What is an ankle sprain or sprained ankle?

An ankle sprain is the most common injury to the ankle and the long term consequences of an ankle sprain is a common cause of chronic ankle pain. The most common type is the inversion ankle sprain, in which the ankle rolls over on the outside.

An ankle sprain is the stretching and tearing of ligaments - in the sprained ankle the most common damage is done to the talo-fibula ligament (if the ankle sprain is worse, the calcaneo-fibula ligament can also be damaged) - sometimes the tendons also get damaged.

Sprained ankle causes:

Anything that makes the ankle 'tip over' increases the chance of an ankle sprain - this can occur in sport (eg jumping and landing on someone's else's foot), walking on uneven surface, twisting motions etc.

A number of factors predispose to ankle sprains:

* poor rehabilitation of a previous sprained ankle

* poor proprioception (proprioception is the ability to sense where a joint is .... if you don't know where your ankle is, the muscles will not be able to prevent the ankle sprain)

* some feet are very easy to 'tip over' - this is common in those who frequently 'roll the ankle', without actually doing any damage and spraining the ankle

* weak muscles (they are just not strong enough to prevent the sprain occurring)

Ankle sprain types:

The sprained ankle is often classified as to how severe it is:

First degree ankle sprain:

* Some stretching or mild tearing of the ligament.
* Little or no functional loss - the joint can still function and bear some weight (...but hurts!!!).
* Mild pain
* Some swelling
* Some joint stiffness.

Second degree ankle sprain:

* Some more severe tearing of the ligaments
* Moderate instability of the joint
* Moderate to severe pain - weightbearing is very painful
* Swelling and stiffness

Third degree ankle sprain:

* Total rupture of a ligament - there is a loss of motion
* Gross instability of the joint - joint function is lost
* Severe pain initially followed by no pain
* Severe swelling

What to do when it you get an ankle sprain or sprained ankle?

* Rest your ankle - do not walk on it.

* Ice - this helps to keep the swelling down. Use ice on the injury several times a day for 15-20 minutes (more than 20 minutes is not advised)

* Compressive bandages are needed to immobilize the ankle sprain and to support the injury.

* Elevate the ankle above your heart level for as much as you can for 48 hours.

If the sprain is a 2nd or 3rd degree ankle sprain, seek professional advice immediately.

Sprained ankle treatment

If the ankle sprain is a 2nd degree sprain, then in addition to the R.I.C.E. principle, a more effective means of immoblising the ankle (splints) may be needed. Anti-inflammatory medication may also be used to help.

If the ankle sprain is a 3rd degree sprain, cast immoblisation is needed for at least 2-3 weeks. Surgery to repair the ruptured ligament is ont often needed.

Physical therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over.

As soon as treatment is instigated, consideration must be given to adequate rehabilitation:

* exercises to increase proprioception

* ankle braces and strapping to facilitate activity

* muscle strengthening and flexibility exercises

* gradual return to any sporting activities

* maintain fitness by doing alternative activities

Exercises for sprained ankle rehabilitation

Range of motion exercises

Balance

Strengthening

What causes long term pain after ankle sprains

The most common cause for long term pain after an ankle sprain is poor rehabilitation of a previous ankle sprain. All causes of chronic pain after an ankle sprain should be evaluation by a health professional.

The common causes are of chronic ankle pain are:

* poor rehabilitation

* a fracture that was not initially diagnosed

* congenital abnormality

* post traumatic arthritis

* osteochondritis dissecans (loose bit of bone in the joint)

* sinus tarsi syndrome

* syndesmotic ligament injury

* functional instability (a feeling of 'giving way')

* ankle impingement

The list is complicated and diagnosis of what is causing the chronic pain after the ankle sprain is not easy.

Prevention of the sprained ankle

A number of things can be done to prevent an ankle sprain, especially if there is a history of recurrent sprained ankles:

* continue to stretch the calf muscles, strengthen the muscles and the balance exercises

* use strapping or an ankle brace

* sometimes a wedge in the shoe will help prevent the ankle from 'tipping over' - this is particular helpful in those who 'roll' their ankle a lot

Those who chronically sprain the ankle on a regular basis usually need surgery to 'tighten' the ligaments or move a tendon to help stabilise the ankle.