Sprained Ankle: Symptoms, Causes and Treatments
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Key Takeaways
- An ankle sprain is a common injury that occurs when you twist your ankle at an awkward angle due to a fall or a sporting injury.
- Though not a severe injury, prompt medical attention helps your ankle recover quickly.
- Ankle sprains typically do not require surgery and can heal with proper nonsurgical treatment methods, including physiotherapy.
- It is essential to maintain regular exercise to help strengthen your ankle, improve its flexibility, and help maintain its balance.
What is an Ankle Sprain?
An ankle sprain is a common injury many suffer at some point in life. It happens when you accidentally injure the ligaments in your ankle when you roll, twist, or turn it awkwardly, often due to tripping or falling over and landing on your feet at an awkward angle.
The ankle contains strong, fibrous soft tissues called ligaments, which help to support your joints and prevent excessive movement. When an ankle sprain occurs, the ligaments are forced beyond their usual tension, causing them to be partially torn. Most ankle sprains affect the lateral ligaments on the outside of the ankle; in some instances, the ligaments may also be torn entirely and can cause your ankle to become very unstable.
What Grade Is My Ankle Sprain?
Ankle sprains are typically divided into three different grades based on the severity of the injury.
Grade 1 sprains are mild injuries where the ligament fibres are slightly stretched or have a microscopic (or very negligible) tear(s). You may also experience some swelling or tenderness around the ankle.
Grade 2 sprains are moderate injuries where the ligaments are partially torn. You will notice a moderate amount of tenderness, bruising, and swelling around the ankle, and you may experience pain and instability when you use the ankle.
Grade 3 sprains are the most severe as there is a completely torn ligament (or ligaments). Significant swelling, tenderness, and bruising will occur around your ankle, accompanied by severe pain and instability when you try to move.
How Do You Tell If It Is an Ankle Sprain?
The symptoms of an ankle sprain will vary depending on its grade, but common symptoms include:
- Pain in the ankle, even when you are not moving around
- A popping sound when the injury occurs
- Tenderness to touch
- Swelling and bruising
- Limited range of motion
- Ankle instability, or feeling as though it will give way any time
A broken ankle typically shares similar symptoms, so you must seek medical attention immediately to diagnose and treat the issue accurately before it worsens.
What Causes Ankle Sprains?
The most common cause of ankle sprains is twisting, pulling, or rotating our ankle to an awkward position, mainly when we suddenly lose our balance and fall over, landing on our ankle at a weird angle that sprains our ligaments. In other instances, an ankle sprain can occur due to a sports-related injury, such as landing from a jump at an awkward angle. Even stepping on an uneven surface, like a hole or a bump, can put you at risk of a fall that causes an ankle sprain.
While an ankle sprain is typically not a severe injury, prompt medical attention is still recommended to ensure you can recover quickly with proper medical advice and support. Otherwise, you may be at risk of complications such as chronic ankle pain, instability that makes it hard to move around, or even arthritis.
How to Diagnose an Ankle Sprain?
Diagnosing with a Physical Examination
Your doctor will perform a physical examination to ascertain if you have an ankle sprain. Apart from taking your medical history, they will carefully assess your ankle’s physical condition. Because of the swelling around the ankle, you will feel plenty of discomfort during the examination; be sure to let your doctor know if the pain is unbearable. Your doctor will carefully touch the injured areas of your ankle and slowly test its range of motion, along with gently pulling your ankle in different directions to check its stability.
Using the Anterior Drawer Test
This particular test looks for instability in the upper ankle joint. You will be instructed to lie down on the examination table with your knee joint slightly bent and the ankle bent in a 10 to 15-degree forward tilt while the doctor holds your heel in one hand. Your foot will rest along the doctor’s forearm as he holds your heel. The doctor will use their other hand to hold your tibia (shin bone) in place before they gently tug your foot anteriorly or towards the front. If this anterior movement is greater than 1 cm compared to the movement of your healthy ankle, it would indicate either a partial or complete tear of your ankle ligament.
Alternatively, the doctor may place your foot at a 10 to 15-degree angle while your foot rests on a plinth, such as a folded towel. Then, the doctor will hold your foot down firmly with one hand while the other hand grasps onto the tibia; they will proceed to gently push downwards against the tibia.
Using the Talar Tilt Test
This test aims to look for signs of damage to the outermost ligaments near the ankle. You will be asked to sit down and let your lower leg dangle off from your seat. Your foot will be bent 10 to 20 degrees perpendicular to the movement you will soon perform for the test. The doctor will hold your tibia steady in one hand while the other hand gently bends your foot towards the left (inversion).
