Ankle Sprains and Ligament Injuries
Ankle sprains are among the most common sports injuries. Without proper treatment they can lead to repeated sprains and chronic instability.
An ankle sprain is a stretch or tear of the ligaments on the outer side of the ankle, usually when the foot rolls inwards. It is common during sport, when stepping on uneven ground or coming down stairs. Although sprains often seem minor, without proper treatment they can cause lasting problems.
Grades of sprain
- Grade 1: The ligament is stretched with small tears. Mild swelling and pain; walking is possible.
- Grade 2: A partial tear of the ligament. Marked swelling, bruising and difficulty bearing weight.
- Grade 3: The ligament is completely torn. Severe swelling, bruising and instability of the ankle.
First aid
In the first 48-72 hours, rest, ice, compression with an elastic bandage and keeping the foot above heart level reduce swelling and pain. If you cannot bear weight, or there is a clear deformity or tenderness over the bone, a fracture must be ruled out.
Diagnosis
Examination shows which ligaments are injured and how stable the ankle is. X-rays are taken if a fracture is suspected. MRI is used when symptoms last long, sprains keep recurring or cartilage damage is suspected. Some injuries involve the syndesmosis ligaments between the two leg bones; these take longer to heal.
Treatment
Non-surgical treatment
Most sprains heal without surgery. Short-term protection (a brace), early controlled weight bearing, and then movement, strength and especially balance exercises are the basis of treatment. Balance work is very important in reducing the risk of another sprain.
Chronic instability and surgery
If the ankle keeps rolling or giving way despite proper rehabilitation, this is called chronic instability. The loose ligaments are tightened and reattached to the bone surgically (a Broström-type repair). If the ligament tissue is poor, reconstruction with a graft can be done. Problems inside the joint are treated arthroscopically in the same session.
Recovery
Mild sprains heal within a few weeks. After severe injuries and surgery, returning to sport can take a few months. A brace or taping may be recommended for a while on return to sport.
Preventing sprains
Wobble board and single-leg balance exercises shorten the reaction time of the muscles around the ankle and reduce the risk of sprains. Warming up well before sport, wearing shoes suited to the surface and using a brace or taping for a while when returning after a sprain are also recommended.
Frequently asked questions
Do I need an X-ray for a sprain?
An X-ray is needed if you cannot bear weight, or there is marked bone tenderness or deformity. It is not always needed for mild sprains.
Should I apply heat to a sprained ankle?
Heat in the first days can increase swelling. Ice is preferred in the first 48-72 hours.
My ankle keeps rolling. What should I do?
Repeated sprains can lead to chronic instability and joint damage. An examination is recommended for balance-focused rehabilitation and, if needed, a surgical assessment.
How long should I wear an ankle brace after a sprain?
From a few days to a few weeks for mild sprains. Longer use may be advised for severe injuries and on return to sport.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.