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Ankle Sprain

From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

What is a sprained ankle?

A sprained ankle occurs following a sudden sideways or twisting movement of the foot. An ankle sprain can occur during athletic events or during everyday activities. All it takes is an awkward step or an uneven surface to cause an ankle sprain--that is why sprained ankles are among the most common orthopedic injuries. Orthopedic doctors see patients for ankle sprains very often, and it is the most common foot and ankle injury.

How does an ankle sprain occur?
A sprained ankle usually occurs when a person lands from jumping or running on to an uneven surface. For example, sprained ankles are often seen when basketball players come down from a jump and land on another player’s foot. Ankle sprains also occur with more routine daily activities such as stepping off a curb or slipping on ice.

What happens inside the ankle when it is sprained?
An ankle sprain is an injury to the ligament in the ankle. The ligaments are structures that control excessive movement of the joint. When an ankle sprain happens, the ligament is stretched too far, and is either partially or completely torn.

There are two broad categories of ankle sprain:

  • Inversion Ankle Sprains
    The most common type of ankle sprain occurs when the foot is inverted, falling inward. When this type of ankle sprain happens, the outer, or lateral, ligaments are stretched too far. There are three ligaments that attach to the outer side of the ankle. About 90% of ankle sprains are inversion injuries. Pain is always on the outside of the ankle, and there is usually no pain on the inside of the ankle joint.

  • Eversion Ankle Sprains
    The other type of sprained ankle is called an eversion injury, where the foot is twisted outwards. When this occurs, the inner ligament, called the deltoid ligament, is stretched too far. Patients will have pain on the inner side of the ankle.

    What are the symptoms of an ankle sprain?
    Common symptoms associated with an ankle sprain are pain with swelling and bruising. The degree of symptoms tends to correlate well with the extent of the damage to these ligaments.

    • Grade I Ankle Sprain:
      Grade I ankle sprains cause stretching of the ligament. The symptoms tend to be limited to pain and swelling. Most patients can walk without crutches, but may not be able to jog or jump.

    • Grade II Ankle Sprain:
      A grade II ankle sprain is more severe partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.

    • Grade III Ankle Sprain:
      Grade III ankle sprains are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.
    As said before, pain and swelling are the most common symptoms of an ankle sprain. Patients often notice bruising over the area of injury. This bruising will move down the foot towards the toes in the days after the ankle sprain--the reason for this is gravity pulling the blood downwards in the foot.

    Do I need to see the doctor if I have an ankle sprain?
    If you do have significant symptoms following a sprained ankle, you should seek medical attention. Signs that should raise concern include:

      • Inability to walk on the ankle
      • Significant swelling
      • Symptoms that do not improve quickly or persist beyond a few days
      • Pain in the foot or above the ankle
    Differentiating between a sprained ankle and an ankle fracture can be difficult, and sometimes an x-ray is needed. While moderate pain and swelling are common symptoms following a simple sprained ankle, symptoms such as inability to place weight on the leg, numbness of the toes, or pain that is difficult to manage should raise concern. If you think you may have done more than sustained a sprained ankle, you should seek medical attention.

    What is a 'high ankle sprain'?
    A high ankle sprain is a particular type of injury to the ligaments around the ankle. In a high ankle sprain, the ligaments above the joint are also injured. These ligaments, called the syndesmosis ligaments, can also be injured, and may necessitate a longer course of rehabilitation.

    What is the treatment of a sprained ankle?
    Treatment of sprained ankles is important because returning to normal activities in a timely manner is important for most patients.

    Read on for more information on the treatment of sprained ankles...

    • Updated: March 25, 2007
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