Ankles

Ankle Sprains

Ankle sprains usually result from injury or trauma to the ankle. You might have twisted your ankle while running or playing sports, rolled your ankle while walking in high heels on an uneven surface, or landed wrong after a jump shot while playing hoops. The result? A swollen ankle that hurts when you stand or walk.

So what actually happens when you sprain your ankle? You stretch or tear the ligaments—the bands of tissue that hold your bones together—usually on the outside of the ankle. Sharp pain lets you know that, ouch, you did sprain your ankle, and swelling and discoloration soon follow.

The good news? Most sprains are minor and will heal, given time and proper treatment. The bad news? Once you’ve sprained your ankle, you are prone to more sprains.

Certain activities can increase your chances of spraining your ankle, including:

Running, walking, or playing sports on uneven surfaces.
Playing sports that require quick changes of direction, like soccer, basketball, and football.
Wearing shoes that don't fit properly or lack good support.

Other factors increase the likelihood of a sprained ankle such as:

High arches.
Supination, or under-pronation, in which the ankle rolls outward instead of inward when you walk or run.
Feet that turn inward (pigeon toes).
Weak ankle muscles.

Loose ligaments from injury or a hereditary condition called “ligamentous laxity,” which can lead to ankle instability.
One leg that's longer than the other, causing imbalance as you run, walk, or even stand.
Previous ankle sprains, which weaken your ankle muscles.

Ankle sprains are classified by severity:

Grade 1: A mild sprain with no tearing of the ligaments, minor swelling, and some pain while walking.
Grade 2: A moderate sprain with partial tearing of the ligaments, noticeable swelling, bruising, and difficulty walking.
Grade 3: A severe sprain with complete tearing of the ligaments, sharp pain, severe swelling, internal bleeding, and the inability to walk.

Think You Might Have a Sprained Ankle?

Did I:

Twist or roll my ankle, or land badly on it?
Hear a popping noise when that happened?

If you answered "yes" to one or both of these questions, you could have an ankle sprain.

Are either of these statements true for you?

I have some swelling around my ankle.
I have some sharp pain in my ankle but can limp around a bit.

If either of these statements are true for you, then you most likely have a minor, Grade 1 sprain.

If your pain is more severe, take the next quiz. 

Do I have:

Severe swelling around my ankle?
Bruising, or black and blue areas around my ankle?
Difficulty or inability to walk or bear weight on my ankle?
Difficulty moving or controlling my ankle?

If you answered "yes" to any of these questions, you may have a more serious Grade 2 or 3 sprain.

See your doctor or podiatrist to assess the damage and receive treatment. You may need an X-ray to rule out damage to your bones or an MRI to examine the ligament damage more closely.

Are There Any Serious Concerns?

Most ankle sprains are minor and clear up through home treatment. But Grade 2 and 3 sprains should be seen and treated by a podiatrist or doctor. Severe swelling or pain can be a sign of internal bleeding, full ligament rupture, or broken or fractured bones.

If you don’t treat your ankle sprain properly, not only will you be prone to frequent future sprains but you may also develop a condition called chronic ankle instability. Make sure you get proper medical attention and treatment for your sprain.

Treatment and Prevention

First, concentrate on healing the damage so you can get back on your feet. This may take as long as 4 to 8 weeks, depending on the severity of the sprain. Be patient and don't rush your recovery—returning to activity too soon risks chronic ankle pain, instability, and other problems.

If you have a Grade 2 or 3 sprain, a doctor or podiatrist should help treat you. If you have a Grade 1 sprain, start off by following the classic RICE principle:

Rest: Put your physical activity on hold and keep your weight off the ankle as much as possible. Use crutches to get around if necessary.
Ice: Ice your ankle for about 20 minutes every few hours for the first few days, tapering down until your symptoms are gone.
Compression: Wrap your ankle in an elastic bandage to keep down swelling and provide support.
Elevation: Prop your ankle up on a pillow when you are sitting or lying down.

You can also take over-the-counter anti-inflammatory medication to help with pain and swelling.

When your ankle no longer hurts and feels as strong as the other ankle, you are ready to resume your normal activities. But even after one sprain, your ankle is now weaker and prone to further sprains, so you'll want to  take some extra preventative measures.

Wear good, supportive shoes that offer:

Firm heel support from a heel counter, usually a hard plastic insert in the heel cup that helps lock your heels in place.
A wide toe box that gives your toes room to move.
A rigid or semi-rigid shank, a piece of hard material under the heel and arch that provides extra support.
Full covering up of your instep and toes, which is a part of the shoe called a vamp.
Wear high-topped shoes that extend up over your ankle for athletic activities.
Wear an ankle brace for support, or continue to wrap or tape your ankle to provide support.
Use lateral heel wedges—inserts that stabilize your heel to keep your foot from rolling in or out.

You'll also want to:

Stretch thoroughly before and after physical activity to help prevent injury.
Stop exercising if you start to feel pain in your ankle.
Be especially careful on uneven surfaces and while jumping.
Strengthen your ankle muscles to guard against future sprains. Try balancing exercises or an ankle inversion exercise.