Ankle sprain: your questions answered

How common are ankle sprains?

Ankle sprains are hugely common and most people do not go to the hospital or to see their GP if they suffer from ankle sprain. For the vast majority of cases, they recover spontanueously, without any medical intervention.

How do ankle sprains normally happen?

Generally, ankle sprains often happen relatively low energy, following a low energy accident or injury e.g. you missed your step or you came down the stairs awkwardely. Perhaps you were running and caught your foot – as your foot was hitting the ground you twisted your ankle and that’s the key- it’s a rotational or twisitng type energy. In the vast majority of the cases it’d be an inversion of the foot, underneath the leg. As you invert that foot, you damage the ligaments on the outside of the ankle Often people hear a snap or something tearing and almost immediately it’s difficult to bear weight.

What should I do to care for a sprained or fracture ankle? As with all soft tissue injuies, the first thing to do is rest the foot, to elevate it and try to reduce the swelling. A familar acronyum used in the physiotherapy community to describe care for sprained ankle is RICE Rest Icing Compression Elevation Those four steps are very helpful in the first 48 hours to help reduce some of the inflammation. By reducing the inflammation, icing it, not overloading the joint, your pain should hopefully have significant improvement over the first 24 or 48 hours. If after 48 hours it’s still significantly swollen, significantly painful and you’re having difficulty bearing weight, you have to think to yourself perhaps this is a fracture, more than a sprain and perhaps you should seek some medical advice.

How does a twisted ankle look?

There’s often a lot of bruisng, perhaps some bleeding under the skin. People often describe seeing an egg or a large swelling which appears outside of their ankle. These symptoms normally develop pretty quickly, within an hour or so.

What is the difference between an ankle fracture and a sprain?

The important thing to differentiate between an ankle fracture and sprain is the ability to bear weight. If after the initial shock and trauma is subsided and after an hour or two you’re unable to bear weight on your ankle, that’s a risk factor or sign that there might be something more serious going on, such as a fracture or broken bone and if that’s the case, you should get an x-ray. If you’ve got an inversion injury, swelling on the outside of your ankle and you’re still able to bear weight (even if it’s a little painful) chances are this is a simple sprain.

What should I do to care for a sprained or fracture ankle?

As with all soft tissue injuies, the first thing to do is rest the foot, to elevate it and try to reduce the swelling.

A familar acronyum used in the physiotherapy community to describe care for sprained ankle is RICE: Rest, Icing, Compression and Elevation.

Those four steps are very helpful in the first 48 hours to help reduce some of the inflammation. By reducing the inflammation, icing it, not overloading the joint, your pain should hopefully have significant improvement over the first 24 or 48 hours. If after 48 hours it’s still significantly swollen, significantly painful and you’re having difficulty bearing weight, you have to think to yourself perhaps this is a fracture, more than a sprain and perhaps you should seek some medical advice.

What is the recovery time from an ankle sprain?

The overall recovery time from an ankle sprain can be quite long. People often think that a sprain is a minor injury and of course there is a whole spectrum of severity, of disease and the whole spectrum of a sprain is where the ligaments are slightly streched but there’s no significant tearing. In most cases that’ll settle down within 24, maybe 48 hours. If there’s been more significant damage to the ligaments, then sometimes it can take several weeks to fully improve.

How long should I wait before I go back to sport?

Everyone is different but for the more severe injury, it can take 6-8 weeks to return to high levels of activity. It also depends on the sport.

Cycling is a great exercise for an injured ankle because the ankle isn’t going to twist or invert; youv’ve got your foot planted on the pedal.

Another good exercise is using the cross trainer in the gym because you won’t twist your ankle on the cross trainer. Moving up, you can go to brisk walking on the treadmill, or even some jogging on the treadmill.

The higher level of activity is where you’re running, perhaps on some uneven ground or activities where you suddenly have to change direction, such as football. These exercises put a lot more stress on the ankle ligament, which makes recovery time significantly longer.

How do you recover from an ankle sprain?

