What is it? An ankle sprain is an injury (a stressing, pulling or tearing) of the ligaments supporting the ankle. Most ankle sprains affect the outside of the ankle, where three small ligaments act together to support the joint. The foot will turn inward at the ankle, in what is called an inversion sprain.  Afterward, the joint may feel sore, unstable or both.

A patient who has sustained an ankle sprain will feel pain, but the degree to which they feel this pain can vary widely.  A minor sprain may cause a few twinges at the time of impact and possibly some minor swelling, while others may feel a crippling pain and see pronounced swelling, and may also find the foot unable to bear weight altogether.  It all depends upon the damage done to the ligament (and of course, upon  the individual’s threshold of pain). In no case, however, should a sprain be ignored. Left untreated, a sprain can cause weakness in the joint that can - and often will - lead to re-injury of that joint, or worse yet - to a particularly harmful fall. 

Sprained ankles are a common injury in both athletes and sedentary persons.  For every tennis player, runner or aerobics dancer that feels the unexpected and painful roll when they are out exercising, there’s a less active individual whose ankle unexpectedly twists under them while they are going down the steps to retrieve mail from the mailbox, or while walking out to their car.

What to look for: First, think about the moment you injured your ankle.  Try to identify a time when joint became unsteady or unstable, and the ankle seemed to twist sideways, possibly causing your leg to buckle.  If you can remember an incident like that, chances are you have joined the legions of sprain patients.

Next, check the joint itself.  Are you seeing swelling?  If you’re not sure, check the joint by comparing it to the one on the opposite leg.  Does one look larger, or redder?  If you rotate the foot, do you feel any degree of pain in the ankle?  If you do, and/or if walking is suddenly difficult, with the ankle feeling as though it might twist again any second, suspect a sprain.

Note that we say SUSPECT a sprain.  A podiatric physician should examine the injury and render a diagnosis.  Remember that other injuries, such as fractures and stress fractures may cause pain and weakness in a bone or in a joint.  And to the layperson, the injuries may look and/or feel identical.  A doctor can confirm your injury and rule out other possibilities.  In some cases, an x-ray may be used to ascertain that there are no broken bones since some sprains can hurt as much as, or worse, than broken bones, depending upon the severity and location of the break.  (The technical term for injuries that do not involve bone breaks is “soft tissue damage.”  It sounds mild but don’t be fooled - it can be painful, serious, and have long-reaching consequences if not tended properly).

What NOT to believe: Common misconceptions concerning sprains are that in the case of a sprain, the patient has not suffered a “real” injury, since there are no broken bones. Nothing could be further from the truth.  A sprain can be not only terribly painful, but seriously disabling.  What’s worse, the insistence that a sprain is not a serious injury can lead to the patient simply waiting for it to “go away on its own.”  It won’t.  Repeated use of a sprained ankle will only weaken the joint, making it ever more unstable.  The patient runs the risk of long-term damage to the joint by allowing the ligaments to become even more weakened, stretched or torn - and worse, he or she runs the risk of tripping and falling, which can result in actual broken bones.

The other common misconception is “no pain, no gain,” suggesting that continuing to use an injured ankle will cause it to “toughen up.”  No such luck.  The only thing that re-use can result in is re-injury.

How can I know it’s a sprained ankle? Unfortunately, you can’t know, at least not without professional assistance.  A podiatric physician will need to examine you and make a determination after having an x-ray, or even an M.R.I. or C.A.T. scan performed.  Any number of problems, such as fractures (although there are many, many others) can cause localized pain and/or swelling that worsens over time and makes walking painful or even impossible.  A doctor will be glad to examine your ankle and rule out other problems.

What it means to you: While a sprained ankle is not a life-threatening condition, it certainly is a problem that deserves medical attention. A podiatric physician can evaluate the symptoms and recommend a course of treatment. As with just about every other medical problem, the best way to rid yourself of a sprain once and for all is to get treatment for it as soon as possible.

What causes it? Hyperextension, or hyperflexion of the joint, which stretches those all-important ligaments, sometimes tearing them.  This takes place when the ankle rolls, stretching the ligaments beyond the limits they were designed to accommodate.  It can happen during any level of activity, although many report that it takes place when they are on uneven ground, such as grass with soft spots or holes, rocky areas, on sandy surfaces or where the ground is slippery for any reason. Often, the unexpected movement of the foot as it slips or slides on these surfaces will twist the ankle.  A person might also fall, and twist their ankle under them as they land.

