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Ankle Sprain

  • Definition

    An ankle sprain is a partial or complete tear of the ligaments that support the ankle. Ligaments are strong bands of tissue that cross joints and connect bones to each other.
    Sprained Ankle
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  • Causes

    Ankle sprains may be caused by:
    • Falling
    • Sudden twisting of the ankle, such as:
      • Stepping on an uneven surface or in a hole
      • Taking an awkward step when running, jumping, or stepping up or down
      • Having your ankle roll over when playing sports or exercising—called inversion of the foot
  • Risk Factors

    Factors that increase your chance of getting an ankle sprain include:
    • Playing sports, especially with the wrong type of shoe
    • Walking on uneven surfaces
    • Weak ankles from a previous sprain
    • Having:
      • Poor coordination
      • Poor balance
      • Poor muscle strength and tight ligaments
      • Loose joints
    • Certain footwear, such as high heels
  • Symptoms

    Symptoms of an ankle sprain may include:
    • Pain, swelling, and bruising around the ankle
    • Worsening of pain when walking, standing, pressing on the sore area, or moving the ankle inward
    • An inability to move the ankle joint without pain
    • A popping or tearing sound at the time of the injury
  • Diagnosis

    An ankle sprain may not require a visit to the doctor. However, you should call your doctor if you have any of the following:
    • Inability to move the ankle without significant pain
    • Inability to put any weight on that foot
    • Significant swelling or bruising
    • Pain over a bony part of your foot or ankle
    • Pain that interferes significantly with walking
    • Pain not relieved by ice, pain relief medication, and elevation
    • Numbness in the leg, foot, or ankle
    • Pain that does not improve in 5-7 days
    • Uncertainty about the severity of the injury
    • Uncertainty about how to care for this injury
    You will be asked about your symptoms and how your injury occurred. An examination of your ankle will be done to assess the injury.
    Images may be taken of your ankle. This can be done with x-rays. If additional details are needed, other images may be done, such as a CT scan or an MRI scan.
    Ankle sprains are graded according to the damage to the ligaments. The more ligaments involved, the more severe the injury.
    Grade 1
    • Some minor tearing of ligament tissue
    • Ankle remains stable
    Grade 2
    • Partial tearing of ligament tissue
    • Mild instability of the joint
    • Usually involves damage to 2 ankle ligaments
    Grade 3
    • Complete tearing of 2 or 3 of the ligaments
    • Significant instability of the joint
  • Treatment

    Supportive Care
    The ankle will need time to heal. Supportive care may include:
    • Rest—Activities may need to be restricted. Normal activities will be gradually reintroduced as the injury heals.
    • Ice—Ice therapy may help relieve swelling.
    • Compression—Compression bandages can provide gentle pressure to help move fluids out of the area.
    • Elevation—Keeping the ankle elevated can help fluids drain out or prevent fluids from building up.
    • Protection—A brace or walking boot may be advised to prevent the ankle from moving as it heals. A short leg cast may be advised in severe cases, but this is rare.
    Over-the-counter medications may be advised to reduce pain.
    Physical Therapy
    A physical therapist will assess the ankle. An exercise program will be created to help recovery and to strengthen the muscles around the ankle.
    Surgery is rarely needed to repair an ankle sprain. However, it may be necessary to repair a third degree sprain in which all 3 ligaments are torn.
  • Prevention

    Many ankle sprains cannot be prevented. However, you can reduce your risk of spraining an ankle:
    • Take a break from sports or exercise when you feel tired.
    • Do exercises that improve your balance and strengthen leg and foot muscles.
    • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments, and tendons, including those around your ankle.
    • If you have injured your ankle before, you are more likely to injure it again. You may reduce your risk of repeated sprains by wearing an ankle brace and by doing certain balance exercises.
    • Wear appropriate footwear when playing sports to avoid injury.

    Ortho Info—American Academy of Orthopaedic Surgeons

    Sports Med—American Orthopaedic Society for Sports Medicine


    Canadian Orthopaedic Association

    Canadian Orthopaedic Foundation


    Ankle sprain. EBSCO DynaMed website. Available at: Updated August 21, 2015. Accessed February 29, 2016.

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    Kerkhoffs GM, Handoll HH, et al. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD000380.

    Sprained ankle. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: Updated February 2016. Accessed February 29, 2016.

    Sprains and strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: Published January 2015. Accessed February 29, 2016.

    10/26/2010 DynaMed's Systematic Literature Surveillance Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

    11/19/2010 DynaMed's Systematic Literature Surveillance van Rijn RM, van Ochten J, Luijsterburg PA, van Middelkoop M, Koes BW, Bierma-Zeinstra SM. Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review. BMJ. 2010;341:c5688.

    9/10/2014 DynaMed's Systematic Literature Surveillance Mosher TJ, Kransdorf MJ, et al. ACR Appropriateness Criteria acute trauma to the ankle online publication]. Reston (VA): American College of Radiology (ACR);2014. 10 p. Available at: Accessed March 3, 2015.

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