Ankle Sprain

What is An Ankle Sprain?

An ankle sprain is an injury to one or more ligaments of the ankle. A ligament is an elastic band of tissue like a rubber band which holds the ankle joint and bones in position.

Ligaments protect the ankle joint from abnormal movements especially twisting, turning, and rolling of the foot.

Ligaments usually stretch within their limits, and then go back to their normal positions. When it is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. Most ankle sprains occur on the outer aspect of the ankle. The severity of a sprain depends on the number of ligaments involved and whether the ligament is stretched, partially or completely torn.

Grade 1 Sprain:

This is a mild sprain. Slight stretching and some damage to the fibers (fibrils) of the ligament.

Grade 2 Sprain:

Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.

Grade 3 Sprain:

Complete tear of the ligament. If the ankle is pulled or pushed during a clinical examination in certain movements, gross instability occurs.

High Ankle Sprain:

This condition occurs when the sprain injures the large ligament above the ankle that joins the two bones of the lower leg, the tibia and fibula, together. The fibula and the tibia are joined together by the syndesmotic ligament which runs from the knee down to the ankle. These high sprains can cause long term problems if not recognised and treated early.

How is this condition diagnosed?

Your consultant will examine your foot and ankle clinically and this usually makes the diagnosis clear. There will be swelling, bruising and tenderness over the affected ligaments. X-rays will be taken to ensure that a fracture has not occurred as symptoms can be similar with a fracture. An MRI scan may also be done to determine whether there has been a complete tear.

What treatment options are there?

The treatment depends on the severity of the sprain and whether it is a mild stretching of the ligaments or a complete tear. Most sprains settle with what is commonly called a RICE regime. This is outlined below.

Rest your ankle by not walking on it.

Ice should be immediately applied. It keeps the swelling down. It can be used for 20 minutes to 30 minutes, three or four times daily. Combine ice with wrapping to decrease swelling, pain and dysfunction.

Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.

Elevate your ankle above your heart level for 48 hours. Most sprains heal with a period of immobilisation in a boot which you will be fitted with. This is normally worn for 4 to 6 weeks depending on the severity of the sprain.

Is Surgery Necessary?

Surgery is rarely necessary for an ankle sprain. It is required if patients develop instability (where the ankle gives way during walking or running) or ongoing pain.

Surgical options include:

Arthroscopy
This involves looking inside the joint through key hole surgery, to see if there are any loose fragments of bone or cartilage, or part of the ligament caught in the joint.

Reconstruction
This involves repairing the torn ligament with stitches or suture, or using other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.

Mr Shariff will go through these options and their pros and cons in greater detail if they are required for your condition.