What is an Ankle Sprain?
A sprain is an injury of a ligament. A ligament connects bone to bone and helps to stabilize joints, such as the ankle or the knee. When somebody sprains their ankle, it usually is from “rolling” the foot inward causing injury and pain on the outside of the ankle. Ankle sprains can also occur on the inside of the ankle, but these are more rare.
What Does it Mean When People Talk About a “High” Ankle Sprain?
A high ankle sprain is different from what is described above. This is when an injury occurs to a joint in the ankle where the two bones of the lower leg meet. There is generally injury to a ligament, as well as a thick connective tissue, called a syndesmosis, between the two bones. This usually occurs if someone’s ankle is forced into an upward and outward position. With high ankle sprains, most people experience pain in the front and inside of their ankle and may even have a sensation of instability. These injuries are generally more severe and may benefit from early evaluation by a physician with x-rays and possibly a boot since lack of treatment of this injury can lead to ankle arthritis and instability of the ankle joint.
How Severe is An Ankle Sprain?
We generally grade ligament sprains as a grade 1, grade 2, or grade 3. A grade 1 sprain is when the ligament fibers are stretched slightly and may experience a small tear, but most ligament fibers remain intact. There is generally mild swelling and bruising associated with this. A grade 2 sprain is more severe than grade 1, but some ligament fibers are still intact. A grade 3 sprain is a complete tear of the ligament and is often associated with severe bruising, swelling, and sometimes a sensation of joint instability. There are three main ligaments on outside of the ankle and the degree of symptoms may depend on how many of these ligaments are involved. The most common ligament damaged is the anterior talofibular ligament (ATFL).
How Do I Treat an Ankle Sprain?
The majority of ankle sprains tend to be grade 1 or grade 2 and often can be treated with conservative management. A common mnemonic used for treatment is “RICE”, which stands for rest, ice, compression, and elevation. Another useful mnemonic is “PRICE”, which is everything mentioned previously, but the P stands for Prevention. This is where ankle rehab comes in. Ankle rehab is grossly underutilized and can help prevent future ankle sprains and injury, as well as hasten your recovery and return to normal physical activities. Healing times can vary, but generally we advise people that they should have significant improvement in their symptoms by 4-6 weeks after the injury. As noted above, high ankle sprains can be more serious and occasionally require surgical repair, which is why early evaluation is important.
Do I Need Surgery?
If an ankle sprain is severe enough or fails to improve with conservative care surgery is indicated. The surgery is done as an outpatient through a small incision. The ligaments that are damaged are repaired with a combination of sutures and anchors. The ligaments that may require stabilization include the ATFL, deltoid ligament, or the syndesmotic ligament in a high ankle sprain. The rehabilitation after surgery will vary depending on which ligaments have been damaged but typically requires about 6 weeks in a boot followed by a strengthening program. It may take 4-6 months to completely rehabilitate the ankle but in some instances athletes may get back to their sport using a more accelerated recovery program.
When Do I Seek Further Evaluation?
If you can’t bear weight and walk on your injured ankle immediately after the injury event, if you have significant tenderness over the bony parts (malleoli) on the inside or outside of the ankle, or if you notice swelling of the ankle joint itself, these could all be signs of a broken bone. In these cases, it may be important to be evaluated sooner than later so you can be treated appropriately. If you have any questions about your injury or feel like you are taking longer than usual to recover, it may be helpful to be evaluated by a physician and possibly set up rehab with a physical therapist.
To set up an appointment for further evaluation, please call (208) 336-8250.