What cures it? The course of action chosen by your doctor will depend upon the severity of the sprain. If the sprain is minor, the doctor may prescribe rest, and will ask the patient to refrain from weight-bearing activities.  Crutches are often the best option to insure that the joint is rested so it can heal.

Some sprains will require immobilizing and stabilizing the area.  Ankle braces, air casts and compression bandages are often employed, depending upon the severity of the injury, and upon the patient’s lifestyle and preferences. 

A formula to remember for treatment and care of sprains is RICE:

R = REST: Stop walking, running, dancing - whatever - on that injured leg.  Crutches will work best to hold it off the ground and to keep all weight off it.

I = ICE: Apply an ice bag or an ice wrap to the affected area to keep the swelling down.  Each doctor has a different theory on how often to apply ice.  Some recommend 20 minutes of ice followed by 20 minutes without.  Others might say for 30 minutes every two hours.  Still others might have different ideas.  Find out what your podiatric physician recommends.  Your local pharmacy or medical supply store may have strap-on ice wraps that will relieve you of having to hold a bag in place constantly.  (Note: Other physicians prefer to alternate ice and heat; ask your doctor what she/he recommends)

C = COMPRESSION: Compression bandages, such as an Ace bandage, will provide support and stability to the joint and keep swelling down.  Air casts and ankle braces might be used in addition to, or instead of, a compression bandage, depending upon your podiatric physician’s recommendation.

E = ELEVATION: Keep the affected leg propped up, so that it does not hang lower than the level of your heart.  If you are working at a desk, bring a chair and a few pillows over, and prop the foot up on those.  This will discourage swelling and increase circulation to the area. This in turn will make the injury less painful.

Your doctor will be best able to recommend a treatment method based on your specific condition; listen to his/her recommendations, and do not be afraid to ask for a second opinion if you are concerned.  Remember that pain and instability in the ankle can be caused by many things, and that it’s best to receive a definitive diagnosis from your podiatric physician before proceeding with any course of treatment.  The longer you wait, the longer it will take the injury to heal, and the more likely you are to re-injure yourself, or to worsen an existing injury. 

Never try to self-diagnose or self-treat a suspected sprain; always have it diagnosed by a professional.

One note of caution: It’s natural to want to get back to your normal activities as soon as possible. Sprains will become less painful relatively quickly, as long as the patient is resting the injured area. Many people, upon discovering that their pain isn’t as severe when they stand or walk, will immediately want to do just that. Remember that as long as you can feel pain - any pain at all - the ligaments are still fragile in that area, and are susceptible to re-injury.  Keep on using the RICE, the crutches, the soft cast, or any other measure prescribed by your doctor, as long as he or she directs.  You won’t heal a sprain by adding to the stress on the joint

How can sprains be prevented?  If your foot has a tendency toward instability (some athletes, for example, over-pronate, or have excessive foot movement in their normal stride), ask your doctor about preventive treatments for sprain.  There are several helpful products on the market, including ankle braces, which can be worn to stabilize the joint during periods of activity (this can mean when you exercise, or it can mean times when you are standing, walking, shopping or doing other activities where you are on your feet for a while.)  The brace may be hard plastic, with a hinge so that you can move comfortably and remain active despite its presence, or it may be a compression bandage that provides light support.  Some patients find that orthoses or  motion-control shoes are all they need in order to stay injury-free. Your doctor and you can work together to arrive at a solution that works best for you.

You may decide that walking or running on specific surfaces, such as uneven trails, or wet or slippery areas, make you more prone to ankle injuries.  Your doctor may be able to recommend specific footgear, or he/she might even advise you to cut back on the time spent on such surfaces, in order to reduce the possibility of injury.

Do these symptoms always mean a sprain? No - as mentioned before, multiple problems, including, but not limited to, injuries caused by improper footwear, stress or traditional fractures, and many other conditions (some very serious) can cause pain in varying degrees of severity.  Therefore, it’s essential to get a professional’s diagnosis of the problem. A delay in getting the correct treatment - not to mention the additional trauma you have inflicted on the damaged area in the meantime - can mean the difference between a simple sprain that heals properly and one that results in a long-term disability.

 Who can help me?
The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) stands ready to help you find a podiatric physician in your area. Simply click on our  foot-help-finder link to find the professional who can help you find the most effective treatment.