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Sprained ankle

A sprained ankle may occur when a ligament around your ankle joint becomes injured. A ligament is a fibrous tissue that connects one bone to another at a joint.

A sprained ankle is a very common musculoskeletal injury. It can happen when your foot twists or rolls beyond its normal motion. This can stretch or tear the ligament that supports your joint.

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Image showing the ankle joint

Details

  • Types Types of sprained ankle

    Sprained ankles are grouped into three grades, which are explained below.

    Grade I

    A grade I sprain is a mild sprain, and may occur when you overstretch a ligament. You may have minor swelling, bruising and pain around your ankle, but you should be able to put some weight on your foot.

    Grade II

    A grade II sprain is a moderate sprain. It may occur when you overstretch and partially tear a ligament. The swelling, bruising and pain around your ankle may be moderate. You may find it difficult to put weight on your foot.

    Grade III

    A grade III sprain is a severe sprain, and may occur when you completely tear a ligament. The swelling, bruising and pain around your ankle is usually severe. You won’t able to put any weight on your foot without feeling extreme pain.

  • Symptoms Symptoms of a sprained ankle

    Symptoms of a sprained ankle will depend on how severe your injury is. The symptoms associated with a sprained ankle include:

    • pain
    • swelling
    • bruising
    • restricted movement
    • limited ability to put weight on your foot
    • a popping or tearing sound at the time of your injury

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  • Diagnosis Diagnosis of a sprained ankle

    You may see different people about your sprained ankle. Some people often go to the emergency department of a hospital, rather than their doctor’s surgery. At the hospital, medical staff may advise you about your treatment. If you see your doctor at your doctor’s surgery, he or she may treat you or refer you to a physiotherapist.

    Your doctor or nurse will ask about your symptoms and examine you. They may also ask you about your medical history and to describe exactly how you injured your ankle.

    Your doctor or nurse may check for any pain, swelling and bruising you might have around your ankle. They may also want to see how much you can move your ankle and whether you can put any weight on your foot.

    You may need an X-ray if your doctor or nurse thinks your injury is severe, as you may need more specific treatment. An X-ray is usually carried if:

  • Treatment Treatment of a sprained ankle

    It’s important that you begin to treat your sprained ankle as soon as possible. This may help to speed up your recovery.

    You may see different people about your treatment. Some people may go to emergency department of a hospital, rather than their doctor’s surgery.

    Self-help

    In the first 48 to 72 hours after your injury, it’s important to follow the PRICE procedure. Many minor sprains will respond well to this. This procedure is described below.

    • Protect your ankle from further harm. You can use things such as an elastic support, ankle tape or a brace to protect your ankle.
    • Rest your ankle for the first two to three days, and then re-introduce movement so you don’t lose too much muscle strength.
    • Ice the injured area using an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage it.
    • Compress your ankle by bandaging it. This will help to support your sprained ankle and reduce swelling. The bandage should fit snugly but not be too tight, and you should remove it before going to sleep.
    • Elevate your sprained ankle above the level of your heart to control swelling. Keep the area supported and try to keep it elevated as much as possible until the swelling goes down.

    For the first 72 hours after your injury, there are certain things you shouldn’t do. These can be remembered using HARM, which is described below.

    • Heat. Don’t use heat packs, hot water bottles or heat rubs on your sprained ankle, and steer clear of saunas and hot baths. Heat encourages blood to flow to the area, which is the opposite effect of using ice.
    • Alcohol. Don’t drink alcohol because it can increase bleeding and swelling around your ankle, slowing down the healing process.
    • Running or any other form of strenuous exercise. Such activities are likely to cause more damage.
    • Massage. This can increase bleeding and swelling.

    Medicines

    Over-the-counter painkillers, such as paracetamol, can be used to help relieve the pain of your sprained ankle. Your doctor may prescribe you codeine in addition to paracetamol. 48 hours after your injury, your doctor may also suggest you use ibuprofen to help reduce the swelling around your sprained ankle.

