Ankle sprain: Causes, signs, and effective treatment options
Written in association with:Ankle sprains, while common, can vary significantly in severity and require appropriate treatment to ensure full recovery. Mr Andrew Goldberg OBE, renowned consultant orthopaedic foot and ankle surgeon from London, provides an expert insight into an ankle sprain, including causes, signs and treatment options.
What is an ankle sprain?
An ankle sprain is a common injury that occurs when the ligaments (tough bands of tissue that connect bones to each other) are torn or stretched beyond their normal limits. This typically happens when the ankle is suddenly twisted, turned, or rolled in an awkward way, causing the ankle joint to move out of its normal position.
Ankle sprains are mostly caused during physical activities that involve quick changes in direction, jumping, or running. However, these injuries can also occur during everyday activities, such as when walking on an uneven surface or missing a step on a staircase.
What are the signs and symptoms of an ankle sprain?
The symptoms of an ankle sprain can vary depending on the severity of the injury, but generally include the following:
- pain, which typically occurs at the site of the sprain
- swelling, bruising, or discolouration of the skin around the ankle
- tenderness, particularly over the injured ligament
- difficulty walking or placing weight on the affected foot
How do you know if it is a bad sprain?
Bruising and swelling typically happen overnight and if you see bruising this usually means the ligament has been torn, which is often described a type 3 sprain.
If you cannot put weight on the ankle or it feels unreliable or unstable, then this also raises concerns of a broken bone or a severe sprain and you should seek medical attention.
How is an ankle sprain treated?
Treatment focuses on reducing pain and swelling, promoting ligament healing, and restoring function to the ankle.
The PRICE Protocol
The initial treatment for an ankle sprain usually involves the PRICE protocol:
- Protect the ankle – get an ankle support brace, such as an Aircast A60, Thuasne BOA Malleoloc, or even a Short Walker Boot (eg Aircast Select) to support the ankle, reduce pain, and give the ligaments the best chance of healing.
- Rest: Avoiding placing weight on the injured ankle.
- Ice: Applying ice to the injured area right away and doing this for 15-20 minutes every 2-3 hours during the first 48 hours after the injury. Do not put the ice directly onto the skin or you could cause a skin burn – I recommend you place the ice into a pillow case cover.
- Compression: I recommend you apply a compression sock or Tubigrip to help reduce the swelling and provide some further support to the area.
- Elevation: Keeping the injured ankle at or above heart level whenever possible.
Medications
Additionally, over-the-counter pain relievers such as ibuprofen can help manage pain and reduce inflammation, but they are not as important as icing in the immediate period after the injury.
How long does it take to recover from an ankle sprain?
With a mild sprain (grade 1), recovery typically takes 1 to 2 weeks. During this time, you may gradually return to normal activities as pain and swelling subside.
With a moderate sprain (grade 2 or partial tear), recovery may take anywhere between 3 to 4 weeks. You may need to wear a brace or use crutches during the early stages of healing. After this point physiotherapy is often recommended, to restore strength, flexibility, range of motion, and balance in the ankle.
With a severe sprain (grade 3 or complete ligament tear), recovery can take several months. You may need to wear a cast or boot for up to 6 weeks, followed by a period of physiotherapy. In cases where the ankle remains unstable after initial treatment, then surgery may be required, but this is less than 10% of cases.
During recovery, it’s important to follow your surgeon’s recommendations and avoid activities that could re-injure the ankle. Gradual return to sports should only occur when the ankle has fully healed and regained strength.
When is surgery required to treat an ankle sprain?
If you follow the above advice, then surgery can be avoided in most cases. The indications for surgery are:
- The ankle continues to feel unstable or gives way after several months of conservative treatment.
- The sprain is accompanied by other injuries that need treating such as fractures, dislocations, or torn tendons.
What surgery is used to treat ankle sprains?
Surgery is only considered after non-surgical treatments have failed. Common procedures include:
- Ligament repair or reconstruction: The torn ligaments are sutured back together or reattached to the bone using special tissue anchors to restore its original position and function.
- Arthroscopy: This minimally invasive procedure allows your surgeon to view and repair the inside of the ankle joint using a small camera and instruments. This option may be used to remove damaged tissue or to address other issues in the joint.
This article was written by Mr Andrew Goldberg OBE
Consultant Orthopaedic Foot & Ankle Surgeon & Director of the London Ankle & Arthritis Centre
If you would like to schedule an appointment with Mr Goldberg, head on over to his Top Doctors profile today.
