Ankle Sprain
An ankle sprain occurs when one or more of the ligaments in the joint tear or are overstretched.
Symptoms and causes
An ankle sprain is the tearing or stretching (strain) of the ligaments that hold the bones of the joint together. It usually occurs due to a twist or abnormal rotation while walking on an uneven surface.
There are three different types of ankle sprains depending on the severity of the injury:
- Grade 1 ankle sprain: this is the mildest form. There is stretching or a partial tear of the ligament fibers.
- Grade 2 ankle sprain: there is a partial tear of the ligament and, although significant, continuity is preserved. It is the most common type.
- Grade 3 ankle sprain: the ligament is completely torn, resulting in joint instability.
The prognosis for ankle sprain is generally very good, as it typically heals within a few weeks (between four and six) with appropriate treatment and rest. However, more severe cases may require a longer recovery period.
Symptoms
Symptoms of ankle sprain vary depending on the grade. The most notable include:
- Grade 1: mild swelling occurs, with pain upon compression or movement, but walking is possible.
- Grade 2: visible swelling and bruising are present. Walking is usually possible, although painful.
- Grade 3: causes intense pain, bruising, and severe swelling. Movement is clearly limited. In these more severe cases, the sprain is often associated with a bone fracture.
Causes
A sprain occurs when the ankle is forced beyond its normal range of motion. As a result, one or more ligaments are damaged. The most common causes are:
- Accidental falls causing the ankle to twist.
- Walking or running on an uneven surface.
- Landing improperly on one foot after a jump.
- Being stepped on while in motion.
Risk factors
Factors that increase the risk of ankle sprain include:
- Age: more common in adolescents, as puberty increases elasticity. Additionally, this is often when higher-intensity sports practice begins.
- Sports participation: a common injury in sports involving rapid changes in direction or jumping.
- Personal history of ankle sprain or ligament rupture.
- Inadequate footwear, such as excessively high heels.
Complications
Severe ankle sprains or those that do not heal properly may cause the following complications:
- Chronic instability with increased susceptibility to injury.
- Recurrent sprains.
- Persistent pain.
- Stiffness: fibrosis formation in tissues limits range of motion.
- Altered gait to compensate for pain or instability.
- Osteoarthritis: cartilage degeneration, pain, and functional limitation.
- Arthritis: joint inflammation and reduced mobility.
Prevention
Ankle sprain can be prevented by following these recommendations:
- Warm up before engaging in sports.
- Stretch after completing exercise.
- Avoid uneven surfaces, especially when running or exercising.
- Use appropriate footwear for the activity being performed.
- Limit the use of high-heeled shoes.
- Strengthen muscles to protect the joints.
- If the ankle is weakened due to previous injuries, use ankle braces during sports activities.
Which doctor treats an ankle sprain?
Ankle sprain is treated within the specialties of Traumatology and Orthopedic surgery, Sports medicine, Pediatrics, and Family and community medicine.
Diagnosis
The diagnosis of ankle sprain includes the following approaches:
- Medical history: collection of relevant data regarding the patient’s medical history, general health status, lifestyle, and reported symptoms.
- Physical examination: the ankle, foot, and lower leg are assessed. Specific points are palpated to detect pain and swelling. The joint is also mobilized to evaluate range of motion and associated discomfort.
- Ultrasound: ultrasound waves are used to obtain real-time images of ligaments and tendons. It is useful for assessing soft tissue response during movement.
- Magnetic resonance imaging (MRI): images of ligaments and other soft tissue structures are obtained using radio waves and a magnetic field.
- X-ray: a minimal amount of X-rays is used to obtain images of the bones and rule out fissures or fractures.
- Computed tomography (CT): X-rays are emitted from different angles to obtain a three-dimensional image of the joint bones, allowing detection of subtle injuries not visible on conventional X-rays.
Treatment
Treatment varies depending on the grade of the ankle sprain. The most effective approaches are:
- Grade 1: the PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) is usually sufficient:
- Protection: immobilize the ankle with a bandage, splint, or orthosis that preserves functionality.
- Rest: avoid weight-bearing on the injured ankle when walking.
- Ice: apply ice to the injured joint to relieve pain and reduce swelling.
- Compression: apply a bandage that exerts pressure (without being excessive) to reduce swelling and provide support.
- Elevation: keep the injured ankle elevated above heart level to reduce edema.
To relieve persistent pain, analgesics may be administered. To reduce inflammation, oral or topical anti-inflammatory drugs may be required.
- Grade 2: the PRICE protocol is combined with the use of a walking splint. For rehabilitation, physiotherapy is usually necessary to maintain range of motion, reduce inflammation, and increase the strength of the muscles surrounding the ankle.
- Grade 3: immobilization with a cast is common to prevent movement and accelerate recovery. Physiotherapy is essential to restore movement and strength, as well as to improve balance. In some cases, although controversial, surgery may be required to repair or reconstruct the damaged ligament.
