Sprained ankle
An injury of the ankle where the bone is not damaged but the soft tissues are (mainly a ligament on the side of the ankle) is called a sprained ankle. This most commonly occurs when you “go over” on your ankle.
Your ankle becomes swollen and painful, and is difficult to walk on. Bruising also appears, often at the swollen part, but later on around the edge of the foot and on to the toes, as blood from the torn tissues finds its way past layers of muscle and tendons.
Symptoms
Your ankle is likely to be swollen from almost immediately after you sprain it. The swelling is greatest on the outer side of the ankle if you injure it by going over on the outside edge of your foot (an inversion injury), and greatest on the inner side of the ankle if you go over on the inside edge of your foot (an eversion injury). Obvious bruising may come up immediately, but often takes hours or even a few days to appear.
Your ankle is likely to be very painful, making it difficult to stand on or move your foot in the normal way. It may seem hotter and redder than usual, as well as swollen. This is known as inflammation.
Causes
Usually the cause is going over on your ankle (sometimes called “turning” the ankle). Sometimes the cause is a strain put on the ankle by an impact, for example a football or rugby tackle or a road traffic accident.
Diagnosis
It is usually quite obvious to you that you have injured your ankle. It will be quite painful, but it is a good sign if you can put some of your weight on it.
For an ankle sprain, the treatment is as laid out below, and you can do the majority of this for yourself, especially as the early use of these approaches minimises pain and swelling. However, if you have a bad sprain, or suspect that you might have a more serious injury (such as a broken bone) you should seek advice from your doctor or the local accident and emergency department.
X-Rays (radiographs) are of value in confirming the presence, position or severity of a broken bone (fracture), but they also involve exposing you to radiation, have a cost, and are time consuming. They are therefore best avoided in a simple sprain.
Your doctor might ask for an X-Ray if their findings suggest a fracture is likely, but may well decide not to do this, and using simple rules (for example The Ottawa Ankle Rules) unnecessary X-rays can be avoided.
Treatment
If you have a sprained ankle, you can often deal with it yourself, but if in any doubt about whether it may be anything else, or about the severity of the symptoms, you should seek professional help.
The standard treatment for sprains is often abbreviated as “RICE”, that is:
Rest
Ice (cold compresses). Try using a bag of frozen peas, or crushed ice in a plastic bag, wrapped in a damp cloth (this helps to avoid ice burns). Do not apply for more than a few minutes at a time.
Compression. For example using a crepe bandage or tubular bandage.
Elevation. Have your leg up on the sofa or a stool, but make sure you do not have a hard edge pressing on your calf muscle (to help to reduce the risk of a Deep Vein Thrombosis / DVT).
Undoubtedly a sprained ankle can be very swollen and painful, and often takes three months to settle. Even then, the ankle is a joint which tends to remain weaker after a bad sprain. It may also remain swollen compared to the other ankle.
Your ankle will become pain-free quicker if you rest it, but total inactivity leads to stiffness and thinning of the bones. Certainly the RICE approach helps for the first day or so, and for most people the best thing is to try to continue non-strenuous activities and avoid things likely to put an undue strain on the ankle.
Generally the pain and swelling is worst over the first few days, and if it gets much worse after this you should seek further advice. You may find you are getting a bit better and then put a bit of extra strain on it and worsen your symptoms a little. However, slowly things will get better.
Pain relief and some reduction in inflammation can be provided by taking a non-steroidal anti-inflammatory drug, such as ibuprofen, if you are not allergic to, or likely to be upset, by this. (If in doubt ask your pharmacist or doctor.)
Straight pain relief (analgesia) can be provided by taking paracetamol.
Some people find an embrocation or liniment applied to the skin helps, but this should not be used on sensitive or broken skin.
Physiotherapy treatments can often help with recovery.
Occasionally, your doctor might suggest a steroid injection. This acts rather like an anti-inflammatory drug, and reduces swelling, pain and inflammation, but the body’s natural healing mechanisms are still needed to mend the tissues, and this will usually take quite a few weeks.
If you develop a very weak ankle after an ankle sprain, with a tendency to sprain it frequently, your doctor may suggest that you see an orthopaedic specialist.
Prevention
Keep generally fit.
Use sensible footwear for walking on rough terrain.
Use appropriate shoes for sporting activities.
If you have had a previous ankle sprain you should consider wearing a support for high risk sports such as soccer and basketball (Interventions for preventing ankle ligament injuries).
Further information
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