Ankle sprains are one of the most common injuries people incur while running, playing sports, or just misstepping on uneven ground.
1. What has actually happened to my ankle when I “roll” or “sprain” it and it begins to swell and hurt?
The most common problem is stretching or tearing of the ligaments of the ankle. Ligaments are tough bands of fibrous connective tissue that bind together the ankle bones and muscles. The tears may be “micro-tears”, but even small tears of ligament tissue cause damage, including the tearing of small blood vessels or capillaries in the ligament tissue. These torn vessels then spill their contents into the surrounding tissue causing swelling and bruising.
2. How do I know I haven’t broken the bones in my ankle?
Most simple sprains that do not involve major trauma do not cause a significant fracture of a bone. Health care practitioners can usually determine if there is a possibility of fracture by history and examination. However, an x-ray examination is the only way to absolutely rule out a fracture. Sometimes an x-ray will show a “chip” or avulsion fracture. The force of the ankle injury may have been sufficient to cause a tendon to pull off a little “chip” of bone (tendons attach muscles to bones). These types of fractures are not usually treated any differently than a bad sprain. And in fact, avulsions heal better than ligament tears!
3. My friend tore the anterior cruciate ligament in his knee and needed
surgery. Do ankle ligaments get surgically repaired?
For several reasons, ankles ligaments are almost never repaired surgically. It generally takes severe trauma to tear ankle ligaments completely apart. In rare cases, especially with professional athletes with repeated injuries, an ankle may be rebuilt.
4. Then how do I get my ankle ligaments back in shape?
First, they need to heal. Get off your ankle and elevate it as soon as the injury occurs. Applying ice will help constrict or clamp down those little torn vessels and there will be less bleeding into the tissues and less swelling and bruising. Ice should be applied for 15-20 minutes at a time for 48 hours or more. The most benefit from icing is derived in the immediate post-injury period, however. Anti-inflammatory drugs such as Ibuprofen help pain and swelling.
5. Do I need crutches or an ace wrap?
Ace wraps provide support for damaged structures and the constriction also retards swelling. Staying off even a mild ankle sprain for the first day or so will “jump start” your recovery, so crutches are a very smart option. Patients often come in to Health Services after a day or two of hobbling around on a sprained ankle. By then they have prolonged the healing process and perhaps done more damage! Crutches should be used until it no longer hurts to walk without them.
6. If I follow all this advice will my ankle return to “one hundred per cent”?
Probably not if it was a bad sprain, but most of the damage can be repaired and overcome with rehabilitation. The ankle is weak and prone to re-injury in the immediate post-injury period. Aircasts and similar devices can help prevent another incident while the ligaments heal. Exercises for strengthening muscles, repairing damaged proprioception in the ankle, and getting moving again are highly recommended. Your health care practitioner can instruct you or refer you to physical therapy for more intensive work.
