Ankle Sprains

Most people have suffered an ankle sprain at some point in their lives.  Whether you are an active athlete injured during a pickup game or a busy professional who twisted an ankle in a high heeled shoe, ankle sprains are ubiquitous injuries.  Yet how many people know how to properly treat an ankle injury?

What is a sprain and how can one differentiate a sprain from a fracture?  First, a sprain is the stretching and even tearing of the ligaments that support the stability of the ankle joint.  Sometimes it is hard to tell the difference by the symptoms alone.  The only sure way to differentiate between a fracture and a sprain is to get an x-ray.  But who should get an x-ray?  This is partly determined by the severity of the symptoms and physical examination.  This decision will rest with you and your doctor.  Generally, x-rays are a safe, low-cost test that can be done quickly.  Let’s assume that a sprain is diagnosed.  What next?

Initial treatment often depends on the severity of the symptoms.  For those patients with a large amount of swelling and pain, crutches and possibly even a walking boot may be necessary.  All patients should utilize the traditional treatment of ice, elevation, rest and compression of the ankle.  This can be begun immediately following the injury and can continue for the first few weeks following the injury.  The use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and Aleve has also been shown to shorten the time to return to activity.  These may also be started immediately following injury.  However, do not expect these to be the magic formula to avert all symptoms.  Furthermore, edema (swelling) of the ankle will not be greatly reduced by these drugs.  The best way to decrease swelling still remains elevation of the extremity as much as possible.
As the swelling and pain begin to subside, functional activities may be initiated.  A physical therapist can assist the patient with the proper exercises that maximize the recovery process.  This regimen consists of range of motion exercises and strengthening exercises.  The first allows the joint to regain its normal motion that may be lost or limited by pain and swelling.  The second promotes the stabilization of the joint by maximizing the use of the surrounding musculature.  Some patients also prefer the use of a lace-up ankle brace or taping to aid in stability of the joint.  This may allow a quicker return to functional activity.

Depending on the severity of the injury, sprains may take several months to completely heal.  Occasionally, the ligaments are stretched so badly or torn that they don’t heal close to the original state.  These patients may continue to experience pain and instability many months or years following the injury.  They may be labeled as having “weak ankles” and be prone to recurrent ankle sprains.  In certain situations, it is possible to surgically repair these ligaments and return the patient to a high level of functioning.

The majority of ankle sprains will heal and the patient will get back to their desired activity.  However, there are many other injuries that can occur in association with an ankle sprain.  An ankle sprain that does not respond to conservative treatment as expected should be evaluated by a physician.