Ankle sprains are among the most common injuries treated in an orthopedic practice. Sprains represent injuries to ligaments which, along with other structures, provide stability to joints. Ankle sprains can occur in patients of all ages but are common among young and middle-aged active individuals. Ankle sprains are also very common in recreational to professional athletes.
Diagnosis of an ankle sprain is made with a careful history, physical examination and often radiographs (X-rays) to rule out fracture. Patients typically report a twisting type of injury to the ankle and note onset of pain, swelling, bruising and often difficulty bearing weight on the affected limb. Physical examination shows tenderness to palpation of the injured ligaments in addition to swelling and bruising and may show joint instability.
Approximately 90 percent of ankle sprains involve the lateral ligaments which are located on the outside of the ankle. Lateral ankle sprains are the result of an inversion injury where the ankle “rolls in.” Injuries to the medial ligaments (inside of ankle) and syndesmotic ligaments (high ankle sprains) are less common.
Treatment of acute ankle sprains involves rest, ice, compression and elevation (RICE). Immobilization is often used for a short period and may include, depending on severity of injury, a cast or removable boot, a splint or taping. Crutches may be used if weight bearing is difficult. Gradual progression of activities is allowed as symptoms abate. If patients are slow to improve, a physical therapy program can be helpful to regain motion, increase strength and decrease swelling. For patients with prolonged pain and dysfunction, additional diagnostic testing such as an MRI scan may be helpful to diagnose an injury to cartilage or bone. Most patients recover fully following an ankle sprain. Some patients with multiple or severe ankle sprains, however, experience ankle instability which sometimes requires surgery to correct. To properly diagnose and treat an ankle sprain, an evaluation by an orthopedic surgeon is necessary.