Varying Degrees of Ankle Sprains
John Davine, M.D.
Family Medicine, Rush Copley Medical Group
A sprained ankle is a very common injury. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports or even by stepping on an uneven surface.
Ankle sprains occur when the foot twists, turns or rolls beyond its normal motions. A sprain can also occur if the foot is planted unevenly on a surface, beyond the normal force of stepping. This causes the ligaments to stretch beyond their normal range in an abnormal position. A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.
There are three grades for ankle sprains determined by the amount of force.
- Grade 1: Stretching or slight tearing of the ligament with mild tenderness, swelling and stiffness. The ankle feels stable and it is usually possible to walk with minimal pain.
- Grade 2: A more severe sprain, but incomplete tear with moderate pain, swelling and bruising. Although it feels somewhat stable, the damaged areas are tender to the touch and walking is painful.
- Grade 3: This is a complete tear of the affected ligament(s) with severe swelling and bruising. The ankle is unstable and walking is likely not possible because the ankle gives out and there is intense pain.
A physician can diagnose a sprained ankle. X-rays are sometimes needed to rule out a broken bone in the ankle or foot. Broken bones can have similar symptoms of pain and swelling. If there is no broken bone, your physician will be able to tell you the grade of the ankle sprain based upon the amount of swelling, pain and bruising.
Depending on the grade of injury, the following rehabilitation steps are suggested.
- Grade 1: Use R.I.C.E. (rest, ice, compression and elevation). Ice should be applied immediately to help keep swelling down for 20-30 minutes up to four times daily. The ankle should be elevated above the chest for 48 hours. Rest your ankle and try not to walk on it. Use compression dressings and wraps to immobilize and support the ankle.
- Grade 2: Utilize the R.I.C.E. guidelines and allow more time for healing to occur. An immobilization device or splint is also recommended.
- Grade 3: Permanent instability can occur with a grade three sprain. A cast or a brace may be required for a couple weeks. Anti-inflammatory drugs like ibuprofen can be used to control pain and inflammation with a sprain. Surgery may be considered in younger, athletically active patients.
If an ankle sprain isn't treated with the necessary attention and care, chronic problems of pain and instability can result. The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility. Here are some additional prevention steps:
- Wear good shoes
- Warm up before doing exercises and vigorous activities
- Pay attention to surfaces on which you run and walk
- Reinforce the foot and ankle's stability with a brace if needed
- Pay attention to the body's warning signs to slow down when you feel fatigue or pain.