“Ahh Gawd! I Twisted my Ankle!”

Ankle sprains

The most common ankle injury, maybe even the most common injury of the body, is the ankle sprain.  Because of that we wanted to provide a little bit more detail into these injuries.  Ankle sprains occurs whenever any of the ligaments that hold the ankle together get stretched from excessive force.

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The most common ankle sprain is the inversion ankle sprain on the lateral ligaments. © Aksana Kulchytskaya | Dreamstime.com

Inversion Sprains

The most common ankle sprain is the inversion sprain that effects the ligaments of the lateral ankle.  (For greater reference head back to our ankle anatomy post for more on just the general anatomy of the ankle).  On the lateral, or outside part of the ankle, there are three main ligaments that hold the ankle together; the anterior (ATFL) and posterior talofibular ligaments (PTFL) and calcaneofibular ligament (CFL).  The number one sprained ligament being the Anterior talofibular ligament (ATFL).  It typically occurs when your ankle goes through an excessive inversion force (rolling over your unturned foot).  If you roll your ankle bad enough you can also injure the other lateral ligaments as well. They are common among athletes who participate in sports that involve running on changing terrains, repetitive jumping, or frequent changes in direction, such as basketball, volleyball, soccer, football, and cross-country.



Eversion Sprains

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Less common but frequently seen in falls or with greater force injuries is the eversion ankle sprain. © Aksana Kulchytskaya | Dreamstime.com

Less common than the inversion or lateral ankle sprain is the eversion or medial ankle sprain.  This involves the deltoid ligament on the inside or medial aspect of the ankle.  It typically occurs with greater force like when people jump and land wrong, when people fall, or if their foot is planted and they get hit from the lateral side.  They are common among athletes who participate in sports that involve running on changing terrains, repetitive jumping, or frequent changes in direction, such as basketball, volleyball, soccer, football, and cross-country.  They are even more common in any of the sports where the athlete could jump and then land on an opponents foot rolling the ankle laterally into excessive eversion.



High Ankle Sprains

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A High Ankle Sprain is when the ligaments that keep the tibia and fibula together get sprained by being separated. © Aksana Kulchytskaya | Dreamstime.com

Even less common than eversion sprains are high ankle sprains.  When you stand up the natural tendency of our lower leg bones is to split apart.  We generate more force when we walk, run, or jump as these and similar activities will try to separate the two bones further.  The ligaments that prevents those bones from separating is called the syndesmosis.  A high ankle sprain effects the syndesmosis when a combination of inversion and dorsiflexion occur at the ankle that will sprain or separate the syndesmosis.  It typically occurs when there is a sudden twisting, turning or cutting motion while a person is running or jumping. They are most common in athletes who play high-impact running sports like football, soccer, basketball and lacrosse.  You would typically feel pain that radiates up your leg from the ankle. Each step you take may be quite painful, and the pain is usually even worse if you move your foot in the same way as when the injury occurred.  For example, if you were running and then cut to the left this motion would continue to hurt.  The other issue with high ankle sprains is that there is typically little to no swelling or bruising.  Due to this it is oftentimes hard for the athlete or coaches to really appreciate the damage that has occurred.  Depending on the athlete, the severity of the injury, and the sport these injuries can take anywhere from 6 weeks to 6 months to fully heal.


Ankle Sprain Grades

All ankle sprains are classified into 3 major categories (Grade I- Grade III) and depending on the grade, symptoms may range from pain, swelling, bruising, tenderness to touch, difficulty or inability to walk or bear weight.

Ankle sprain, inversion ankle sprain, eversion ankle sprain, high ankle sprain

Lateral ankle sprains are the most common type of ankle sprain. © Alila07 | Dreamstime.com

Grade I is the mildest form of ankle sprain. Microtearing may occur in the ligaments presenting with minimal swelling, no bruising, and slight point tenderness to palpation of the area. The person may present with a slight limp and difficulty with jumping or hopping. Recovery may take 2-10 days.

Grade II presents with slight bruising and localized swelling in the area of the injury due to partial ligament tearing. The person will most likely have difficulty with heel raises, running and jumping. They will present with a limb and difficulty bearing weight on that leg. Recovery may take up to 30 days.

Grade III is the worst case ankle sprain scenario. Ligaments are completely torn and the person will present with significant pain, swelling and bruising for the ankle/foot. They will be unable to bear any weight on the foot. Due to the severity of ankle instability, this recovery could take up to 3 months.

Depending on the grade/level of sprain symptoms may range from pain, swelling, bruising, tenderness to touch, difficulty walking or even an inability to walk or bear weight.

Immediately after injury the first course of treatment would be rest, ice, compression,and elevation.  Afterwards depending on the severity it could range from just rest, taping/bracing of some sort, all the way up to significant time being immobilized in a boot or non-weight bearing.  In the most severe cases involving a full tear of the ligament a surgical repair would be required.   Rehabilitation consists of exercises to improve swelling, range of motion, strength, balance, return to walking normally, and in athletes a return to running/sports. If not rehabilitated properly, probability of ankle sprain re-injury could be as high as 50%.

If you have sprained your ankle or are having any symptoms described in this article or have any new/unusual pain, numbness, stiffness or tingling in any part of your body, arms or legs, contact us today!  With Direct Access in NJ we can get you in for an evaluation without you having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!  

Please, call us to schedule your evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700)  with one of our highly trained Doctors of Physical Therapy!

McGovern, R. P., & Martin, R. L. (2016). Managing ankle ligament sprains and tears: current opinion. Open access journal of sports medicine7, 33–42. https://doi.org/10.2147/OAJSM.S72334

Dubin, J. C., Comeau, D., McClelland, R. I., Dubin, R. A., & Ferrel, E. (2011). Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of chiropractic medicine10(3), 204–219. https://doi.org/10.1016/j.jcm.2011.02.001