What is a Sprained Ankle?
A sprained ankle is a tear of the ligaments that connect the foot bones to the ankle bones. Ligaments are structures that hold bones together so we can walk with stability. There are oftentimes multiple ligaments between each bone which adds to our stability and normal joint motion. Sprains can be minor with only partial tear of the ligaments to significant with complete disruption of multiple ligaments. The most common ankle sprain involves the lateral ligaments (opposite midline) Anterior Talo-Fibular Ligament (ATFL) which connects the talus to the fibula and the Calcaneo-Fibular Ligament (CFL) connecting the calcaneus (heel bone) to the fibula.
Diagnosis and Exam
A sprained ankle can cause pain and discomfort. Common symptoms can include:
- Popping sensation or sound
How is a Sprained Ankle Diagnosed?
An ankle sprain diagnosis typically involves your doctor performing an examination of your foot and ankle.
- Physical exam is an important aspect of making the correct diagnosis. Patients will usually experience pain around the fibula (the outside ankle bone). Oftentimes walking is initially difficult but improves with time.
- X-rays may be taken which are oftentimes normal, but are important when history or exam suggests a more significant injury.
- Magnetic resonance imaging (MRIs) are reserved for those patients with a severe pain or a recovery that extends beyond what is expected.
How is a Sprained Ankle Treated?
The R.I.C.E. (Rest, Ice, Compression, Elevation) method is recommended for initial treatment. Use of an ice bag is critical, however, one should never leave the ice directly against the skin and no more than 20 minutes at a time. A simple ace wrap or compression sleeve can be used, and patients should elevate as needed based on swelling and pain. Some practitioners advocate the use of NSAIDS, like ibuprofen. There is some concern that these medicines may actually slow the healing process. We recommend their use only necessary for pain relief. The use of braces or medical/walking boots may be needed initially to permit patients return to their daily activities, however, weening their use as soon as possible is important. Research has shown patients improve faster when extended brace or boot is limited.
Physical Therapy can also be valuable. Research has shown faster return to normal activities and sport in patients going to physical therapy. Physical Therapy immediately following a sprain may not be indicated for everyone; however, we do recommend it for athletes and those whose job require rigorous activity. We also recommend Physical Therapy for those patients still with problems one month or longer following their sprain.
How Long Does it Take to Get Over a Sprain?
A typical sprain takes about two weeks to be able to return to normal activities with minimal problems. This is the average time period shown for college athletes to return to play. Some may take longer. Most important, is that the patient feels like they are getting better. Unfortunately, up to 20% of patients with ankle sprains may not have complete resolution of their symptoms. When problems last longer than four months, we recommend evaluation by one of our foot & ankle doctors at the ROC.
There are other sprains that normally take about six weeks. Those are high ankle sprains involving the syndesmosis, which is the group of ligaments between the tibia and fibula above the ankle joint. Also, foot sprains in the middle of the foot also take between six and twelve weeks. Patients who are still having difficulty walking by four weeks should be evaluated by one of our specialists.
How Do I Prevent an Ankle Sprain?
Unfortunately, most sprains occur when we least expect it so there is no expectation. Proper shoes/boots can be important when participating in activities where sprains are likely to occur.
For our athletes, there are preseason exercises that can be performed by a trained coach, personal trainer, or physical therapist that have been shown to decrease incidence of sprains. ROC physical therapy run these programs for sports specific conditioning and injury prevention. A program like this would be particularly important for patients with a history of sprains.
The most superior device to prevent a sprain is a sports stirrup brace. This is a relatively low profile brace with plastic supports on the inside and outside. This brace has shown to have the lowest missed days in college athletes participating in high sprain risk sports like basketball, soccer, and volleyball. In fact, most NCAA programs require their athletes participating in these sports to wear these braces. At ROC, we support this and recommend athletes wear these sport stirrup braces who play high risk sprain sports, particularly if they have had previous sprains. These braces can be found online, or at our ROC Shop.
Lace up braces offer the second best protection followed by ankle sleeve braces. Taping has not been shown to decrease sprains in these sports.
Why Do I Still Have Problems After my Sprain?
Unfortunately, up to 20% of patients do not make a full recovery following their sprain. It may be a relatively minor problem such as swelling; however, most of these patients have pain and/or instability. Instability is a feeling that their ankle is “weak” and going to roll again on uneven ground. Patients may have a history of multiple sprains as a result of their instability. The ligaments heal, they just heal long or more like a rubber band that our pre-injury ligament that behaves more like a belt preventing abnormal motion at the ankle.
Pain may come from many different problems. The most common is either scar tissue that has built up in the ankle or damage to the cartilage. Damages cartilage is known as an Osteochondral Defect. MRI oftentimes does not diagnosis these problems, and up to 80% of the time, the MRI images and report do not show these problems. This is because the cartilage in the ankle is very thin, at just over a millimeter thick. Other problems include tendon tears, most commonly the peroneal tendons behind the fibula on the outside of the ankle. There are many other subtle injuries that can occur that are less common. The specialist at ROC are well trained to recognize and diagnose these causes of pain and instability in those patients with persistent problems following sprains.
What Happens if I Need Ankle Sprain Surgery?
For those patients with persistent pain and or instability, ankle sprain surgery may be an appropriate step on the road to returning to pre injury condition. Fortunately, surgery for problems related to sprains is highly successful with high rates of success, approximately 85% resolution of pain and better than 95% of patients feel stable when returning to regular activities and sport. Ankle sprain surgery generally consists of arthroscopy, a technique where the surgeon makes small incisions to access the ankle joint with a camera and tools to manage problems related to scar tissue and cartilage injury. In addition, many patients need their ligaments tightened which can be performed with a relatively small incision. Other problems identified by the surgeon pre-operatively can be fixed at the same time.
Post-operatively, we let patients walk on their ankles immediately. Physical therapy is an important aspect for patients to have the best result possible following their surgery and return to their desired activities faster.
Our foot and ankle doctors at ROC are leaders in the industry and have numerous published papers and international presentations related to treatment options and recovery methods associated with surgery for ankle sprains.
- Particulated Autograft Cartilage Implantation for the Treatment of Osteochondral Lesions of the Talus: A Novel Technique
- Acute Tears of the Tibialis Posterior Tendon Following Ankle Sprain
- Immediate Unrestricted Postoperative Weightbearing and Mobilization after Bone Marrow Stimulation of Large Osteochondral Lesions of the Talus
- Not just a sprain: 4 foot and ankle injuries you may be missing
- Matrix-induced autologous chondrocyte implantation of talus articular defects
Why Choose ROC?
In need of an orthopedic specialist? Schedule an appointment with one of our specialty-trained foot & ankle doctors to talk through your options. Reno Orthopedic Clinic offers comprehensive treatment for a full range of traumatic injuries at multiple convenient locations in Reno, Sparks and Carson City.