I sprained my ankle- what should I do?

By Adrienne Tawney PT, DPT
Clinical Director
Orthopaedic Rehab Specialists- West Clinic

Ankle sprains are one of the most common orthopedic injuries that people sustain.  These can occur with an awkward step, landing wrong from a jump, or slipping on ice.  With an ankle sprain there is an injury to the ligaments of the ankle. Ligaments are the bands of tissue that stabilize a joint.  When a ligament is stretched too far, it can partially or completely tear the ligaments.

Ankle sprains can be either inversion sprains or eversion sprains.  An inversion sprain is the most common type of sprain, happening 90% of the time.  This happens when the foot falls inward. This type of sprain stretches the outer ligaments too far, and can cause a tear.  A majority of the pain will be on the outside of the ankle. Eversion sprains occur when the foot is twisted outwards. This will stress the inner ligaments and will present more pain on the inside of the ankle.

Symptoms of an ankle sprain can include swelling, bruising, and increased pain with weight-bearing.  There are different grades of ankle sprains based on the degree of symptoms associated with the injury.  They can be classified as the following:

· Grade I Sprain- Swelling and pain due to stretching to the ligaments but patient can walk without crutches.  May not be able to run/jump right away.

· Grade II Sprain- Swelling and bruising due to a partial tear of the ligaments.  Pain with walking but can take a few steps.

· Grade II Sprain- Very painful, instability/giving out, swelling, bruising as a result of complete tearing of ligaments.  Walking is very difficult and usually requires crutches.

If your symptoms are significant enough, you should seek medical attention.  Signs that you should see a medical professional include: Inability to walk on the ankle, significant swelling, delay recover/lack of improvement, numbness, and significant pain.  When going into the Doctor’s office they may perform an x-ray to rule out a fracture as the symptoms they present are very similar. The basic method to treating an ankle sprain at home is the RICE method, which consists of Rest, Ice, Compression, and Elevation.

· Rest- Discontinue activities such as recreational activities and excessive walking/squatting/standing.  Gradually increase the amount of weight put on the ankle and use crutches until a normal walking pattern is attained.

· Ice- For the first three days after the injury, apply ice at least 15 minutes every 3-4 hours.  If you do not have an ice pack at home, using a bag of frozen vegetables will do just fine.

· Compression- Wrapping the ankle with a compressive bandage such as an Ace bandage can help decrease initial swelling.  Begin at the toes and wrap all the way up to the top of the calf muscles. Overlap the bandage by one-half the width with each turn around.  It should be snug but should not cause your foot to get cold, blue, or tingly. If this is the case, it needs to be rewrapped.

· Elevate- Keep the affected ankle higher then the level of the heart as often as possible.

If physical therapy is recommended after an ankle sprain it may consist of the following exercises:

· Range of motion exercises to maintain and gain ankle motion such as writing the alphabet in the air.

· Achilles stretches done in either sitting or lying by taking a towel and looping it around the toes.  Then use the towel to pull the toes upward with a stretch felt in the back of the ankle. Do this multiple times each day holding for about a minute each time.

· Strengthening exercises that will help increase stability in the ankle joint over time to prevent re-injury such as toe raises, mini-squats, and even sport-specific exercises.

· Proprioceptive training that will work toward increasing feedback to the brain on the ankle’s position as with an injury this can be damaged.  Balance exercises such as on wobble boards will help retrain this system.

· Pain and edema may also be addressed when participating in therapy.

There is also the possibility that surgery is required due to recurrent ankle sprains and persistent ankle pain.  Surgery will work toward tightening the ligaments that are too loose to keep the joint stable. A doctor’s visit will be beneficial to determine what is the best approach toward handling a sprained ankle, whether it be home care, rehabilitation, or surgery.

Adrienne is a Physical Therapist and the Clinical Director at our West Clinic in Jackson and can be reached at adriennept@orsmi.com