Ankle sprain – causes, symptoms, diagnosis and treatment

An ankle sprain occurs when the ankle joint’s range of motion is significantly exceeded. The risk of injury is increased by professional and amateur sports that require twisting movements. Most often, ankle dislocation is diagnosed with, among others: in people playing tennis and team games, e.g. basketball and volleyball. However, you should know that an ankle sprain may be a consequence of, for example, careless walking on uneven terrain, slipping on a wet floor or careless walking up the stairs.

As a result of an injury in the ankle joint, ligaments are stretched or torn and the joint capsule is damaged. An ankle sprain requires treatment to restore the proper functions of the ankle joint. Treatment for a sprained ankle depends on the type of injury and the degree of damage to the ankle joint. It is worth knowing what symptoms indicate an ankle sprain and how to provide first aid to the injured person so as not to worsen the injury.

What is worth knowing about the ankle joint?

The ankle joint is exposed to very heavy loads. It connects the bones of the lower leg and the bones of the foot. There are two parts to the ankle joint: the upper ankle joint and the lower ankle joint. Ligaments are responsible for stabilizing the ankle joint. There are four ligaments within the upper ankle joint: the triquetral ligament, the anterior talofibular ligament, the posterior talofibular ligament and the calcaneofibular ligament. Three ligaments are responsible for stabilizing the lower ankle joint: the plantar calcaneo-navicular ligament, the calcaneo-navicular ligament and the talo-navicular ligament.

During an ankle injury, the anterior talofibular ligament or the triquetral ligament are most often damaged. Less frequently, the calcaneofibular ligament is damaged. We distinguish:

• lateral ankle sprain – in this case, the sole of the foot turns inwards, which causes damage to the talofibular ligament,

• external ankle sprain – in this case, the sole of the foot turns outwards, which causes damage to the triquetral ligament.

When you sprain your ankle, not only the ligaments are damaged. As a result of an injury, the joint capsule may also be damaged.

Degrees of ankle sprain

A three-point scale is used to diagnose an ankle sprain. We distinguish:

• 1st degree ankle sprain – it is harmless. In this case, there is no rupture of the ligaments and no serious injury to the joint capsule. A first degree ankle sprain is associated with stretching of the ligaments and joint capsule. The injury does not cause any troublesome symptoms;

• II degree ankle sprain – leads to damage to the joint capsule and partial rupture of ligaments. Grade II ankle sprain causes moderate pain;

• 3rd degree ankle sprain – causes complete tearing of ligaments and tearing of the joint capsule. The injury is associated with severe pain and difficulty walking.

More severe injuries may result in serious damage to the ankle joint, which requires not only specialized treatment, but also rehabilitation. The treatment for a sprained ankle depends on the severity of the injury.

Symptoms of an ankle sprain

The symptoms of an ankle sprain depend on the severity of the injury.

Grade I ankle sprains result in minor pain, swelling, and limited mobility without instability. The injury does not involve damage to the joint capsule, which means that the joint retains its functions. There are no extensive bruises or hematomas; redness may occur. In case of a first degree ankle sprain, the symptoms last for several days and disappear without specialist treatment. The use of cold compresses is recommended to reduce swelling. A sprained ankle should not be put under excessive weight. To avoid worsening the injury, it is recommended to wear a brace. A first-degree ankle sprain, although not very troublesome, requires giving up physical activity, which may worsen the injury.

Grade II ankle sprains result in more severe symptoms. Symptoms of a grade II ankle sprain include: moderate pain, swelling, redness, and partial instability of the ankle joint. A second degree ankle sprain prevents you from moving freely, causing increased pain when you try to put weight on the ankle joint. Cold compresses help reduce pain and swelling. It is necessary to avoid putting any weight on the affected ankle and to immobilize it and wear a stabilizer.

If a third degree ankle sprain occurs, severe pain, significant swelling, joint instability, and extensive hematomas occur, which is related to damage to the joint capsule. The ailments cause serious difficulties in walking, which intensifies when trying to put weight on the foot. It is necessary to immobilize the ankle and wear a stabilizer, avoid physical exertion, and use compresses, among others. from acidic water or cold compresses, which reduce pain and swelling. Due to the severity of symptoms, it is necessary to use painkillers. Quite often, grade III ankle sprains require surgical intervention.

Symptoms of ankle sprain should always be consulted with a specialist. Even in the case of a minor ankle sprain of the first degree, it is recommended to take an X-ray to exclude more serious injuries.

Ankle sprain – how long does treatment take?

The duration of treatment for an ankle sprain depends on the degree of damage to the ankle joint. A degree 1 ankle sprain does not require long treatment and rehabilitation – by following the specialist’s recommendations, we can return to normal functioning approximately 7-10 days after the injury. A grade II ankle sprain requires slightly longer treatment. It usually takes about 14 days for the symptoms to go away. Grade III ankle sprain requires 4-6 weeks of treatment and rehabilitation.

Important! Treatment time depends on the severity of the injury. The process of tissue regeneration does not always proceed in the same way, which may prolong the duration of symptoms.

Treatment of a sprained ankle is preceded by assessing the degree of injury. If the symptoms indicate a first degree ankle sprain and the X-ray does not reveal any abnormalities in the form of bone fractures or cracks, the patient does not need to undergo additional tests. More serious injuries require specialized tests – to assess the extent of the damage, e.g. magnetic resonance imaging of the ankle joint may be performed.

Sprained ankle – first aid

If you suspect an ankle sprain, you should:

• protect the ankle joint – you cannot put any weight on the painful ankle,

• stiffen the ankle joint, e.g. with an elastic bandage,

• apply a cooling compress,

• prevent significant swelling – it is recommended to raise the leg above the level of the heart.

Important! An ankle injury should prompt immediate cessation of physical activity and consultation with a doctor.

Sources:

Monika Bilewicz, Robert Stebel, Anna Czerkies, Ankle sprain and the consequences of its treatment, PrzypadkiMedyczne.pl, 2012, 23, pp. 88–92.

Agnieszka Pedrycz, Małgorzata Frąckiewicz, Beata Cichacz, Piotr Siermontowski, Injuries in the ankle joint. Diagnostics, prevention, surgical treatment, Polish Hyperbaric Research, 4(49), 2014.

Brzezińska P., Mieszkowski J., Comprehensive physiotherapy treatment for ankle sprain, Journal of Education, Health and Sport, 5/2015.