How to Identify and Treat a Sprained Ankle

Sprained ankles are the most common sports-related injury, with about 25,000 occurring daily. They account for 45% of all basketball injuries, 31% of soccer injuries and also frequently occur in football players, gymnasts, and runners.

So what exactly is an ankle sprain, what do you do for it, and when should you be concerned?

It’s easier to understand ankle sprains if you are familiar with the basic anatomy: the three main bones that comprise the joint are the talus (in the foot), tibia and fibula (in the leg). Basically, it is a hinge joint that connects the leg and foot. The primary ligaments of the ankle include the lateral ligament, deltoid ligament, and the syndesmosis.

The lateral ligament is the most commonly injured in an ankle sprain so we will go into a few more details about it.  It is comprised of three components: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These structures help maintain the stability of the ankle.

An ankle sprain usually occurs secondary to an inversion injury. An example is a basketball player jumping up for a rebound and, upon landing, steps on an opponent’s foot and “rolls the ankle”. Often, a “pop” is either heard or felt. Initially there can be swelling and bruising (which can be impressive). With severe sprains, there can be difficulty with weight bearing on the affected side.

When you come into the office after a sprain, we look for significant lateral ankle swelling along with bruising that can extend all the way down the foot and into the toes. There is usually tenderness over the lateral ligament, and with severe sprains over the deltoid ligament and syndesmosis as well. We commonly obtain radiographs (x-rays) of the ankle at the first clinic visit to assess whether or not any associated ankle injury was sustained. For acute ankle sprains, further imaging (such as MRI) is not necessary, as it does not alter the treatment plan.

In case of more severe sprains, treatment involves short term immobilization in a walking boot for comfort and to more rapidly promote healing. However, in simple sprains a boot is not needed and an ankle brace alone provides sufficient protection and stability. Physical therapy is initiated once the patient’s acute pain and swelling subside. The physical therapist works on stretching, proprioception, and strengthening at each session. As the patient progresses, the physical therapist will begin to work on more sports specific training; when this can be done without pain, the athlete is ready to return to play. This can take anywhere from 2-8 weeks depending on the severity of the sprain. We recommend continuing to use a brace during athletic training and competition to avoid re-injury.

Fortunately, most ankle sprains fully heal when proper treatment is initiated; however, there are circumstances in which an ankle sprain doesn’t progress as anticipated. In such cases, further imaging and surgical intervention may be warranted.

If you ever suffer an ankle sprain, or if you have had frequent sprains in the past and continue to struggle with pain or weakness, please call our office today (615.342.0200) to schedule an appointment.

–Lauren Erickson, PA-C

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