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The most common way to sprain an ankle is when the foot lands on an uneven surface and the foot rolls inwards. This is called an inversion injury.
The ligaments are stretched (sprained) and depending on the severity of the injury may be partially or completely torn.
Pain on the inside (medial side) of the ankle may be due to bruising of the bones or ligaments.
In addition, there may be injury to the cartilage (osteochondral lesion), tendons (e.g. Achilles tendon tear), the small nerves in the ligaments that aid in balance (proprioception) and the nerves that supply sensation to the ankle (causing numbness).
A sprained ankle is usually painful and swollen. There may also be bruising, tenderness to touch and it may be difficult to put weight through or stand on the foot. More severe ankle injuries can cause fractures or even a complete dislocation of the ankle joint in which case it is very important to seek medical attention.
The Sajid Shariff clinic is a private orthopaedic clinic based in SE London and Kent that specialises in surgical and non-surgical treatment of foot and ankle conditions including ankle sprains, bunions, plantar fasciitis and achilles tendonitis.
Keep an eye on the shape of your feet; if you see changes see a doctor to find out if there are any recommendations to prevent hallux valgus from forming
Strengthen your feet by exercising them
Wear shoes that fit your feet well and offer good support
Try to avoid shoes that have a heel or pointed toe
Look at the bones and are useful for showing fractures/broken bones. Sometimes the fracture or break may be subtle such as a hairline fracture and the it may be necessary to get further tests.
These are taken while the ankle is being pushed in different directions and can help to show whether the ankle is moving abnormally because of the torn ligaments.
These scans are very good at looking at the soft tissues such as ligaments, tendons or the cartilage of the joint surface. Subtle fractures such as avulsions (small bone chip), hairline fractures and stress fractures which are not visible on an xray may be picked up on the MRI scan.
This type of scan helps to observe the ligament directly while your ankle is moved. This allows the doctor to determine how much stability the ligament provides.
Anterior Drawer Test – tests whether the ATFL is torn
Inversion Stress Test
For milder sprains, the simple home treatment follows the RICE protocol:
RICE: Rest Ice Compression Elevate
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling.
Some sprains will require treatment in addition to the RICE protocol and medications.
10-20% of patients who have a significant ankle injury will still have recurrent instability and sprains of their ankle. This may limit daily activities, work or sporting pursuits.
In this situation surgery to reconstruct the lateral ligaments may be considered.
By about 6 weeks, the majority of patients will be significantly better. By 3 months many will be back to most activities but a complete return to competitive sport may take 4-6 months.
Patients who have ongoing pain after an ankle sprain, which may due to an additional injury to other parts of the ankle will require further investigation.
What if the ankle repeatedly gives way/ recurrent sprains?
If the ankle is unstable it may become swollen and painful. If there are recurrent inversion sprains over a long period these may damage the cartilage of the ankle joint and there is a risk of developing spurs or arthritis.
Almost all ankle sprains can be treated without surgery in the first instance. Even a complete ligament tear can heal without surgical repair if it is immobilised appropriately.
A three-phase program guides treatment for most ankle sprains:
Phase 1: resting, protecting the ankle and reducing the swelling.
Phase 2: restoring range of motion, strength and flexibility.
Phase 3: maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. This will be followed later by being able to do activities that require sharp, sudden turns such as tennis, basketball, or football.
This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries.