Ankle sprains are the most commonly encountered athletic injuries and the most common musculoskeletal reason for emergency room visits. Ankle sprains occur as a result of inversion or “rolling” of the ankle. Side to side motion of the foot occurs not through the ankle but through the subtalar joint. When the subtalar joint, located below the ankle joint, is pushed beyond its limits as the foot inverts (rolls over), injury can occur to the soft tissues that stabilize the ankle. The term “sprain” refers to injury to these soft tissue, usually the ligaments, of the ankle.
At the time of the injury most patients report hearing or sensing a “pop” as their ankle rolled. Immediately following the injury the ankle becomes swollen, painful. Bruising can appear along the outside of the heel and represents bleeding of the injured tissues. Commonly, it is painful to bear weight and sometimes weight bearing is not possible due to pain.
The diagnosis of an ankle sprain is usually made by the history the patient provides and a physical examination including x-rays of the ankle and foot. MRI, because they are so sensitive, are not very helpful initially and may even cause confusion regarding the severity of the injury. This study is usually reserved for cases where a tendon injury or occult fracture is suspected.
Initial treatment of ankle sprains consists of controlling swelling and pain and restricting activity. Initially, RICE – rest, ice, compression and elevation is the best means of providing comfort. While ice is helpful for the first 72 hours, elevation of the foot above the heart is the best way to control swelling and the associated discomfort. Non-steroidal medications will not will help control the swelling rather they decrease the inflammation in the tissues that contributes to pain.
In severe cases where weight bearing is not possible, the ankle is immobilized in a boot-brace to maintain a neutral position and provide protection. More commonly, a lace-up type brace that can be worn in a tennis shoe can suffice. This allows the ankle to move up and down but protects against re-injury by preventing side-to-side motion. This brace is recommended until the patients own protective reflexes are restored through physical therapy. Until such time, activity is restricted to walking on flat, level surfaces, avoiding run, cut, pivot activities and jumping.
If treated appropriately, one may expect complete resolve of pain and return to a pre-injury level of activity by 3 months after injury. If pain or dysfunction persists further evaluation is necessary.