What Is A Sprained Ankle?

Ankle sprains are a common orthopaedic injury that can affect people of all ages and activity levels. Whether you're an athlete, a weekend warrior, or simply going about your daily routine, a misstep or an awkward landing can lead to the sudden onset of pain, swelling, and discomfort in your ankle. 

In this comprehensive guide, we will delve deep into the world of ankle sprains, providing you with the knowledge to understand their causes, recognize their symptoms, explore effective treatment options, and learn how to prevent them.

Anatomy of the ankle

Before we dive into the specifics of ankle sprains, it's important to understand the anatomy of the ankle. The ankle joint is a complex structure composed of three bones: the tibia (shinbone), the fibula (the smaller bone in the lower leg), and the talus (a bone that connects to the foot). Ligaments, tendons, and muscles surround these bones, working together to provide stability and facilitate movement.

Some of the key components of the ankle include:

The ankle ligaments: sturdy guardians of stability

The human ankle is a complex joint made up of several bones, and its stability is heavily reliant on a network of ligaments. These ligaments function like durable bands of tissue that connect bone to bone, providing support and preventing excessive movement. The ankle ligaments that come into play when we talk about ankle sprains are:

Anterior talofibular ligament (ATFL)

The ATFL is one of the most frequently injured ligaments in ankle sprains. It connects the fibula (one of the two lower leg bones) to the talus (a bone in the foot). This ligament is particularly vulnerable when the ankle rolls inward (inversion) due to its location on the outside of the ankle. A sprain in the ATFL is often associated with mild to moderate ankle sprains.

Calcaneofibular ligament (CFL)

The CFL is another ligament located on the outer side of the ankle. It connects the fibula to the calcaneus (heel bone). Similar to the ATFL, the CFL can be damaged during an inversion injury. A sprain of the CFL can range from mild to severe, depending on the extent of the damage.

Posterior talofibular ligament (PTFL)

The PTFL is situated at the back of the ankle, connecting the fibula to the talus. While less commonly injured than the ATFL and CFL, damage to the PTFL can still occur, often in conjunction with sprains to other ligaments.

Deltoid ligament

Unlike the previous ligaments that are on the outside of the ankle, the deltoid ligament is located on the inside. It is a complex structure made up of several ligaments that connect the tibia (the other lower leg bone) to various bones in the foot. Inversion injuries can also affect the deltoid ligament, leading to medial ankle sprains.

Syndesmotic ligament (Anterior and posterior tibiofibular ligaments)

These ligaments run between the tibia and fibula, providing stability to the ankle joint, particularly at the front and back. A sprain of these ligaments is commonly referred to as a high ankle sprain, which is often more severe and requires specialized care.

What Is an ankle sprain?

An ankle sprain is a soft tissue injury that occurs when the ligaments connecting the bones in the ankle are stretched, torn, or partially ruptured. Sprains are typically classified into three grades based on the severity of the injury:

Grade I: Mild sprain with minimal ligament stretching or microscopic tearing. This results in mild tenderness, swelling, and little to no loss of function.

Grade II: Moderate sprain with partial ligament tearing. This leads to moderate pain, swelling, and difficulty walking or bearing weight on the affected ankle.

Grade III: Severe sprain with complete ligament rupture. This results in significant pain, swelling, and the inability to bear weight on the injured ankle.

Types of ankle sprains

There are two main types of ankle sprains: Inversion and Eversion sprains.

• Inversion Sprain: This is the most common type of ankle sprain, occurring when the ankle rolls inward. It typically affects the lateral (outer) ligaments of the ankle.
• Eversion Sprain: Eversion sprains are less common and happen when the ankle rolls outward. This type of sprain typically affects the medial (inner) ligaments of the ankle.

Causes of ankle sprains

Ankle sprains can happen to anyone at any time. Some common causes of ankle sprains include:

1. Sports and Physical Activity: Athletes involved in sports like basketball, soccer, and running are at a higher risk of ankle sprains due to sudden movements, cutting, jumping, or landing awkwardly.
2. Uneven Surfaces: Walking or running on uneven terrain, such as hiking on a rocky trail, can increase the risk of missteps and ankle injuries.
3. Footwear: Inappropriate or ill-fitting footwear can compromise ankle stability and increase the likelihood of sprains.
4. Weak Muscles and Ligaments: Poor muscle strength and inadequate flexibility in the ankle region can make it more susceptible to sprains.
5. Previous Ankle Injuries: An ankle that has been previously sprained may be more prone to re-injury.