    Exercise

    As you feel that your pain is tolerable, start doing some gentle exercises. These may help prevent stiffness and will get your ankle moving in all normal directions.

    Hospital treatment

    If you have a severely sprained ankle, your doctor may advise you to immobilise your ankle (keep your ankle still) for a short period of time (up to ten days). They may also advise you to wear a below-knee cast or brace. Evidence suggests that wearing a cast or brace may help to reduce the pain and swelling around your ankle quicker than a compression bandage.

    Physiotherapy

    If your sprained ankle is more severe, you may need physiotherapy. This aims to keep your ankle moving, prevents stiffness, and strengthens the muscles and joint around your ankle. All of these things mean you’re less likely to sprain your ankle again. Your physiotherapist may ask you to focus on building your strength and mobility through co-ordination exercises and balance training. You may find physiotherapy helpful; however, there isn’t enough evidence to say how effective it is for a sprained ankle.

    Surgery

    If your ankle is severely sprained, you may need surgery. However, there isn’t enough evidence to suggest that surgery is more effective than physiotherapy and exercise.

    If your ankle is still causing you pain and is not responding to treatment, your doctor may refer you to an orthopaedic surgeon (a doctor who specialises in bone surgery).

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Recovery Recovering from a sprained ankle

    The length of time it takes you to recover from a sprained ankle will depend on how severe your injury is.

    If you don’t have any complications, you will probably be able to walk within one to two weeks and achieve full movement of your ankle within six to eight weeks.

    See our FAQs for more information about recovering from a sprained ankle.

  • Causes Causes of a sprained ankle

    A sprained ankle most commonly happens when your foot twists inwards. This can make the ligaments on the outside of your ankle stretch past their normal range. This is known as an inversion sprain.

    A sprained ankle may be caused by a number of different things, such as:

    • an accident caused by walking on an uneven surface
    • a sudden change in direction while playing sport
    • landing awkwardly from a jump

    You may sprain your ankle if you have done so previously. This may be because the ligaments didn’t heal properly the first time and so they are weaker.

  • Complications Complications of a sprained ankle

    If your sprained ankle doesn’t heal properly, is left untreated or you rush back to normal activities too soon, your ankle may feel unstable. If this happens you’re at risk of spraining your ankle again.

    See our FAQs for more information about complications of a sprained ankle.

  • Prevention Prevention of a sprained ankle

    It’s impossible to totally remove the likelihood of spraining your ankle but there are a number of ways you can help prevent a sprained ankle. The most important thing you can do is to maintain the strength and flexibility of the muscles surrounding your ankle. Some other examples are listed below.

    • Wear shoes that fit and are appropriate for the activity you’re doing.
    • Stay a healthy weight for your height.
    • Eat a healthy, balanced diet – this will help to keep your muscles strong.
    • Take care when walking or running on uneven surfaces.
    • Warm up and stretch your muscles before playing sport.
    • If you’re taking part in a sport, ensure that you wear protective clothing if you need it.
    • Try to do stretching exercises every day.
    • If you’re tired, try not to play any sports or exercise.
    • Wearing high top shoes, an ankle brace or ankle tape may provide you with some support and prevent further injuries when doing certain activities.
  • FAQs FAQs

    How long will it take to fully recover from a sprained ankle?

    Answer

    The length of time it takes for you to recover from a sprained ankle will depend on how severe your sprain is.

    Explanation

    In order to speed up your recovery, it’s important that you receive an accurate diagnosis, ruling out broken bones.

    In the first 48 to 72 hours after your injury, it’s important you follow PRICE (protect, rest, ice, compression, elevate) and avoid HARM (heat, alcohol, running and massage). Your physiotherapist may be able to give you exercises to do once you can stand without pain. These exercises may help to:

    • keep your ankle moving
    • prevent stiffness
    • strengthen the muscles around your ankle

    If you have a mild sprained ankle, you may be able to walk within the first two weeks after your injury. You may be able to fully move your ankle without any pain within six to eight weeks. And you can probably go back to playing sport within eight to 12 weeks.

