An ankle sprain refers to stretching or tearing of the ligaments of the ankle. Most common ankle sprain occurs on the lateral or outside part of the ankle. It can also be associated with fracture of the ankle occasionally.
Symptoms and Clinical Presentation
Most patients present with a twisting injury of the ankle. This is mostly an inversion injury, which means the foot rolls underneath the ankle or leg which can commonly occur during sports. There is pain on the outside of their ankle along with some swelling and bruising. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot and walk.
It can be diagnosed fairly easily given that they are common injuries. The location of pain on the outside of the ankle with tenderness and swelling just below the prominent bone on the outside of the ankle called the lateral malleolus. Normal x-rays suggest that the bone has not been broken and instead the ankle ligaments have been torn or sprained. An ankle sprain is graded based on severity of injury. It may only involve stretching of a few fibres, may be partially or completely torn. A complete tear of the ligaments is uncommon.
However it is very important, not to simply regard any ankle injury as an "ankle sprain" because other injuries can occur as well, for example, the peroneal tendons (the tendons that are behind the outer ankle bone) can be torn, fractures in other bones around the ankle could be a possibility.
In some cases, an MRI may be warranted to rule out other problems in the ankle such as damage to the cartilage (a flexible connecting tissue). An MRI, however, is not necessary to diagnose a sprain.
The grade of the sprain will dictate treatment. Surgery is not required in the vast majority of ankle sprains. Primary treatment of ankle sprains includes RICE which is a combination of rest, ice, compression bandaging and limb elevation. A temporary cast may also be required in order to provide immobilization of the ankle joint. Physiotherapy to strengthen the muscles around the ankle may be necessary after the primary treatment.
Minor injuries recover quickly within a few weeks. More severe injuries and injuries in athletic individuals, may take a longer time to recover. Outcome is generally good and most patients heal from an ankle sprain and are able to get back to their normal lives, sports, and activities. Some people, however, who do not properly rehabilitate their ankle or have had a severe sprain, may go on to have ankle instability. Repeated episodes can be dangerous because they can lead to cartilage damage within the ankle and may require surgery.
Surgery is rarely indicated when in spite of appropriate conservative treatment and physical therapy, the ankle joint continues to feels unstable and frequently gives way. Here, the ligaments are either repaired or reconstructed (using tendon grafts which involves replacing damaged tendons by borrowing them from a different area in the body)