Recognizing the symptoms of ankle sprains

Ankle sprains can be painful and debilitating. It's crucial to recognize the symptoms of an ankle sprain to determine the appropriate course of action. Common symptoms include:

1. Pain: A sudden, sharp pain at the time of injury, followed by persistent pain in the affected area.
2. Swelling: Swelling around the ankle, often within hours of the injury.
3. Bruising: Discoloration or bruising may develop, indicating blood vessel damage.
4. Instability: The feeling of wobbliness or instability in the ankle, as if it may "give way."
5. Tenderness: Touching the injured area can be painful.
6. Limited Range of Motion: Difficulty moving the ankle, particularly during activities like walking or running.
7. Popping or Snapping Sound: In some cases, there may be an audible sound at the time of injury.

Diagnosis

If you suspect that you've sprained your ankle, it's important to seek immediate medical evaluation for an accurate diagnosis. 

A healthcare professional will typically perform a physical examination and may recommend imaging tests, such as X-rays or MRIs, to rule out fractures or assess the extent of ligament damage.

Treatment options

The treatment for an ankle sprain depends on its severity.

Research shows that acute ankle sprain responds well to gentle movement as well as RICE - rest, ice, compression, and elevation.

1. Rest: Give your ankle time to heal by avoiding strenuous activities and providing it with adequate rest. Using crutches to keep weight off the injured ankle may be necessary, especially for severe sprains.
2. Ice: Applying ice to the injured area can help reduce swelling and alleviate pain. Ice should be used in 15-20 minute intervals, with a cloth or towel between the ice pack and your skin to prevent frostbite.
3. Compression: Wrapping the ankle with an elastic bandage can help control swelling and provide some support.
4. Elevation: Elevating the injured ankle above heart level when resting can reduce swelling by promoting better blood flow back to the heart.

Physiotherapy is important for moderate to severe sprains. A physiotherapist may be recommended to help improve strength, flexibility, and range of motion in the ankle.

Other treatment options are

1. Medications: Over-the-counter pain relievers like ibuprofen or paracetamol can help manage pain and inflammation. Your healthcare provider may prescribe stronger medications in severe cases.
2. Bracing and Splinting: In some cases, you may be given a brace or splint to stabilize the ankle during the healing process.
3. Surgery: Surgery is rarely needed for ankle sprains but may be considered for severe injuries with significant ligament damage that doesn't respond to non-surgical treatments.

Rehabilitation

Rehabilitation plays a crucial role in the recovery process after an ankle sprain. It helps to restore strength, stability, and range of motion. 

A physiotherapist can create a personalized rehabilitation program to guide you through the following phases:

1. Early Motion: Gentle range of motion exercises to prevent stiffness.
2. Strength and Stability: Targeted exercises to strengthen the muscles that support the ankle and improve stability.
3. Functional Activities: Gradual reintroduction to activities like walking, jogging, and sports.

Preventing ankle sprains

Prevention is always better than treatment when it comes to ankle sprains. Here are some strategies to reduce the risk of spraining your ankle:

1. Wear Proper Footwear: Choose shoes that provide adequate support and stability, especially if you engage in sports or activities that involve frequent lateral movement. High heels should be worn sparingly.
2. Warm-Up and Stretch: Before engaging in physical activities, take the time to warm up and stretch your muscles. This can help improve flexibility and reduce the risk of injury.
3. Balance and Proprioception Exercises: Improving your balance and proprioception (awareness of your body's position in space) can enhance ankle stability. Simple exercises like standing on one leg or using balance boards can be beneficial.
4. Strengthen Ankle Muscles: Engage in exercises that target the muscles around your ankle, including the calf muscles and the muscles that support the lateral ligaments.
5. Be Cautious on Uneven Surfaces: When walking or running on uneven surfaces, pay close attention to your footing and choose appropriate footwear.

Conclusion

Ankle sprains are not just injuries; they are unwelcome disruptions to our daily lives. However, understanding what an ankle sprain is, how it happens, and how to deal with it can be empowering. By taking the right steps to prevent sprains and seeking prompt medical care and rehabilitation when needed, you can get back on your feet faster and stronger.

Whether you're an athlete chasing your goals, a parent taking care of your family, or simply someone who enjoys being on the move, your ankle health matters. 

If you're currently dealing with an ankle sprain, remember that you're not alone, and there are countless success stories of individuals who have fully recovered. Patience, determination, and proper care are your best allies in this journey towards healing. You can do this!

As always, please consult with a healthcare professional for any specific concerns or questions about your health. Your well-being is worth every effort and attention.