In the first instance, rest, ice, compression and elevation. You must make sure that you haven’t got a fracture. You should take it easy for the first 48 hours and you can take anti-inflammatories because they’re particularly helpful.

Following this, you can see how things go and then make a gradual return to activity, as your symptoms allow.

Should you avoid movement when you sprain your ankle?

In the first instance, when the ankle is desperately pain, when the ligaments and soft tissues are all inflammed, then it’s useful to just rest the ankle. You don’t need to be strict about not moving it but you shouldn’t overdo things. You should think about RICE; rest, ice, compression and elevation.

For the first 24 to 48 hours, it’s useful to take weight off the ankle. You should offload it, keep it elevated and don’t do too much while the intial inflammation and swelling settles. You don’t have to be super strict about not moving it. In fact, gently moving it or putting it through a surf, a simple range of movement and doing things such as moving your toes up and down, getting your ankle gently moving, inverting, everting it, without any load on it, is actually very helpful. These exercises pump fluid out of the soft tissues, which gets the swelling to come down.

After 48 hours, you need to think about getting the ankle back into action. Putting some gentle movement into a load through it in a controlled fashion, doing things such as walking on flat ground rather than uneven ground, that’s a really helpful thing to try and get the muscles and ligaments working again.

If you immobilise an ankle for too long, such as putting it in a plaster or booth for too long, the ankle can get quite stiff. This will make future rehabilitation much harder.

Afer 48 hours you should try to improve that range of movement with gentle weight bearing and trying to get the ankle functioning.

Should I buy a brace or strap my ankle up?

These are very expensive and most of the time they are not necessary.

A brace can be useful in the later stages of rehabilitation. One of the big issues is that as you’re recovering from ankle sprain, the muscles which control the inversion and e-version of your ankle aren’t working properly, so you need to try and get them back into action. This is when physiotherapy comes in.

If you’re still struggling after three or four weeks, seeing a physiotherapist is a really helpful thing to do. In this stage an ankle brace can be quite helpful for a short period; it’ll stop you from twisting the ankle again, particularly when you’re doing activities, such as walking on uneven ground or you’re in a situation where you think you’re at risk of twisting it again, but it shouldn’t be a long term solution.

The majority of people would be able to be out of the brace in four weeks.

What are the different treatment options for ankle sprains?

The majority of people who have ankle pain will recover without any intervention. 95% of people will not need to attend a clinic- they’ll get better without any issues at all. They can recover without doing anything special- without doing physiotherapy, rehabilitation or ankle braces. They will be sore for a week or two but their ligamemts will heal.

Around 1 in 20 people will have ongoing ¡ssues and that will manifest in a few different ways. Sometimes pain is an issue, persistent instability (an ankle that keeps giving way) or stiffness which just won’t go back to a normal physiological state.

What if I’m still suffering for 6-8 weeks?

If you find yourself suffering for 6-8 weeks after the intial injury, going to physiotherapy is important. The physiotherapist will be able to assess the function of your ankle and what they need to work on with you, to get the muscles working in an appropriate way – this is known as proprioception. It is a cobcious awareness of what your ankle and muscles are supposed to be doing. For most cases, proprioception effective.

For a small number of cases, following this, patients will feel persistent pain and instability. Sometimes in those cases, surgery is an option.

In the first instance, the doctor images the ankle, normally with an MRI scan, often combined with a regular X-ray to make sure they’ve not missed an old fracture and to see the severity of the lateral ligament injury.

If you’re still struggling after weeks of conservative managment and physiotheraoy, either with persitent pain or persistent instability, sometimes there is a role for an ankle arthroscopy,, which is key hole surgery to look into the ankle and take away any scar tissue or inflammation and address any other pahology found there, such as damage to the cartilage or a lateral ligament reconstruction which whereby the ligsments at the outside of the ankle are tightened up amd reattached right onto the bone, to restore stability to the ankle. 

In some cases, the doctor ends up doing both an ankle arthroscopy and a ligament recostruction.