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Introduction

Sprained ankles – sometimes referred to as twisted ankles – are a very common injury and it’s likely that most people, particularly those who play sport, have experienced an ankle sprain at some point in their lives.

The ankle joint acts like a hinge between the lower leg and the foot, allowing the foot to bend upwards and downwards, as well as allowing a small amount of rotation. The ankle’s stability comes from both how the bones are arranged as well as from the surrounding ligaments1 – the fibrous bands that support and hold joints together. A sprained ankle happens when the ligaments of the ankle are over-stretched and torn.2

The image below shows the different ligaments of both the inside (medial view) and the outside (lateral view) of the ankle.

Source: Anatomy & Physiology, Connexions Web site

There are three grades of ankle sprain, which are categorised depending on how severely the ligament fibres have been torn:3

  • Grade I: only a few ligament fibres have been torn
  • Grade II: a considerable proportion of the ligament fibres have been torn
  • Grade III: complete tear of the ligament fibres

Causes & Risk factors

Ankle sprains result from movements that force the ankle beyond its normal range of motion. Common causes of a sprained ankle include:4

  • A fall which causes your ankle to roll or twist
  • Walking or running on an uneven surface
  • Landing on your foot awkwardly after a jump or turn
  • Some-one else landing or stepping on your foot during sport

There are certain factors that can increase your risk of spraining your ankle. These include:4

  • Playing sports: Sprained ankles are a common sports injury, especially in sports that involve jumping, pivoting or twisting movements
  • Uneven surfaces: Walking, running or playing on uneven surfaces, such as sports fields kept in poor condition, can increase your risk
  • Improper shoes: Shoes that aren’t appropriate for the activity you are doing, shoes that don’t fit properly, and high-heels in general, increase your risk of ankle sprains
  • Previous ankle injury: If you’ve previously sprained your ankle (or had another ankle injury) you are more likely to sprain it again
  • Poor physical condition: Poor ankle strength or flexibility can increase your risk

Signs & Symptoms

The signs and symptoms of a sprained ankle depend on severity of the injury (see Introduction to read about the different grades of ankle sprains). The typical signs and symptoms of an ankle sprain include:4

 Pain, particularly weight-bearing pain (unable to put weight on the affected foot)

  • Tenderness when the ankle is touched
  • Swelling
  • Bruising
  • Restriction of ankle movements
  • Ankle instability
  • A popping or cracking feeling or sound at the time of the injury

Remember that if you have any concerns about any signs or symptoms that you are experiencing, it is highly recommended that you visit your health professional (see When to see a doctor or physiotherapist below).

How to treat a sprained ankle

Treating ankle sprains quickly: RICE

Treating your ankle sprain quickly can make a big difference by helping to reduce the pain, swelling and bruising. RICE – Rest, Ice, Compression and Elevation – is recommended as soon as possible in the first 2-3 days:2

  •  Rest: It is important to avoid all activities that cause pain. If you are unable to put weight on your foot, crutches are recommended. Try to limit the amount of walking you do and if you do walk, try to walk as normally as possible
  • Ice: Wrap some ice cubes, an ice pack or some frozen peas in a damp towel. Apply to the injured ankle for 15-20 minutes every hour or two. Never place ice directly on the skin
  • Compression: Apply a bandage firmly on the affected ankle – from the toes to above the ankle. Make sure you do not apply the bandage too tightly as this can restrict blood flow to your toes. Remove the bandage when you sleep at night
  • Elevation: When resting, raise the affected foot so it is above the level of the heart

In the early stages of recovery, it is important that you avoid HARM (Heat, Alcohol, Re-injury and Massage). Heat, alcohol and massage can all increase blood flow and subsequent swelling. Alcohol can also make you less aware of whether you might be aggravating your injury, and massage can further damage your ankle if performed too early.2

When to see a doctor or physiotherapist

Generally, most people will recover from a sprained ankle in one to six weeks.  If you feel your ankle isn’t getting any better after a week, it is recommended that you visit your doctor or physiotherapist.2

 If any of your symptoms are severe (eg. severe pain), you should see your local doctor – this could suggest that you have significantly damaged a ligament or even broken a bone in your ankle or lower leg.4

The role of physiotherapy

A physiotherapist can provide help and support with healing and rehabilitation, particularly for more severe sprained ankles. A few days after the initial injury, the recovery process can generally be facilitated with stretching and strengthening activities (your physiotherapist can tailor these to your specific needs). Some of these activities could include:2

  • Full range of movement exercises: Move your ankle up and down, down and in, up and out, and in circles

Image Credit

  • Wall stretches: Place your injured ankle behind you while you lean on a wall, facing the wall, keep your heel on the floor and tuck your bottom in. Try first with your knee straight and then with knee bent, holding for 10 seconds
  • Strengthening exercises: Stand on the edge of a step with your heel over the edge, lower your heel and hold for 5 seconds. Then try standing up on your toes, holding for 5 seconds

Do I need an X-ray?

 In most cases of a simple ankle sprain, an X-ray won’t be necessary. This is because X-rays aren’t very good at finding damaged ligaments (and even if it did, it wouldn’t really change your treatment plan).3

Generally, your doctor will only organise an X-ray for you if they suspect the possibility of a bone fracture. In fact, there are a specific set of rules – called the Ottawa Ankle Rules – that are used by health professionals to determine whether or not patients should have an X-ray following an ankle injury.3

Complications

Most people will recover without any complications following an ankle sprain.2 However, improperly managing a sprained ankle (such as participating in activities too soon after the injury, or misjudging the severity of the injury) might lead to the following complications:4

  • Chronic pain in the ankle
  • Ongoing ankle joint instability
  • Arthritis

Your health professional is in the best position to help address any concerns that you might have about ankle sprain complications.

Prevention tips

The following tips can help to reduce the risk of spraining, or re-spraining, your ankle:1

  • Always warm up before exercise or playing sport to ensure surrounding muscles are ready to support the ankle
  • Always wear appropriate footwear
  • Regularly undertake stretching, strengthening, flexibility and balance exercises
  • Always allow for adequate recovery time between exercise sessions
  • Check the training and playing area to make sure the surface is flat and even
  • Make sure you only participate in activities or sports that you are conditioned for
  • For previously injured ankles, wear an ankle brace or tape your ankle
  • ALWAYS avoid activities that cause pain
  • Drink water before, during and after excercise

 

A: Use HealthEngine to find and book your next Physiotherapist appointment. Click on the following locations to find a Physiotherapy clinic in your state or territory.

This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.

References

  1. Sports Medicine Australia (online). Ankle Injury [accessed 19 Feb 2019]. Available from: URL link
  2. Queensland Government (online). Emergency Department fact sheets: Ankle sprain [accessed 18 Feb 2019]. Available from: URL link
  3. NPS MedicineWise (online). Ankle sprains: 10 things you should know (accessed 18 Feb 2019]. Available from: URL link
  4. Mayo Clinic (online). Sprained ankle [accessed 18 Feb 2019]. Available from: URL link