    If you have a moderate sprained ankle, it may take you two to three months to recover. A severely sprained ankle can take between eight to 12 months.

    Will I have problems in the future with the ankle that I've sprained?

    Answer

    Most people make a full recovery after spraining an ankle. However, if you have sprained your ankle in the past, you may sprain it again if the ligaments have not healed properly.

    Explanation

    If your sprained ankle doesn’t heal properly or is left untreated, or you rush back to normal activities too soon, you may sprain it again. This may cause complications such as:

    • chronic pain – pain that lasts a long time
    • chronic instability – when you ankle remains unstable for a long time
    • loss of balance
    • muscle weakness

    Following your injury, it’s important to begin gentle exercises when you can, as these prevent stiffness and keep your ankle moving. Exercise, together with things such as an elastic support, ankle tape or a brace may help to protect your ankle from further sprains.

    After completing your treatment, if your sprained ankle doesn’t improve, it’s important to seek advice from your doctor.

    How do I know if I have a high ankle sprain?

    Answer

    A high ankle sprain is less common than an inversion ankle sprain. You’re more likely to get a high ankle sprain if you take part in sports or exercise that requires you to change direction quickly, such as football or skiing.

    Explanation

    Your lower leg is made up of two bones: the tibia and fibula. Your tibia is an important part of your ankle joint and also supports your weight.

    If you have a high ankle sprain, the ligament, known as the syndesmosis, between your tibia and fibula, may become stretched or torn. This will have happened because you twisted your lower leg and foot outwards.

    If you have a high ankle sprain, you may feel pain at the front of your lower leg and when you move your foot outwards. This area may be tender to touch.

    High ankle sprains are harder to diagnose and have a longer recovery time than inversion sprains. Therefore, it’s important that you get an accurate diagnosis as early as possible.

    Your doctor or physiotherapist can give you advice on treatment if you have a high ankle sprain. You may need to wear a fracture boot or short leg cast.

  • Resources Resources

    Further information

    Sources

    • Sprains and strains. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2012
    • Musculoskeletal sprains and strains. BMJ Best Practice. bestpractice.bmj.com, published 13 May 2010
    • Ankle sprain. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 13 May 2010
    • Ankle sprain. Medscape. www.emedicine.medscape.com, published 15 July 2013
    • Ankle injuries. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 January 2012
    • Sprains and strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases. www.niams.nih.gov, published July 2012
    • Concise colour medical dictionary Oxford: Oxford University Press, 2002:392/671 (printed version)
    • Sprains, strains and tendon tears. The Merck Manual. www.merckmanuals.com, published October 2007
    • Acute ankle injury–presentation. Map of Medicine. www.mapofmedicine.com, published 17 January 2013
    • Sprained ankle. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published September 2012
    • Tibia (shinbone) shaft fractures. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2010
    • MacAuley D. Sport and exercise medicine. 1st ed. Oxford: Oxford University Press, 2007:254–5 (printed version)
    • Bleakley C, O’Connor S, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ 2010; 340:c1964. doi:10.1136/bmj.c1964
    • van Rijn RM, van Ochten J, Luijsterburg PA, et al. Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review. BMJ 2010; 341:c5688. doi:10.1136/bmj.c5688
    • Kerkhoffs G, H Handoll, de Bie R, et al. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database of Systematic Reviews 2007, Issue 2. doi:10.1002/14651858.CD000380.pub2
    • Ankle instability. British Orthopaedic Foot and Ankle Society. www.bofas.org.uk, accessed 20 January 2014
    • Molinari A, Stolley M, Amendola A. High ankle sprains (syndesmotic) in athletes: diagnostic challenges and a review of the literature. Iowa Orthop J 2009; 29:130–8. www.ncbi.nlm.nih.gov
    • Williams GN, Allen EJ. Rehabilitation of syndesmotic (high) ankle sprains. Sports Health 2010; 2(6):460–70. doi:10.1177/1941738110384573
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    Reviewed by Kuljeet Battoo, Bupa Health Information Team, March 2014.

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