The next part of the test will require you to bend your foot upwards (as instructed by the doctor) while the doctor holds your tibia steady and uses their other hand to gently tilt your foot from side to side. Your doctor may repeat this phase by bending your foot as far upward as possible and repeating the gentle tilting motion.
The test is considered positive if you experience pain at any point during the test or if there is “excessive gapping” compared to your other ankle.
Diagnosing with Imaging Tests
Additional tests can help to confirm the diagnosis, especially if the physical exam does not give a satisfactory result. These tests could also help differentiate your condition from other conditions that share similar symptoms.
- X-ray scan: The X-ray can provide a clear picture of dense structures like bone, allowing the doctor to look for any bone damage in your ankle or foot. There may also be a need for stress X-rays, where the ankle is carefully pushed in different directions during the X-ray scan. This particular method may be helpful to determine if your ankle’s instability is due to injured ligaments.
- Ultrasound: Sound waves create a clear image of your ankle and foot’s structure, which may help detect injured ligaments or tendons.
- Magnetic resonance imaging (MRI): This test may be needed if your doctor needs to examine your cartilage and tendons around the ankle or look for signs of a high ankle sprain or an injury to the ligaments and structures that connect the bones of your lower leg. It may also be helpful when symptoms persist 6 to 8 weeks after the injury, even with treatment.
How to Treat Ankle Sprains
For most ankle sprain cases, non-surgical treatment methods are the best way to help your ankle recover with optimal results. Even grade 3 sprains, where the ligament is completely torn, can also heal over time with proper rehabilitation treatments.
Treating Ankle Sprains Without Surgery
Treating Ankle Sprains via First Aid Techniques
The RICE method can help you reduce symptoms and manage pain.
- Rest: Avoid activities that put pressure/stress on the affected ankle.
- Ice: Place a cold compress or ice pack in a towel on the affected area for 20 to 30 minutes, 3 or 4 times daily. Ensure you do not place ice directly onto your skin.
- Compression: Wrap the affected area with bandages or a compression wrap to immobilise the foot, decrease swelling, and allow the ankle to heal.
- Elevation: Position your ankle above the level of your heart as often as possible. You can prop up your ankle with pillows.
You may also be asked to use crutches or apply a splint or brace to your ankle to help it gradually recover.
Treating Ankle Sprains via Physiotherapy
Physiotherapy can help you reduce pain and swelling, strengthen the ligaments and tendons, and slowly restore your range of motion and flexibility. Your physiotherapist will show you various exercise methods to help with this. Most activities will revolve around improving your ankle function, including balance, flexibility, and strength. As such, several physiotherapy sessions can alleviate your symptoms and get you moving once again.
Note that you should start with simple exercises, as suggested by your physiotherapist. You can slowly build up the intensity and duration of exercises as your ankle’s condition improves.
- Ankle flexes: Rest your heel on the floor, then point your toes away from you before pulling them back towards you. Repeat this several times throughout the day.
- Ankle alphabet: Sit or lie down with your feet flat on the floor or propped on a pillow. Slowly lift your injured foot and use your big toe (or your whole foot) to draw the letters of the alphabet. You can also do this with your other foot to strengthen your other ankle.
- Knee swing: Sit on a chair with your foot flat on the ground. Slowly rock your knee side to side for 2 to 3 minutes while keeping your foot flat.
- Towel stretching: Sit comfortably on the floor with your affected leg straight out. Place a towel around the affected foot and hold both ends in your hands. Gently pull the towel back until you feel your calf being stretched; hold the position for 15 to 30 seconds, then repeat it 2 to 4 times.
- Heel raises: Stand up with your hands in front of you while resting against a wall or other hard and stable surface or object (such as the wall). Keep your feet a shoulder’s width apart, then slowly raise yourself on your toes and come back down. Start small (10 turns) first and slowly work your way up as your ankle improves.
It may be a good idea to continue these exercises even after you fully recover. Since you could injure yourself again if you are not careful, maintaining your strength and balance can go a long way to help you avoid falls.
Treating Ankle Sprains via Medication
Medications can provide much-needed relief to your ankle sprain. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin can relieve pain and reduce swelling around the ankle.
Treating Ankle Sprains With Surgery
Surgery is primarily reserved for ankle injuries that do not seem to respond well to non-surgical treatment methods or in cases where people continue to experience persistent ankle instability and frequent pain even after receiving treatment. It may also be necessary if you have sustained other injuries, including fractures or ruptured tendons.
Treating Ankle Sprains via Arthroscopy
An ankle arthroscopy is a minimally invasive surgical procedure that involves making small incisions on your skin. The surgeon can insert special instruments through the incisions, including a camera (the arthroscope), to reach the ankle joint. The camera projects what it sees onto a surgical team’s monitor to examine your ankle. Once the problems have been identified, the surgeon will use the inserted surgical tools to remove loose fragments of bone or cartilage or even parts of the ligament that may be caught on the joint or torn.
