How will an ankle sprain be diagnosed?
Our doctors will conduct a physical examination of the twisted ankle to determine the extent of the injury. It often involves checking for signs of swelling, bruising, and tenderness. Your healthcare provider may also perform several tests to evaluate your gait, stability, and range of motion. You may also be asked to recount the incident where you sprained your ankle and describe how it happened, along with any sensations you felt at the moment in the affected area.
Next, you may be recommended to undergo an X-ray to rule out the possibility of a fracture. While ankle sprains mainly involve ligaments, the symptoms of a severe twisted ankle may overlap with that of ankle fractures.
An MRI scan will be prescribed if your symptoms do not improve after a period of conservative treatment. This imaging technique can provide a detailed look at your tendons, ligaments, and soft tissues. It helps in ruling out the presence of other injuries such as stress fractures, which may display symptoms similar to twisted ankles. MRI scans are also useful for ruling out other concomittan injuries like bone bruises, tendon injuries and cartilage lesions.
Which parts of an ankle are involved in a sprain?
When it comes to ankle sprains, understanding the anatomy of the ankle is crucial. This injury mostly affects the ligaments, sturdy bands of tissues that provide stability to the joints by connecting bones.
Also known as the deltoid ligament, the medial ligament is found on the inner side of the ankle. It consists of several components which connect the tibia to the navicular bone and calcaneus bone. Damage to this ligament typically occurs when the ankle rolls outwards (eversion), and may be accompanied with other injuries such as an ankle fracture.
Anterior Talofibular Ligament (ATFL):
The ATFL is commonly involved in ankle sprains due to its anatomical position. This ligament extends from the front of the ankle joint, connecting the fibula to the talus. Its position makes it prone to excessive stretching or tearing when the foot is suddenly forced into an unnatural inversion position. Compared to other ligaments, the ATFL is smaller in size, thinner and has less strength. This makes it more prone to injury when exposed to sudden inversion movements.
Located slightly lower and on the outer side of the ankle, the CFL plays a significant role when it comes to resisting excessive inversion. However, similar to the ATFL, the CFL is thinner and less robust compared to other ligaments in the ankle. Therefore, it is more prone to strain or tearing when the ankle is inverted.
Posterior Talofibular Ligaments (PTFL):
The PTFL is the least commonly injured ankle ligament, except in cases of severe ankle sprain. Its primary role involves stabilising the back of the ankle by restricting the backward displacement of the talus.
What are the different types of ankle sprains?
Eversion ankle sprain:
Also known as medial ankle sprain, the eversion ankle sprain happens when the ankle rolls outward. This results in injuries to the deltoid ligaments on the inner side of the ankle.
Inversion ankle sprain:
An inversion ankle sprain is the most common type of ankle injury. It occurs when the ankle rolls inward, damaging ligaments such as the anterior talofibular ligament (ATFL). In serious cases, the calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) may also be affected.
High ankle sprain:
Unlike eversion or inversion sprains that affect the ligaments around the ankle joint, a high ankle sprain involves damage to the syndesmosis, a set of ligaments connecting the tibia and fibula. This is usually caused by a sudden and powerful upward motion of the foot.
What are the different grades of ankle sprains?
Grade 1 Mild Tears:
This is the mildest form of muscle tear, involving minimal tearing of muscle fibres. It often results from overstretching or minor trauma and may cause mild pain and discomfort. They typically heal relatively quickly with rest and conservative treatment.
Grade 2 Moderate Tears:
Grade 2 tears involve a more significant tear of muscle fibres, causing moderate pain, swelling, and impaired muscle function. These may take several weeks to heal and often require more comprehensive treatment, including physical therapy.
Grade 3 Severe Tears:
Grade 3 tears are the most severe, often involving a complete or near-complete tear of the muscle. These injuries result in severe pain, significant swelling, and a marked loss of muscle function. They may require surgical intervention and have a more extended recovery period.
What are the treatments for ankle sprain?
What are the non-surgical treatments?
For a mildly twisted ankle, RICE (Rest, Ice, Compression, and Elevation) is a recommended treatment to be performed as soon as you can.
Refrain from participating in sports or activities which may require the use of the affected ankle. It allows the ligaments to heal while alleviating pain and swelling.
Apply ice packs to the affected area to limit inflammation, reduce swelling, and alleviate pain. Do not apply ice directly to your skin.
Use compression bandages, or dressings to provide support and minimise swelling.
Keep the affected ankle elevated above the level of the hip and knee. This can reduce swelling and pain. You can achieve this by using cushions or pillows.
Immobilisation involves the use of supportive devices such as boots, braces or splints to restrict movement of the affected ankle. This reduces the risk of further injury or worsening of the condition, and allows ligaments to heal.
Physical therapy is a crucial part when it comes to treatment plans for twisted ankles. This treatment aims to improve balance, strength, and flexibility. It typically involves a range of exercises and movements:
- Strengthening exercises
Having a weak ankle increases the risk of sustaining a repeat of spraining your ankle or suffering from another injury. Designed to target the muscles and tendons in your leg and ankle, these exercises are essential to rebuilding muscle strength and restoring ability to the injured ankle.
A routine usually involves calf raises, and resistance band exercises. However, based on the severity of your injury, specific needs, and limitations, a physical therapist will come up with a suitable exercise plan that may include a combination of these activities.
- Proprioception training
Proprioceptors are specialised sensory receptors found in muscles, ligaments, and joints. These receptors play a crucial role in transmitting information from the environment to the brain, which results in changes to the body’s position. When the ankle sustains an injury, the nerve endings may be damaged, resulting in either slowed or less effective.
If left unresolved, this can lead to further incidents of ankle sprain. For twisted ankles, the training often involves balance exercises using a balance board or wobble board. There are also other activities available which can be customised and included in the individual’s proprioception training.
- Range of motion exercises
Usually performed in the early stages of physical therapy, it seeks to alleviate stiffness in the affected ankle to allow for enhanced mobility. This stiffness can impair movement if left untreated and potentially lead to future injuries. These exercises help loosen tight muscles along with ligaments around the ankle and restore the ankle’s ability to move freely.
Examples of such exercises include ankle alphabet, toe flexes, and towel stretches. They are performed gently and progressively to avoid causing discomfort or injury while supporting the ankle’s recovery process.
It's important to note that the severity of these symptoms can vary depending on the degree of the muscle tear. Mild strains may only result in minor discomfort and swelling, while severe tears can cause significant pain and swelling.
What are the surgical treatments?
When it comes to twisted ankles, surgical treatments are only recommended if the condition does not improve after months of conservative treatment. Surgery may also be recommended if the ankle strain is too severe.
Arthroscopy is a minimally invasive procedure where a surgeon will make tiny incisions and insert a small camera, known as an arthroscope. This allows the surgeon to identify the scope of damage and repair what is needed. It can be used to diagnose and address issues within the joint such as loose fragments, cartilage damage, or scar tissue that may be contributing to persistent issues.
This is a surgical procedure which aims to repair and reconstruct damaged ligaments in the ankle. The surgeon may use either the Brostrom-Gould technique where the ligaments are repaired with sutures, or tendon transfer, where the damaged ligament is replaced with a tendon which will be strengthened using synthetic materials.
If you experience any of the signs listed above, we strongly recommend seeking immediate medical intervention to assess the severity of your injury and receive a suited treatment plan.