By Live Dr - Tue Sep 02, 1:28 pm
Reviewed by Dr John Pillinger, GP
How do you sprain an ankle?
A sprained ankle happens when the ligaments have been damaged by the joint being twisted.
When you twist your foot or ankle, it usually twists inwards damaging the ligaments on the outside of the ankle. Outward twists damaging the inside ligaments are rare.
The majority of cases are sports injuries but a sprained ankle can also happen in everyday life.
If you do not receive the appropriate physiotherapy treatment and allow the injury time to recover you will be more likely to sprain the area again.
What does a sprained ankle feel like?
A sprained ankle can be very painful. But the speed of onset and the severity of the pain can vary greatly.
Sometimes, the pain can be delayed, at other times it is instant. The level of pain is not always a measurement of the extent of the damage. Some people hear a ‘pop’ in their ankle. This could suggest a torn ligament. The twist is followed by swelling of the area.
Rapid, significant swelling usually indicates severe damage has taken place. The swelling is caused by bleeding of the damaged tissue and the resultant bruise or discolouration is a result of gravity pulling the blood downwards. So the swelling is often situated a small distance away from the actual damaged site.
What are the danger signs?
There are no actual danger signs but after a sprain you may feel your ankle is unstable, you may have problems controlling it, or you may have balance problems when standing on the affected foot. In these circumstances, it is essential to get advice about appropriate physiotherapy treatment and exercise.
If you have persistent pain and a feeling of instability, you may have sustained damage other than a sprain. These symptoms need further assessment by a doctor.
What can be done at home?
Injuries of this kind should receive first aid treatment following the RICE principle, which stands for Rest, Ice, Compression and Elevation. Cooling the injury as fast as possible will reduce the swelling and pain.
The injured foot must be rested for the first 24 to 48 hours to prevent any further injury.
The damaged area must be cooled by using an icepack or a packet of frozen peas. The ice must never have direct contact with the skin or the patient could get frostbite. A cloth should be placed between the ice and the skin. Ice can be laid on the affected area for up to 20 minutes every hour, but for no longer than three hours in all. Ice treatment has been known to be effective for up to 24 hours after the injury occurred.
The compression must be firm but not too tight. It must not be allowed to affect the blood circulation. An elasticated bandage from the toes to the middle of the lower leg would be ideal.
The foot must be elevated above heart level. It is most comfortable to lie down and elevate the limb with a few pillows. If you are sitting down, the legs can be raised on a chair or a table. This elevation should be maintained for a few days.
How does the doctor make a diagnosis?
The doctor will assess the degree of swelling and the extent of the damage and whether the tenderness corresponds to the position of the ligaments or bones. Finally, any weakness of the ankle will be assessed.
If a fracture is suspected, an X-ray examination will be necessary.
Depending on how bad the damage is, these symptoms will usually go away between one and four weeks after the accident.
The immediate tenderness can persist for one to four weeks, depending on the extent of the damage. Support-related pain can persist for up to three months.
With the correct approach, there will rarely be any lasting symptoms but a small number of people have ongoing pain and a feeling that their ankle is weak. If this is the case, further investigation may be needed to find the cause of any ongoing symptoms.
For a more severe sprain, you need physiotherapy and you should not do any sports training for at least six weeks.
The primary treatment by RICE is adequate to achieve recovery following minor sprains.
When receiving treatment, it’s important to give the physiotherapy time to work. The patient must avoid damaging the ankle further by not allowing it to bear too much weight too early.
The physiotherapy is aimed at starting to move the foot after one or two days. After this, a lot of balance training is required, on the floor and using other apparatus such as a wobble board or seesaw board or a trampoline. This is important to restore the stability of the ligaments.
In addition, strength must also be restored to the joint by training. Later in the recovery period more complicated running patterns can be attempted such as running zigzags, figures of eight and so on.
If the ankle is not allowed to mend properly, sportspeople often complain of loose joints or ligaments. This is almost always avoidable by patience and rehabilitation. It is better for sportspeople to be able to concentrate 100 per cent on their sport rather than on their fear of another injury due to lack of careful rehabilitation training.What medication can be used?
The doctor may prescribe a non-steroidal anti-inflammatory drug such as ibuprofen (eg Brufen).
Your doctor or pharmacist will also be able to advise you about creams, gels and support bandages which can be used to treat minor sprains and be bought from a pharmacist without a prescription.
Based on a text by Dr Hans Gad Johansen, specialist and Dr Ejnar Kuur, consultant