In some instances, debridement may be required to remove damaged tissue or reshape your bones to correct other complications in your ankle.
Treating Ankle Sprains via Ligament Repair/Reconstruction
If you have chronic ankle instability, ankle ligament repair or reconstruction surgery may be the best option to treat the complication. The surgeon may be able to repair partially torn ligaments by reattaching the torn parts using stitches or sutures. If this is not possible, the surgeon may need to use a tissue graft from your ligaments or tendons in and around your foot or ankle and reconstruct the ligament. The graft is then held in place with sutures or pins; your surgeon may need to observe the ligaments to ensure that the repair or reconstruction procedure went smoothly.
How to Prevent an Ankle Sprain
Prevention is always better than cure, so you must do all you can to protect your mobility and independence. Here are some valuable tips to consider to protect yourself.
- Get regular exercise: Even after your recovery, you should consistently exercise to stay in good shape and reduce the risks of an ankle sprain.
- Warm up first: Before starting any exercise routine, stretching and other warm-up activities can prep your body for the intense workout ahead.
- Stretch often: Even if you are not exercising, frequently stretching your feet can help to minimise ankle sprains. You should stretch every time you wake up in the morning and before and after your exercise routine.
- Slowly increase your physical activity: Our bodies need time to get used to physical activity. If you are new to this, start with a warm-up session to prepare for the day’s exercises. Start slowly and then steadily build up the intensity. Make sure to pace yourself appropriately so you do not strain your body unnecessarily.
- Watch your step: Pay attention to where you are walking or running to avoid hazards like potholes, uneven dirt paths or rocky roads.
- Wear appropriate shoes: Avoid wearing shoes that are too tight for you. You should also ensure your shoes have adequate cushioning support so you do not put too much stress on your ankles.
Getting Professional Medical Attention
Ankle sprains are not a life-threatening complication, but it is nonetheless crucial that you seek medical attention to help with its recovery. Here at Avant Orthopaedics, our professional orthopaedic specialists are ready to support you with comprehensive medical support to get you back on your feet. Contact us to book an appointment and receive personalised care, where we will diagnose your condition and recommend the best course of action.
Orthopaedic Doctor for Sprained Ankle in Singapore
Dr. Ramesh Subramaniam
MBBS (NUS, SG) | MRCS (Edinburgh, UK) | M Med (Ortho) (NUS, SG) | FRCS (Ortho) (Edinburgh, UK)
Dr Ramesh, a fellowship-trained orthopaedic surgeon, focuses on shoulder, knee, and arthroscopic sports surgery.
Dr Ramesh obtained his MBBS and Master’s in Orthopaedic Surgery from the National University of Singapore and completed Advanced Surgical Training. He earned his Fellowship from the Royal College of Surgeons of Edinburgh in Trauma and Orthopaedics. He was awarded the HMDP scholarship for a clinical fellowship in Shoulder and Knee Surgery in Dublin, followed by the Tan Tock Seng Scholarship for a Sports Fellowship in Knee Surgery in Barcelona. He also completed a Shoulder Surgery Fellowship at Hospital Del Mar and was trained in arthroscopic joint reconstruction and joint replacement surgeries.
Frequently Asked Questions (FAQ)
If the pain is still bearable, you can move around without support. However, doing so can increase your risk of complicating the injury and cause further issues, including chronic ankle instability.
Your recovery period will depend on the grade of your ankle sprain and if other complications interfere with your stability and balance. Typically, it may take two weeks for a minor sprain to recover, while it may take six to 12 weeks to treat a severe sprain.
If you are recommended an ankle brace, you must wear it for as long as your ankle sprain needs to heal. Typically, minor sprains may not necessitate an ankle brace, though grade 2 and 3 sprains will usually require you to wear one for as long as a week to six weeks or more.
Related Conditions
Foot and ankle pain can manifest in various ways, and the symptoms you experience can vary based on the underlying cause of the pain. Here are some common symptoms.
Achilles tendinitis is the inflammation of your Achilles tendon. The Achilles tendon connects your calf muscles (located in the lower back of your leg) to the heel bone. Its primary purpose is to enable you to walk, run, jump and stand on the balls of your feet.
A common cause of heel pain, plantar fasciitis is the inflammation of the plantar fascia, which is the tough, fibrous tissue that extends across the heel of each foot and connects our heel bone to the base of our toes. The plantar fascia experiences much wear and tear in the day-to-day, as it is used when you walk or move your foot.
