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Have you sprained your ankle?

by Ray Moore MCSP

There are many ways to sprain your ankle. Injuries occur in both sporting and non sporting environments. In this article Ray Moore, specialist physiotherapist at physio2go at York Lodge St. Albans discusses common causes of this injury and effective treatment strategies. In his clinic, Ray sees injuries caused in a variety of sporting arenas, including football, hockey, tennis and rugby. However, people undertaking what are considered less dangerous activities such as walking, dancing and even getting out of bed are also susceptible to an ankle injury.

What is an ankle sprain?

An ankle sprain normally occurs following a sudden sideways or twisting movement of the foot. Most medical sources agree a sprain is defined as, “to wrench or twist a ligament or muscle of a joint without dislocating the bones”.

What happens?

The most common type of ankle sprain occurs when the ligaments of the outside of the ankle are over stretched (inversion injury). Less common is an injury to the inside of the ankle (eversion injury). Ligaments, under normal circumstances, are strong structures which hold bones together and form joints. Ankle sprains generally will not only cause damage to the ligaments but can damage other soft tissue such as tendons and muscles. These can get over-stretched or actually torn during injury.

How bad is it?

Ligament sprains are graded by degree of severity:

• Grade I – Described as a stretching / minor tear of the ligament. Normally this causes some degree of pain and swelling. Normal daily activity will not be affected but the patient will not be able to jog or jump without pain.
• Grade II – Described as a severe tearing of the ligament. In most cases there will be increased swelling compared to a grade 1. There is likely to be bruising, which can extend up the lower leg and and or down into the foot. Patients will normally find walking painful but can take a few steps. They may have to use crutches or sticks to aid mobility.
• Grade III – Described a complete tear of the ligament. There will normally mean quite severe pain. Walking is usually difficult, commonly the ankle can give way or feel unstable.

What if I get injured?

Having injured your ankle, what should you do? Do you need to see the GP? Do you need an x-ray? Generally, you must decide on the severity of your symptoms to determine the best course of action. Symptoms that may need a medical opinion include:

• Inability to put weight on the foot
• Significant pain above the ankle or in the foot
• If the ankle does not improve after a few days
• Significant swelling (unable to get shoe on due to swelling that does not go down over night).
• Numbness or pins and needles in the foot or toes

Treatment / Management

The initial treatment of an acute ankle injury follows the P.R.I.C.E. guidelines. This involves 5 steps to minimize the effects of injury. The following protocol should be used as soon as injury occurs:

• Protection. Protect against further damage - take weight off the injury - use crutches or splints if necessary.
• Rest. Injuries need time to heal. The initial 24-48 hours after the injury is critical for treatment and management. As a general rule, put as much weight on the ankle as you feel able. Little and often is the best approach.
• Ice. Use ice or a cold pack to reduce pain and inflammation. Wrapping ice or very cold products in a cloth will help reduce the risk of ice burn. It is very important for the first 48 hours after an injury to use the ice on a regular basis. I would normally recommend every 3-4 hours for 10 minutes at a time. Leaving ice on for more than this period can damage the soft tissue.
• Compression. Compression of the swollen area helps reduce swelling. You can use specific elasticized bandage or can use normal bandage. Remember to start wrapping from the toes up and bandage to at least two thirds up the calf. Make sure the foot / toes do not go numb, blue or cold, if this happens your may have the wrapping too tight.
• Elevation. Elevating the injured area above the heart reduces blood flow to the area, this helps to decrease swelling.

Do I need an ankle support?

In most cases it is unnessessary to wear a specific ankle support. If the ankle is very swollen, elasticated bandage can help. It is not advised to buy other types of ankle support / brace without advice from a health care proffessional.

Note – in severe cases where you are not sure you should always consult a medical professional.

When will it be better?

Speed of recovery depends on many factors, including age, general health and fitness. As with any injury, the worse the damage, the longer the healing time. It is important to follow a graduated return to normal activity, be it high level sport or just walking the dog.

What if doesn’t get better

If an ankle injury does not get better, it is important to seek expert advice. At Physio2go I see many patients with old ankle injuries, in some cases after months and even years. In most cases, with appropriate assessment, treatment and specific exercise prescription, these chronic problems can br resolved.

Typical patient

In a typical week I would see a handful of ankle patients of varying degrees of severity. A recent patient was lady of 38 who had stepped off a curb awkwardly and “rolled “ her ankle. At the time of the incident she was able to walk, but was limping heavily. The ankle was swollen and was very painful.

I saw her 1 day after her injury. She had iced it (but only twice); she had tried to keep the ankle still with minimal weight bearing. She was unable to go to work as she had to go on the train. She had not seen her GP or been to the A&E. She was normally an active lady who jogged occasionally but liked to walk.

Examination revealed decreased movement of the ankle joint, swelling around the outer aspect of the ankle, redness and slight bruising of the ankle, foot and lower leg. The ligaments of the outside of the ankle were very painful to touch. The lady was treated as a grade 11 inversion injury. She was treated and rehabilitated on a graduated basis. Over a 10 week period she regained full mobility, was pain free and was able to return to jogging.