Sprains (Ligament Injuries)

1. This shows the anatomy of the shoulder joint.

1. This shows the ankle joint, with many of the connecting ligaments.

2. This shows the different severities of an ankle sprain.

3. Soccer athletes are at risk for ankle sprains, due to the cutting and rolling the foot motions in the sport. Competitive soccer athletes are particularly at risk for high ankle sprains, which are more severe ankle injuries resulting from high energy collisions.

4. This shows the characteristic bruising and swelling of an ankle sprain.

Ligament Injuries

What is an ankle sprain?

The ankle, or talocrural joint is a complex structure of muscles, tendons, ligaments and other soft tissues. Ankle ligaments are a type of slightly stretchy tissue that connects bones within the ankle.

An ankle sprain is when one of the ligaments of the ankle is torn. This is often caused by falling, someone stepping on your foot, or walking or running on uneven surfaces. Sports like soccer, tennis, and basketball that involve cuts or rolling the foot can also increase the risk of these injuries.

Anatomy of the Ankle Joint

The ankle ligaments connect the the tibia, fibula, and calcaneus bones of the ankle. They help support the ankle, absorb shock, keep it stable, and stop it from moving in unnatural ways.

The ankle has three types of ligaments: medial, lateral, and syndesmotic. The lateral ligaments are on the sides of the ankle and the medial ligaments are located on the inner ankle, and the syndesmotic ligaments lie on top of the ankle, connecting to the tibia or fibula.

What are the types of ankle injuries?

Ankle sprains can occur in many different ways and severities. The three most common types of ankle injuries are inversion, eversion, and high ankle sprains.

In eversion, the foot rolls inward, injuring the lateral ligaments of the outer ankle. This is the most common ankle sprain as lateral ligaments are the weakest.
Eversion injuries occur when the ankle rolls outward, injuring the medial ligaments. This type of injury is typically caused by running or jumping, especially on uneven surfaces.
High ankle sprains are more severe injuries that last longer than other ankle sprains, and they injure the syndesmotic ligaments. They happen when your foot is flexed forward and it is twisted, often as a result of collisions. These high energy collisions are more common in competitive athletes that play soccer, football, hockey, or snow skiing. It typically takes around six weeks to recover from a high ankle sprain.

What are the symptoms of this condition?

If you are experiencing local pain, swelling, trouble bearing weight on the joint, weakness, instability, or a “loose feeling” in the ankle, you may have an ankle sprain. Bruising is also a common symptom, though the more severe high ankle sprains have less bruising than the less severe injuries.

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Ligament Injuries

The Complications of Repeated Ankle Sprains

Ankle sprains are not a serious injury in themselves, but failure to recover and repeated sprains can cause more injuries. Repeated sprains weaken the ankle and increase the risk of reinjury, leading to chronic ankle pain, arthritis, or chronic instability. Ongoing pain may be a sign to consult your physician.

Diagnosis and Grades of Sprains

Your physician will perform a history and physical, as well as various imaging tests like X-Rays, MRI, CT, and ultrasound to diagnose your injury. Grade 1 injuries are mild sprains, which may have some swelling and bruising but do not have pain with weightbearing. Grade 2 injuries are partial tears of the ankle that cause some difficulty with weight bearing and rotating. Grade 3 injuries are complete tears of the ankle ligaments, which cause instability and the inability to put weight on the leg.

How is it treated?

Given the variety of ligaments in the ankle that can be torn, severity, and an individual’s pain and risk for future injuries, treatment for these injuries varies. Treatment typically begins with a period of RICE (resting, icing, compression, and elevation) along with immobilization to reduce swelling.

For immobilization, grade two injuries may require a brace and grade 3 injuries may require a cast. Non steroidal inflammatory drugs like Advil, Motrin, Aleve, and Voltaren can help treat pain and inflammation throughout the course of this injury. After immobilization, individuals can begin a range of motion exercises through physical therapy as needed. A variety of medical devices like tape, bandages, crutches, and boots may be used for this injury depending on its severity. If the ankle stays swollen for weeks, you may need to consult your doctor.

If more conservative treatments have been unsuccessful, surgery may be necessary. Recovery from surgery includes a period of rehabilitation with RICE, NSAIDs, and immobilization and then rehabilitation with physical therapy. Recovery time depends on the severity of the injury, but can take from six-eight weeks to months.

How do I prevent it?

Though ankle injuries are common, they are preventable. And preventing repeat sprains is crucial to preserving the stability of the joint. Good shoes, avoiding uneven surfaces, and putting the weak ankle in a brace or taking it up can help prevent these injuries. While you are exercising, especially if you play a sport with an increased risk of ankle sprains, make sure to stretch and warm up before exercising, and “mix up” the type of exercise to avoid overuse injuries. Strengthening the muscles around the ankle joint via exercises can also be helpful. You can find some of these exercises below under “Patient Resources” or under the “Physical Therapy Resources” page of our website.

Sources

Attribution for Images

1. OpenStax College. "919 Ankle Feet Joints". Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:919_Ankle_Feet_Joints.jpg.

2. Laboratoires Servier. “Ankle sprain -- Smart-Servier”. Wikimedia Commons, 29 September 2019. https://commons.wikimedia.org/wiki/File:Ankle_sprain_--_Smart-Servier.jpg.

3. Lorie Shaull. “Carli Lloyd”. Wikimedia Commons, 4 September 2019. https://commons.wikimedia.org/wiki/File:Carli_Lloyd_(48677254417).jpg.

4. Thomas Steiner. "Baenderriss". Wikimedia Commons, August 2005, https://commons.wikimedia.org/wiki/File:Baenderriss.jpg.

5. Edwin Martinez. “Serena Williams”. Wikimedia Commons, 29 August 2013, https://commons.wikimedia.org/wiki/File:Serena_Williams_(9630796711).jpg.

6. Whoisjohngalt. "Ankle brace for grade I or II". Wikimedia Commons, July 16, 2016, https://commons.wikimedia.org/wiki/File:Ankle_brace_for_grade_I_or_II.jpg.

7. Ssu. "Hoka One One". Wikimedia Commons, 22 June 2020, https://commons.wikimedia.org/wiki/File:Hoka_One_One_-_Bondi_6.jpg

8. Cogitato. "Footbalance Insole". Wikimedia Commons, May 5, 2015, https://commons.wikimedia.org/wiki/File:Footbalance_Insole.jpg.

5. Tennis athletes are at risk for ankle sprains, due to the cutting and rolling the foot motions in the sport.

6. This shows a brace offering moderate support and compression for a Grade I ankle sprain.

7. These are Hokas, a brand of supportive shoe. Good shoes, especially good running shoes can help prevent future ankle sprains.

8. Insoles or orthotics can help correct alignment issues of the foot to correct the function of joints, including the ankle joint.