A sprained ankle is an injury to the ligaments in the ankle caused by “rolling” the foot. Rolling of the foot occurs when foot twists inward or outward depending on the direction of the force being applied. This usually occurs when the foot is pivoting on the heel or when pushing off with the plantar in a flexed position. Common causes of sprains include walking, running, or jumping on an uneven surface or when a laterally directed force is applied to the foot thus causing the ligaments to stretch beyond their normal range.
Classifications of Ankle Sprains
There are three classifications of sprained ankle injuries – Grade1, Grade2, and Grade 3. In a Grade 1 sprain, there is slight stretching and minor damage to the fibers of the ligament. Common signs and symptoms include minimal tenderness and swelling. In a Grade 2 strain, a partial tearing of the ligament occurs, resulting in decreased range of motion, instability, and moderate swelling and tenderness. Grade 3 is the most severe type of sprain. This involves a complete rupture of the ligament which results in severe instability and significant pain and swelling.
How is an Ankle Sprain Diagnosed?
Since a severe sprain can be symptomatically similar to an ankle fracture, the foot and ankle specialist will usually order X-rays of the injured ankle to rule out any fractures. A complete physical examination of the foot will also be administered. In some cases, once the swelling and bruising resolve, a MRI may also be ordered to verify the severity of the damage to the ligaments.
Non-Surgical Treatment Options for Sprains
Most ankle sprains can be treated without requiring surgery. Grade 1 sprains are usually treated by resting the ankle, applying ice to the injury, wrapping the ankle in compression dressing to help stabilize the foot, and keeping the foot elevated above the level of the heart for 48 hours. Non-steroidal anti-inflammatory medications are also usually prescribed to help reduce pain, swelling, and inflammation.
Grade 2 sprains are treated in the same manner, however because of the extended time needed to recover; a splint or immobilization device may be used to help prevent the ankle from moving.
Treatment for Grade 3 sprains usually consist of a short leg cast or a cast-brace for two to three weeks.
As the recovery progresses, rehabilitation exercises and ultrasound or electrical stimulation can also be administered to help reduce pain and swelling in the foot. Proprioception training and agility drills may also be added to the rehab to help increase strength, range of motion, and balance.
When is Surgery Needed?
Surgery to repair a sprained ankle is rare, but not an impossibility. In some cases where the patient does not respond to conservative treatments, the foot and ankle specialist may recommend surgery. There are two types of surgery usually associated with sprains – arthroscopy and reconstruction.
An arthroscopy is when the surgeon cleans out the joint, removing any loose bone fragments or pieces of cartilage. This procedure is also used when the ligament is caught in the joint itself.
A reconstruction is when the surgeon repairs the ruptured ligament using sutures or stitches. In some cases, the surgeon may use other ligaments or tendons in the foot and around the ankle to repair the torn ligament.
Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.