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by Scholten A

Ankle Sprain

Definition

An ankle sprain is a partial or complete tear of the ligaments that support the ankle. Ligaments are strong bands of tissue that cross joints and connect bones to each other.
Sprained Ankle
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Causes

Ankle sprains may be caused by:
  • Falling
  • Sudden twisting of the ankle, such as:
    • Stepping on an uneven surface or in a hole
    • Taking an awkward step when running, jumping, or stepping up or down
    • Having your ankle roll over when playing sports or exercising—called inversion of the foot

Risk Factors

Factors that increase your chance of getting an ankle sprain include:
  • Playing sports especially with the wrong type of shoe
  • Walking on uneven surfaces
  • Weak ankles from a previous sprain
  • Having:
    • Poor coordination
    • Poor balance
    • Poor muscle strength and tight ligaments
    • Loose joints
  • Certain footwear (for example high heels)

Symptoms

Symptoms of an ankle sprain may include:
  • Pain, swelling, and bruising around the ankle
  • Worsening of pain when walking, standing, pressing on the sore area, or moving the ankle inward
  • An inability to move the ankle joint without pain
  • A popping or tearing sound at the time of the injury (possibly)

Diagnosis

An ankle sprain may not require a visit to the doctor. However, you should call your doctor if you have any of the following:
  • Inability to move the ankle without significant pain
  • Inability to put any weight on that foot
  • Significant swelling or bruising
  • Pain over a bony part of your foot or ankle
  • Pain that interferes significantly with walking
  • Pain not relieved by ice, pain relief medication, and elevation
  • Numbness in the leg, foot, or ankle
  • Pain that does not improve in 5-7 days
  • Uncertainty about the severity of the injury
  • Uncertainty about how to care for this injury
The doctor will ask about your symptoms and how your injury occurred. An examination of your ankle will be done to assess the injury.
Images may be taken of your ankle. This can be done with x-rays. If additional details are needed, other images may be done, such as a CT scan or an MRI scan.
Ankle sprains are graded according to the damage to the ligaments. The more ligaments involved, the more severe the injury.

Grade 1

  • Some minor tearing of ligament tissue
  • Ankle remains stable

Grade 2

  • Partial tearing of ligament tissue
  • Mild instability of the joint
  • Usually involves damage to 2 ankle ligaments

Grade 3

  • Complete tearing of 2 or 3 of the ligaments
  • Significant instability of the joint

Treatment

Most sprains heal well. Treatment for a sprained ankle includes:
  • Rest—Avoid putting any pressure on your ankle by not walking on it. Using crutches will let you bear partial weight. This is allowed early on, except when all three ligaments are torn.
  • Ice—Apply ice or a cold pack to the ankle for 15-20 minutes, 4 times a day for at least 2-3 days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
  • Compression—Wrap your ankle in an elastic compression bandage. Wrap from the toes going up toward the knee. This will limit swelling of your ankle and foot.
  • Elevation—Keep your ankle raised above the level of your heart as much as you can for 48 hours. This will help drain fluid and reduce swelling.
  • Oral pain medicine such as, ibuprofen, naproxen, acetaminophen, aspirin or topical pain medicines, such as creams and patches that are applied to the skin
  • Rehabilitation exercises—Begin exercises to restore flexibility, balance, range of motion, and strength of the muscles around your ankle as recommended by your doctor. You may benefit from working with a physical therapist that can teach you the exercises and make sure that you are performing them correctly.
  • Brace—You may need to wear a brace or walking boot to prevent your ankle from moving. In many cases, a brace, which stabilizes and compresses the ankle, will allow for early weight bearing and an earlier return to activity. You will be rehabilitating the ankle as it heals. If you play sports, you may need to wear an ankle brace or tape your ankle when you return to play.
  • Leg cast—If you have a severe sprain, your doctor may recommend a short leg cast for 2-3 weeks, but this is very rare. In many cases, there are special braces that can be used instead of a cast.
  • Surgery—Surgery is rarely needed to repair an ankle sprain. However, it may be necessary to repair a third degree sprain in which all three ligaments are torn.

Prevention

Many ankle sprains cannot be prevented. However, you can reduce your risk of spraining an ankle:
  • Take a break from sports or exercise when you feel tired.
  • Do exercises that strengthen leg and foot muscles.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments, and tendons, including those around your ankle.
  • If you have injured your ankle before, you are more likely to injure it again. You may reduce your risk of repeated sprains by wearing an ankle brace.
  • Wear appropriate footwear when playing sports to avoid injury.

RESOURCES

American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org
American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Ankle sprain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed April 4, 2013.
Kemler E, van de Port I, et al. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med . 2011;41(3):185-197.
Kerkhoffs GM, Handoll HH, et al. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev . 2007 Apr 18;(2):CD000380.
Sprained ankle. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00150. Updated September 2012. Accessed April 4, 2013.
Sprains and strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Sprains%5FStrains/default.asp. Published July 2012. Accessed April 4, 2013.
10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.
11/19/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed : van Rijn RM, van Ochten J, Luijsterburg PA, van Middelkoop M, Koes BW, Bierma-Zeinstra SM. Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review. BMJ. 2010;341:c5688.
9/10/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mosher TJ, Kransdorf MJ, et al. ACR Appropriateness Criteria acute trauma to the ankle online publication]. Reston (VA): American College of Radiology (ACR);2014. 10 p. Available at: http://www.guideline.gov/content.aspx?id=48284#Section420. Accessed September 10, 2014.

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