Around the house, on the playing field, or somewhere in between, many of us will suffer a sprained ankle or two in our lifetime. In fact, it’s been estimated that approximately 28,000 Americans sprain an ankle each day. Interestingly enough, while ankle sprains represent nearly 10 percent of all emergency room visits, roughly 68 percent of people who suffer from them do not seek professional medical treatment. Many individuals (especially athletes) are used to simply “walking it off” and may potentially return to play well before the injury has fully healed. This is truly unfortunate, because an ankle sprain may weaken the surrounding tissues, leading to ankle instability and increasing the chances of the injury occurring again in the future. A single severe sprain or a history of ankle sprains may set the stage for other conditions, including osteoarthritis, later in life. Of course, not all ankle sprains will require professional treatment, and there are many at-home remedies suitable for treating mild sprains. However, if a chronic condition does develop, it may require conservative care therapies or other treatments. At Sports Medicine Oregon, we specialize in a range of sprained ankle treatments and preventative care options, to keep athletes and other active individuals on the move.
First, it’s important to understand the structure of the ankle. The ankle joint is made of three bones: the tibia, the fibula, and the talus. A set of strong, fibrous tissues known as ligaments connect the various bones of the ankle to one another. Together, these ligaments support the joint during movement and provide stability. An ankle sprain occurs when one or more of these ligaments is stretched too far. In extreme cases, this overstretching may result in complete tears of the ligaments. It’s worth learning the signs of a sprained ankle, in order to have a clearer idea of whether you’re facing a sprain or something more serious, but remember that only a medical professional can properly diagnose the injury. Common sprained ankle symptoms include swelling around the ankle, bruising, and general instability. Ankle sprains vary in severity and are classified on a spectrum ranging from grade 1 to grade 3, with a grade 3 ankle sprain being the most severe. More severe ankle sprains are typically sensitive to the touch, and the affected joint may be unable to bear weight.
A grade 1 ankle sprain involves an overstretched or partially torn ligament. Grade 1 ankle sprain symptoms include pain, swelling, and instability, but the patient is usually able to walk with minimal pain and discomfort.
A grade 2 ankle sprain involves a more substantial but still incomplete ligament tear. Grade 2 ankle sprain symptoms also include pain and swelling, often accompanied by bruising and difficulty walking.
A grade 3 ankle sprain involves a full tear of one or more of the ankle’s supporting ligaments. Common grade 3 ankle sprain symptoms include severe pain, swelling, and bruising along the foot and ankle. After suffering a grade 3 ankle sprain, the ankle will be highly unstable, and many patients find walking impossible due to the torn ligaments. The swollen area may be sensitive to even light touch.
Every injury is unique, and the anticipated sprained ankle recovery time will vary depending on the severity of the sprain. That said, most ankle sprains will heal within a week or two with proper rest and protection from further injury. More severe ankle sprains may require a month or longer to heal before an athlete as able to return to the playing field. If there is no noticeable symptom improvement within a few days, professional medical attention is highly recommended.
Ankle sprains are classified as either high ankle sprains or low ankle sprains. The difference between a high and low ankle sprain is determined by which ligaments are damaged during the injury.
A high ankle injury is characterized by damage to the syndesmosis — a fibrous joint connecting the tibia and fibula in the lower leg. High ankle sprains are typically the result of rapid external rotation. In other words, the front of the foot must be forced suddenly towards the shin to produce this kind of injury. Conversely, low ankle sprains are caused by inversion. During an inversion sprain, the ankle “rolls” inward, forcing the sole of the foot to rise and face the other leg. The majority of ankle sprains are low ankle inversion sprains. High ankle sprains often involve less bruising and swelling than lower ankle sprains, however, higher ankle sprains will normally take longer to heal.
Over time, torn or overstretched ligaments may lead to ankle instability. Unfortunately, a less stable ankle joint is more likely to sustain additional sprains and injuries in the future, creating a chronic issue. Both acute and chronic ankle injuries may lead to other conditions later in life, including posttraumatic arthritis, which accounts for more than 10 percent of all instances of osteoarthritis. For this reason, effective treatment and prevention are key to lifelong ankle health.
After sustaining an ankle sprain, there are many at-home remedies individuals can utilize to treat pain, swelling, and general discomfort. However, a severely sprained ankle or chronic ankle sprains may require physical therapy or surgery. For immediate relief from pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as directed during the initial stages of recovery. Additionally, the RICE method may help reduce symptoms and expedite the healing process. So what is the RICE method? Let’s take a look
The “RICE” in “RICE Method” is an acronym for rest, ice, compression, and elevation. The RICE method is an effective treatment for many common aches and pains as well as ankle sprains. Immediately after suffering a sprained ankle, it’s best to rest the affected foot. Resting a joint doesn’t mean complete immobilization by any means, however, it is important to avoid further injuring the joint during the initial recovery. Resting the foot and may involve the use of crutches, braces, or bandages to assist with mobility. For the first 48 to 72 hours following an ankle sprain, ice therapy can be used to constrict the blood vessels, reducing blood flow to the ankle and surrounding tissues. This will minimize swelling and reduce the overall recovery time. Ice packs are effective for this purpose, but they should always be wrapped in a layer of fabric to create a partial buffer just above to skin, and ice therapy treatments should be limited to 20 minutes or less. Some sprains may respond adequately to a single daily ice treatment, while severe ankle sprains may require multiple daily ice therapy treatments.
