An Introduction to the Sprained Ankle
Don’t let a sprained ankle keep you out of the game: an introduction to the sprained ankle
Virtually everyone has at one time or another sustained a twisting injury or sprain to one of their ankles. In fact, sprained ankles represent the most common athletic injury happening today.
Despite being so common, the sprained ankle is often misunderstood and under-treated. So before you miss another basketball game, trail run, or triathlon because of an ankle sprain, let’s try to better understand how this injury occurs, how to recover from it, and how to prevent future sprains.
There are two major ligaments that provide stability to the outside part of the ankle. One is called the calcaneofibular ligament (CFL). The other is the anterior talofibular ligament (ATFL).
Under normal circumstances, these ligaments provide stability by resisting stresses that tend to invert the ankle or cause it to turn in. Thus, any cutting maneuver, change in direction, or walking or running on uneven ground is made possible by the ATFL and CFL.
Ankle Sprain Symptoms
A sprain occurs when there is some degree of stretching or even tearing of these ligaments. This stretching of the ligament produces the characteristic swelling, bruising, and pain on the outside of the ankle.
In general, these symptoms vary depending on the amount of stretching of the ligaments that has occurred. Physicians and trainers will frequently grade ankle sprains from I-III to describe how severe an ankle sprain is.
You may also hear of athletes sustaining what is called a “high ankle sprain”. This type of sprain is much less common. It occurs when the entire ankle and leg are twisted outward, unlike the more common ankle sprain which occurs when the ankle twists inward. The reason it is called a “high” ankle sprain is because the injured ligaments actually extend from the ankle all the way up the leg almost to the knee.
Pain, swelling, and bruising may actually be worse on the inside of the foot and ankle. It is important to diagnosis a “high” ankle sprain because the recovery from it is generally much longer than for a standard ankle sprain.
Initial Treatment for the Sprained Ankle
When a sprained ankle has occurred, it is important to distinguish it from a broken ankle. If there is any gross deformity to the ankle or if the injured person is completely unable to put any weight on the affected leg, then the injury should be evaluated by a physician or trainer. They are best able to determine if an X-Ray is needed.
Once a sprain is diagnosed, treatment should begin as soon as possible.
Ankle Sprain Treatments
In most cases, an initial course of R.I.C.E. therapy is the best practice. R.I.C.E. stands for Rest, Ice, Compression, and Elevation.
“Rest” the foot by avoiding strenuous activity and limiting the amount of weight put on the injured ankle. When the ankle has been sprained, bearing weight on the ankle will not cause additional damage so light walking is encouraged. Although soreness is expected after a sprain, weight-bearing should be tolerable and shouldn’t cause significant pain. If weight-bearing is extremely painful, crutches may be used for a few days. However, if the pain and need for crutches persists beyond 3-7 days, an orthopedic surgeon should be consulted.
“Ice” applied to the ankle for 15 minutes once per hour will also help by decreasing inflammation and swelling in the sprained ankle. This is best performed by placing a towel over the ankle then applying a plastic bag of ice or a commercial cold pack. Ice directly on the skin should be avoided and the duration of icing should be no more than 15 minutes to avoid damage to the skin. Don’t put ice directly on the skin (keep a thin piece of cloth such as a pillow case between the ice bag and the skin) and don’t ice more than 20 minutes at a time to avoid frost bite.
“Compression” can also be quite helpful in controlling swelling. A simple ACE wrap can be applied to the injured ankle by gently but snugly rolling it onto the leg starting at the toes and proceeding toward the knee. Although the ACE wrap is probably the simplest technique for compression, medical compression stockings and stirrup-type inflatable ankle braces can also be extremely effective at decreasing swelling.
“Elevate” the foot by propping it up on 1-2 pillows so that it is positioned above the waist or heart. Gravity is the enemy. Gravity makes it more difficult for swelling fluid to return to the heart. The more the foot hangs down, the more the fluid will accumulate, and the more the ankle will throb and hurt.
R.I.C.E. therapy is simple to do and will begin to decrease the pain, swelling, and bruising that occurs with sprained ankles.
Two other treatments can also be quite effective in helping the acute sprained ankle. The first is to begin taking a non-steroidal anti-inflammatory medication (NSAID) such as ibuprofen or another over-the-counter NSAID. These medications work to block the body’s inflammatory response to injury and can help to decrease pain as well as swelling.
However, these types of medications aren’t for everyone, and you should confer with your primary doctor before beginning to take one of these medications.
Another extremely helpful treatment for the sprained ankle is the ankle brace. Many individuals find that wearing a simple ankle brace such as those available at most sporting goods stores can make the ankle feel better during the first few days. An ankle brace can help the ankle feel more stable and make it easier to resume walking. It also provides protection from re-injury.