Your Guide to Ankle Sprains: Causes, Treatments and Recovery

YOU'RE VOLLEYING LIKE A Wimbledon pro when your foot suddenly twists and you stumble. You see your ankle swell to nearly the size of a tennis ball. Painfully, you limp off the court to deal with your newly sprained ankle.

Ankle sprains are extremely common, accounting for 40 percent of all sports injuries and 10 percent of all muscular/skeletal injuries, according to a July 2016 summary in Podiatry Today. Sports mishaps, work miscues and walking missteps can all lead to ankle sprains. Here's what to do at home, and when to see a doctor or physical therapist to help your ankle heal.



Strain, Sprain or Break?

As you step onto a cracked driveway or jagged cobblestone sidewalk, your foot and ankle could twist. Sports involving lateral or cutting actions, such as soccer, basketball or tennis, can also cause sprains. Landscaping or construction work that has you moving across irregular surfaces may also set you up for ankle injuries.


"The most common cause is where a person steps down on an uneven surface, such as ground where there's a dip, or a curb where they don't see the edge of the pavement, and one foot goes in one direction and the other foot goes in another," says Dr. Richard Mendelsohn, medical director and founder of the Family Foot and Ankle Center, with offices in Virginia. "In some cases, people fall to the side where the foot is rotated."

Sports involving a lot of side-to-side motion challenge ankle stability, Mendelsohn says: "People tend to go in directions where the joint normally doesn't move."

The difference between a strain and sprain is a matter of degree. "A strain is a mild stretch of a tendon or a ligament, whereas a sprain is more severe," Mendelsohn explains. "A fracture is a bone-related injury. The sprain and strain are more soft-tissue, whereas a fracture would be an extreme injury where you a break a bone."

Ankle Anatomy

Three bones – the shinbone (tibia), calf bone (fibula) and heel bone (calcaneus) – all connect to your ankle bone (talus) to form your ankle joint. The ankle also includes a network of muscles, nerves, blood vessels, tendons and ligaments. This relatively small joint supports the entire weight of your body when you stand, walk, jump or run.

Ligaments provide essential support for ankle joints. These ligaments, which connect the bones to one another, are fibrous and flexible. However, when ligaments stretch too far, they can tear and result in a sprained ankle.

"Biomechanically, people who have hypermobile or flexible feet tend to be more susceptible to ankle sprains, due to the extreme range of motion that occurs in the midfoot," Mendelsohn says. Conditions such as extreme flatfeet, or structural deformities in rear or midfoot, make people vulnerable to sprains, he says.

Some patients have chronic, repetitive sprains. "That can be attributable to an injury to the outer part of the ankle – the ligaments are just too loose," Mendelsohn says. In some cases, he says, patients may benefit from ankle-stabilizing surgery to tighten the ligaments.

RICE Right Away

The standard regimen for most ankle sprains is RICE – rest, ice, compression and elevation. Start with RICE as an immediate home remedy:

• Rest: It takes about 24 to 48 hours to get swelling down and stabilize the ankle before you should test it with significant activity, Mendelsohn says.
• Ice: Fill a bag with ice to place on your ankle to reduce swelling. Ice packs and chemical cold pack products are available in first-aid aisles of pharmacies and grocery stores. In a pinch, place a package of frozen peas or other frozen veggie around your injured ankle.
• Compression: Compressing the ankle pushes swelling out of the joint, says Ashlee Jones, a physical therapist, athletic trainer and orthopedic certified specialist with Drayer Physical Therapy Institute in Hummelstown, Pennsylvania. A compression wrap (like an Ace elastic bandage) or ankle brace also provides support and stability to the ankle.
• Elevation: Propping your foot and ankle on a stack of pillows to raise it above the rest of the leg will temporarily relieve swelling, preventing it from moving down into the foot.

Over-the-counter medications like ibuprofen (Advil or Motrin) work well for mild ankle pain, Mendelsohn says. "In some cases you have to go to a prescription version of ibuprofen to get the pain under control," he says. Most people don't need narcotic painkillers for an ankle sprain unless it's severe, he adds.

Kids and Sprains

Children are less likely to have major sprains. "Kids tend to be very flexible so you don't see the kind of injuries that you see in adults, unless it's severe trauma when there's either an accident or a kid got hit while playing a sport," Mendelsohn says. "You typically don't see children who just walk and twist their ankle."

Because their ligaments are much more pliable, kids are less likely to sustain post-injury symptoms than adults, Mendelsohn says. "The treatment's slightly different," he notes. "We try to rehab them much quicker using physical therapy and splinting."

However, one concern is that children's bodies are still developing. "With kids, we have to be aware of growth plates," Jones says. Depending on how the injury occurred, she says, treatment and recovery may need to progress more slowly. Kids should hold off on returning to sports before their ankles are fully healed.

When to See a Doctor

With obvious dislocation or extensive bruising, let your doctor know at once. Also, consider seeing a specialist when your ankle isn't healing well at home. Choices include podiatrists (foot-and-ankle specialists) and orthopedists. These clinicians evaluate the sprain's severity and make sure you don't have a fracture. They check for tenderness in key ligaments and look for bruising and discoloration.

"If you hear something pop or crack when you fall, it's usually recommended you get an X-ray," Mendelsohn says. An X-ray is also indicated if 48 hours after the injury you put weight on your ankle and it still hurts, he says, or "your foot is not in the right position – it's twisted or it doesn't look like it's sitting properly."

Early weight-bearing is recommended for less-severe ankle sprains. "If it's mild to moderate, we like patients to walk, because we believe the healing will occur quicker," Mendelsohn says. "We'll either use an Aircast ankle brace or a splint around the ankle."

However, Mendelsohn says, patients with severe ankle injuries and tears should stay off their feet for a few weeks to allow complete healing.

Physical therapy is an option if ankle-sprain recovery is lagging. A physical therapist might suggest crutches, if needed, and offer a variety of treatments.

Hands-on therapy like range-of-motion exercises, and treatments such as transcutaneous electrical nerve stimulation, ultrasound and compression devices may be part of the regimen. "Physical therapy can also provide a home-exercise program and lead patients in the right direction in a quicker fashion," Jones says.

It's better not to rush back into action. "It takes muscles at least four to six weeks to get stronger after an acute injury," Jones explains. "To return to more functional training, it can take up to six to eight weeks for full proprioception and strength." Proprioception encompasses body awareness, balance training and the ability to tolerate uneven surfaces and change of direction while you're performing activities.

"We start with getting all that acute pain, swelling and inflammation down," Jones says. "Then, slowly putting that ankle through more weight-bearing and strengthening exercises to allow people to return to their activity-specific training, whether that be a sport activity or a work activity. And then hopefully returning stronger than before the injury."

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