Ankle Sprain

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What are the ankle ligaments?

The ankle Ligaments are tough fibrous bands that hold the bones in the ankle together, making the joint strong and stable, whilst allowing ankle movement within a specific range. These ligaments are divided into three main groups, that are located on the outside of the ankle (lateral ankle ligaments), above the ankle (syndesmosis) and on the inside of the ankle (deltoid ligaments).

What is an ankle sprain?

A lateral ankle ligament injury is what most people picture as the ‘classic’ ankle sprain and is the focus of this information sheet. It is a frequent injury that can happen while walking on uneven ground, playing sport or wearing high heels. The ankle rolls inwards (inversion) beyond it’s normal range and the lateral ankle ligaments are stretched or torn, leading to pain and swelling on the outside of the ankle.

The ATFL is the weakest of the lateral ankle ligaments and is the most commonly injured, followed by the CFL. People are more likely to have an ankle sprain if they play running and jumping sports, are overweight, have hypermobile joints, weak ankles or high arched feet.

What is a high ankle sprain?

A high ankle sprain is a different injury and much less common. This occurs when the ligaments above the ankle joint (syndesmosis) are stretched or torn. A longer rehabilitation period is required to fully recover.

What are the symptoms of an ankle sprain?

The immediate symptoms will vary on how severe the ankle sprain is, which can include: pain, swelling and bruising on the outside of the ankle with a popping or tearing sound at the time of injury, difficulty putting weight through the ankle and restricted ankle movements.

If a severe ankle injury is sustained medical advice should be sought immediately. Symptoms that suggest a severe injury include: pain preventing any weight bearing, a deformed ankle, the skin over the ankle is broken, the injury was caused by a severe force (for example fall from a height) or the pain and swelling gets worse over the first few days.

In some cases, other structures around the ankle can be injured at the same time. These include damage to the ankle joint surface (osteochondral defect), injury to the peroneal tendons or deltoid ligament and bone fractures (5th metatarsal, anterior process of the calcaneum, fracture lateral process of the talus).

How are ankle sprains graded?

Ankle sprains can be graded to help determine the severity of the injury and how long it will take to heal. An ultrasound or MRI scan can be arranged if accurate grading is required.

Grade 1 (mild) is when at least one of the lateral ankle ligaments are overstretched, with minimal ankle swelling, pain and bruising. Grade 2 (moderate) is when at least one of the lateral ankle ligaments are partially torn, with moderate ankle swelling, pain and bruising. Grade 3 (severe sprain) is when at least one of the lateral ankle ligaments are completely torn with severe ankle swelling, pain and bruising.

What is the initial treatment for an ankle sprain?

Most ankle sprains are minor injuries, which will improve overtime with simple treatments. Follow the RICE protocol as soon as possible after your injury to reduce the swelling:

  • Rest your ankle by taking the weight off it for a few days.
  • Ice packs to be applied for 10-15 minutes, 3-4 times a day
  • Compression with a support bandage or strapping
  • Elevate the ankle above the level of the heart as often as possible

Non-steroidal anti-inflammatory mediations (NSAIDs) such as ibuprofen or naproxen can help control the pain and swelling. Ask advice from your doctor or pharmacist before taking these medications as they can have side-effects in some people.

For moderate and severe ankle sprains immobilisation may be required, with a supportive ankle brace or surgical walking boot, for several weeks.

Do I need physiotherapy after an ankle sprain?

Most ankle sprains get better without any specialist treatment. Moderate to severe ankle sprains will benefit from physiotherapy exercises, once the initial symptoms of pain and swelling have settled.

Physiotherapy involves early ankle motion to prevent stiffness, then ankle strengthening exercises with balance (proprioception) training to prevent chronic ankle instability. Return to sport will vary depending on the severity of the ankle sprain and your own individual activity level.

Will I need surgery after an ankle sprain?

Surgery is reserved for patients with persistent ankle instability in their normal daily activities, that does not improve with a course of physiotherapy. Even a complete ligament tear (grade 3) can heal without surgical repair if it is immobilised appropriately.

Surgery can provide a stable ankle. It usually comprises of a lateral ankle ligament reconstruction (Broström procedure), to reattach and retighten the damaged ligaments to the bone on the outside of the ankle.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.

If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.

We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.