Next, braces or bandage wraps can be used to compress the joint, minimizing the buildup of fluids around it. Some people find slip-on compression braces convenient and effective, while others prefer to use adjustable bandages for a customizable fit. A bandage may be easier to apply for individuals dealing with greater pain and sensitivity. Lastly, it’s important to keep the sprained ankle elevated after the injury. As is the case with the compression and ice portions of the RICE method, keeping the sprained ankle elevated will limit the blood flow to the area and minimize swelling. This can be achieved by propping the ankle up on a pillow while in bed or seated. Remember, keeping the leg elevated above the heart is ideal.
As a general rule, rest, ice, compression, and elevation should be used for the first 48 to 72 hours following an injury, although it may be necessary to rest the joint and use assistive devices for a longer period of time. After the first 72 hours, heat therapy can be used to help aid the body’s natural healing process. Although there’s no strict protocol to follow with heat therapy, it’s best to incorporate heat once the initial swelling has subsided. Adding heat too soon following an injury will cause capillaries to dilate and increase blood flow to the area, leading to increased swelling. There are many heating products designed to help with at home ankle sprain treatment. Heating pads, heating packs, and even a soak in a warm bath can all be used to aid the healing process.
There are many ankle sprain treatment options available and, depending on the injury, surgery may be recommended for optimal results. After repeated ankle sprains, the surrounding ligaments (namely the anterior talofibular ligament and the calcaneofibular ligament) may become loose due to overstretching. These weakened or overstretched ligaments will leave the ankle unstable and lead to an increased risk of future ankle sprains. An acute ankle injury such as a severe ankle sprain may also result in torn ligaments. Lateral ankle ligament reconstruction (also known as the Brostrom procedure) is a common ankle surgery used to treat both chronic ankle instability and severe ankle sprains. During the procedure, the surgeon will make a small incision along the ankle and then tighten the overstretched ligament or ligaments to increase stability and minimize the risk of future ankle sprains. If a patient has suffered a torn ankle ligament, the surgeon will use sutures to repair the damaged ligament. Depending on the extent of tissue damage, it may be necessary to use a tissue graft to support the damaged ligaments and stabilize the joint.
To minimize the risk of chronic injury, it’s best to have a proactive strategy in place both on and off the playing field — prevention is the best sports medicine, after all. One of the easiest ways to prevent ankle sprains during athletic activity is by simply wearing appropriate equipment for the sport or activity at hand. As comfortable as those favorite sneakers may be, overly worn shoes lack the necessary traction to prevent slips and missteps. Appropriately fitting shoes with adequate traction will support the ankle joint and minimize the risk of overstretching or tearing a ligament. High-top sneakers can offer extra ankle support for activities that involve quick directional changes such as football, soccer, basketball, and tennis. If an athlete has a history of ankle sprains, it may be necessary to invest in secondary assistive devices such as a brace or rigid ankle supports. Additionally, warming up and stretching are essential to ankle injury prevention. A light warm-up “primes” your body for the workout ahead, raising your overall body temperature and increasing blood flow to muscles, tendons, and ligaments throughout the body. Stretching before and after a workout will increase flexibility and range of motion to support the joint. Foam rollers can also be used to stretch muscles and treat muscle soreness. One of the easiest ways to prevent an injury is simply by knowing your limits. Many injuries occur when an individual pushes too far too soon during a workout or practice. Instead, it’s safer and more effective to increase workout intensity and strength training programs incrementally over time.
Physical therapy is a popular rehabilitation treatment for severe ankle sprains, and it can also help prevent re-injury for those struggling with ankle instability and chronic ankle sprains. Physical therapy for ankle sprains focuses on strengthening the muscles of the foot, as well as targeting connective tissues to increase flexibility and range of motion. A physical therapist will create a personalized exercise regimen based on the injury and physiology of the patient. During the initial stages of treatment, the physical therapist will demonstrate how to properly perform these exercises. However, once the individual is comfortable, these exercises can be performed from the convenience and comfort of home. Physical therapy exercises should be performed daily for optimal results.
Whether you are struggling with ankle instability as a result of chronic ankle sprains, or have a child who has just suffered his or her first ankle sprain, there are many treatment options that can restore stability and prevent future sprains in the years ahead. At Sports Medicine Oregon, we offer a wide range of conservative care treatments, as well as surgical options when appropriate, to help athletes and active individuals achieve their activity and stability goals. Don’t let ankle instability hold you back. Take the next step and minimize your risk of injury-related osteoarthritis today!
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