bone (fibula), and the calcanealfibular ligament, which connects your fibula to your heel bone. Physicians often rate the severity of ankle sprains with a three-point scale that is based on the amount of ligament damage:

   Grade I: Stretched ligaments.
   Grade II: Partially torn ligaments.
   Grade III: Completely torn ligaments.

In the majority of ankle sprains, people twist their ankles inward (inversion), damaging the ligaments on the outside of the ankle. Ankles are less frequently sprained by an outward (eversion) ankle twist that damages the ligaments on the inside of the ankle. It also is possible to sprain your ankle by bending your foot too far up or down. In some cases, ligaments on both the outside and inside of your ankle can be damaged.

Causes

Ankle sprains often result from a fall or tackle in contact sports like football, or awkward landing in sports like basketball, soccer, and volleyball. Any activity that involves side-to-side motion, like tennis or racquetball, can put you at risk for an ankle sprain. Walking or running on uneven, rough surfaces, or taking an step on an unexpected rock or hole, can sprain your ankle. Shoes that do not fit properly, or that do not provide enough side-to-side support when needed, may increase the risk of an ankle sprain. Poor muscle strength and conditioning in the lower leg and foot can leave your ankle too weak to withstand the stress of any abnormal movements that you may encounter. Overuse or previous injury may weaken your ankle strength, hindering your ability to perform stressful ankle movements without risking a sprain. Starting a new sport or increasing the intensity of your activities can put new strain on your ankle that may damage the ligaments.

Most ankle sprains heal with the R.I.C.E. (rest, ice, compression, and elevation) and physical therapy. However, your primary physician may refer you to an orthopedic specialist if you experience any of the following symptoms:

   A popping, snapping, or tearing sensation when the injury occurs.

   Any significant, persistent swelling or pain in the area.

   Prolonged instability when trying to put weight on the ankle.

If you suffer severe pain and are unable to move your ankle, see your physician as soon as possible after the injury. If not treated properly, an ankle sprain can weaken ligaments, which can hinder your ability to participate in activities later in life. People who suffer multiple ankle sprains may have a chronic ankle weakness that needs special medical attention. Surgery usually is performed after you have tried conservative treatments yet continue to suffer ankle sprains. However, surgery may be necessary soon after a severe, Grade III sprain.

Orthopedic Evaluation

Though many people with mild or moderate ankle sprains feel they can treat themselves at home, you should have your ankle evaluated by a physician, who can check for complications and decide on a specific treatment program for your ankle. There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

Your physician likely will ask about your activities, which may have caused the ankle sprain, and inquire as to when the soreness or pain began. If you have had any prior ankle injuries, your physician will ask about the treatments you have tried in the past. You should reveal any history of ankle surgeries at this time. You will probably be asked how long the ankle took to begin swelling, whether you were able to continue playing after the injury, and, if you stopped playing, whether you required assistance to leave the field. You may also be asked about your physical and athletic goals ¡V information that will help decide what treatment might be best for you in achieving those goals.

PHYSICAL EXAM

Your physician usually can make an early assessment of an ankle sprain by feeling around the injured area. While asking you questions to pinpoint your pain, he typically will test ligament strength and check your ankle's range of motion. Each ligament in your ankle is usually pressed and manipulated to pinpoint the exact location of the sprained tissue. After ruling out other injuries, your physician usually determines the grade (I to III) of the sprain.

TESTS

Should your physician require a closer look, these imaging tests may be conducted:

   X-rays taken from different angles may be used to rule out ankle fractures.

   MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians examine ankle ligaments, cartilage, and tendons.

RELATED TOPICS

   Imaging techniques