Ankle sprains are the most common sports injury. Most ankle sprains occur on the outside part of the ankle and happen when your foot is pointed down and inward. One of the most important things is the correct diagnosis of the ankle sprain and its severity. Managing the injury is very important to prevent further injuries down the road. If left untreated, ankle sprains can lead to chronic instability and impairment.
Grading Scale for Ankle Sprains
- Grade I:
- Involves a stretch of the ligament with microscopic tearing, but no macroscopic tearing
- Little to no functional loss
- No difficulty weight-bearing
- Minimal to no swelling
- Localized tenderness to ATFL (ligament towards outside part of ankle)
- Requires 14 days to return to normal
- Grade II:
- Involves a stretch of the ligament with partial tearing
- Moderate functional loss
- Mild-to-moderate joint instability
- Usually have difficulty bearing weight
- Localized swelling
- More diffuse tenderness to lateral ankle
- Requires 2-6 weeks to return to normal
- Grade III:
- Involves complete rupture of the ligament
- Inability to bear weight – typically, cannot bear weight without experiencing severe pain
- Moderate-to-severe instability of the joint
- Significant swelling
- Should seek medical attention to rule out rupture
- Greater than 6 weeks to return to normal
Now that you have figured out how severe your ankle sprain is, what comes next? The very first step is listed below. No matter which category the sprain falls into, you need to start by managing the acute symptoms.
- Protect – use bandage or splint depending on severity
- Rest – avoid prolonged standing or walking
- Ice – to reduce inflammation and pain
- Compression – to help manage swelling
- Elevation – keep above heart level
- Early Physical Therapy! – learn what to do and what not to do, use modalities to accelerate healing and reduce swelling/inflammation, strengthen muscles, regain normal mobility, and normalize walking mechanics. Your physical therapist will let you know when your ankle has returned to baseline. They can also guide you back into more dynamic activities appropriately so you don’t re-injure yourself.
If you do not fully rehab after an ankle injury, it can lead to recurrent ankle sprains or other injuries down the road. “Lateral ankle sprains are often considered a benign injury with no lasting consequences. However, at least one-third of individuals who sustain an lateral ankle sprain will experience residual symptoms (Shah).”
Common Risk Factors of Recurrent Ankle Sprains
- Healing of ligaments in lengthened position
- Weakness of previously injured ligaments
- Foot and ankle muscle weakness
- Distal tibiofibular or subtalar instability
- Genetic hypermobility
- Loss of proprioception
- Ankle impingement
When is Surgery Needed?
- Most ankle sprains can and will be treated nonoperatively and do not require surgery.
- If any ligament is completely torn and your ankle has become unstable, surgery will be required.
- If you have had multiple ankle sprains and your ligaments have been stretched out over time, it is possible your ankle has become unstable and may benefit from a stabilization surgery.
To dive further into ankle sprains, click on the link and go to our page dedicated to them!
Shah, S., Thomas, A. C., Noone, J. M., Blanchette, C. M., & Wikstrom, E. A. (2016). Incidence and Cost of Ankle Sprains in United States Emergency Departments. Sports health, 8(6), 547–552. https://doi.org/10.1177/1941738116659639