Ankle Sprains

Cause of Ankle Sprain
Ankle sprain is the most common orthopedic injury. An ankle sprain will occur when you "twist" your ankle.

Almost all ankle sprains happen when the foot twists under the leg in inversion. This will injure the lateral side of the ankle. People have most of their pain in that area.

Anatomy
A sprain is an injury to the ligaments at a joint. The ligaments are the tissue that holds bones together at a joint. You can think of it as "gristle". The ankle has a very large ligament on the inside, called the deltoid ligament. The ankle has two rather small ligaments on the outside. Those two outer ligaments, the Anterotalofibular ligament (ATF) and the Calcaneofibular ligament (CF), are most commonly injured in a sprained ankle.

Ankle ligaments have very good blood supply, so they generally heal quite readily. Some ligaments in the body have poor blood supply, and when they have been injured they will not heal. Almost always ankle ligaments will heal given some time and protection. There are some instances when they heal elongated, and if that occurs it is possible that the ankle will be left with some chronic instability.

When you sprain your ankle there is usually immediate Swelling and pain. Often there will be bruising from broken blood vessels in the area.

Treatment
The initial treatment for any ankle sprain is conservative. Often Braces are used to allow for protected weight-bearing. Physical therapy is helpful in returning to function as quickly as possible. There is really no indication for surgical treatment with acute ankle sprains.

The mnemonic RICE describes things you can do initially after an ankle sprain:

Rest is important for any injury.

Ice applied to the ankle can help minimize the swelling and also can act as an anesthetic. An ice pack may be used, or even a bag of frozen peas or corn from the home freezer can be effective.

Compression also helps to decrease swelling. Using an Ace bandage about the ankle is an easy way to provide general compression.

Elevation will also help decrease swelling.

Recurrent Sprains
Patients who have Recurrent Sprains in the ankle should be evaluated. It may be that the ankle ligaments are entirely normal, and the unfortunate patient is just having multiple episodes of ankle trauma. However, when there are repeated ankle sprains it may indicate that the ankle ligaments have become elongated, and they are not providing enough stability for the joint. In that case, the problem is Laxity of the lateral ligaments.  Laxity can be treated with the use of a Brace to provide external support, or by Surgery to tighten the ligaments internally.

Persistent Pain
Patients who have pain in their ankle after one month should also be evaluated. It is possible with a twisting injury that other structures about the ankle are injured, not just the ligaments.

For more information about ankle sprains please see the AAOS website.