Ankle Sprain
What is an Ankle Sprain?
Definition:
An ankle sprain is an injury involving the ligaments of the ankle, typically due to an excessive twisting or rolling motion. It most often affects the lateral (outer) ligaments, especially the anterior talofibular ligament (ATFL).
Grading (Severity):
- Grade I (Mild): Stretching or microscopic tearing of ligament fibers; mild tenderness/swelling.
- Grade II (Moderate): Partial ligament tear; moderate swelling, bruising, and instability.
- Grade III (Severe): Complete ligament rupture; significant swelling, bruising, instability, and inability to bear weight.
Common Mechanism of Injury:
- Inversion of a plantarflexed foot (rolling the ankle outward)
- Sports, running on uneven surfaces, improper footwear
Structures Commonly Involved:
- Lateral Ligaments:
- Anterior talofibular ligament (ATFL) – most commonly injured
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL) – less commonly
- Medial Ligament (Deltoid ligament): Less commonly injured
- Syndesmosis (High ankle sprain): Injury to ligaments between tibia and fibula
Symptoms:
- Pain at the site of the injured ligament (usually lateral ankle)
- Swelling, bruising, and tenderness
- Instability or feeling of the ankle “giving way”
- Difficulty bearing weight or walking (depending on grade)
Diagnosis:
- Clinical Exam: Palpation, range of motion, anterior drawer and talar tilt tests
- Ottawa Ankle Rules: Determine need for X-ray
- Imaging:
- X-ray (to rule out fractures)
- MRI or ultrasound (if severe or persistent symptoms)
Treatment:
Initial (First 48–72 hours):
- RICE Protocol:
- Rest
- Ice (20 minutes every 2–3 hours)
- Compression (elastic bandage)
- Elevation
- Immobilization: Air splint or brace for moderate to severe injuries
- Pain Control: NSAIDs (e.g., ibuprofen)
Rehabilitation:
- Phase 1: Protect and reduce swelling
- Phase 2: Restore range of motion and begin weight-bearing
- Phase 3: Strengthening and balance/proprioception training
- Phase 4: Return to sport/activity
When to Consider Surgery:
- Chronic instability after failed rehab
- Complete ligament rupture with persistent dysfunction
- Associated injuries (e.g., osteochondral defects, peroneal tendon tears)
Prognosis:
- Most Grade I–II sprains heal in 2–6 weeks with conservative care.
- Grade III may take several months and may have risk of chronic ankle instability if not treated properly.
