The ankle joint connects the leg and the foot. It is formed by three separate bones, the tibia, fibula and talus. The shinbone (tibia) supports most of a person's weight when standing. The outer bone (fibula) is the smaller bone of the lower leg. A small, irregular-shaped foot bone (talus) connects the tibia and fibula. Acting as a hinge, these bones form the ankle. The ankle joint allows movement such as walking, running and jumping, and also contributes to lower limb stability.
The ankle is reinforced by fibrous tissue (ligaments) that connects bone to bone. Ligaments have an elastic structure that allows them to stretch, within their limits, and then return to their normal positions. Ligaments protect the ankle from abnormal movements—especially twisting, turning and rolling of the foot.
When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers of the ligament. A sprained ankle is a very common injury that produces pain and swelling. If the sprain is a result of excess force, you may hear a "pop" sound when the injury occurs. The grade, or severity, of the sprain is determined by the amount of force that caused the injury.
The amount of pain and tenderness resulting from a strain depends on the amount of stretching and tearing of the ligament. The ankle may be swollen and painful, and walking may be difficult. Instability occurs when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
A sprained ankle can happen to anyone, child or adult, athlete or not. It can occur during sports and physical fitness activities, or it can be the result of something as simple as stepping on an uneven surface or stepping down at an angle. When the foot twists, rolls or turns beyond its normal range of motion and the ligaments stretch in an extreme or abnormal position, the ankle may be sprained.
If an ankle sprain is not recognized and treated with the necessary attention and care, chronic problems of pain and instability may result, so it is important to seek care right away. A broken bone or fracture can have similar symptoms of pain and swelling, so your physician may order X-rays to be sure there are no broken bones in the ankle or foot. Once a break can be ruled out, your physician may be able to diagnose the grade of the sprain based on the amount of swelling, pain and bruising. Although the ankle may be tender or painful, it may be necessary to move it in various ways during the exam to determine which ligament has been hurt or torn. After swelling and bruising subsides, an MRI (magnetic resonance imaging) scan may be needed to help ensure a correct diagnosis if your physician suspects a severe injury to the ligaments, injury to the joint surface, a small bone chip, or other problems.
Most ankle sprains need only a period of protection to heal. Swelling and pain usually last 2 to 3 days, however, the healing process takes about 4 to 6 weeks. During this time, use rest, ice, compression and elevation (R.I.C.E.) to help with pain and swelling, and you may also need to use crutches if walking causes pain.
A Grade 1 sprain is commonly treated with R.I.C.E. If your sprain is Grade 2, it make take longer for healing to occur and your physician may use a splint or other device to immobilize the ankle. Grade 3 sprains can be associated with permanent instability. Surgery is rarely needed, however a short leg cast or cast-brace may be used for 2 to 3 weeks.
Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability following months of rehabilitation and nonsurgical treatment. Surgical options include:
With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.
The length of time you can expect to spend recovering after surgery will depend on the extent of injury and the amount of surgery that was required. Rehabilitation to restore strength and range of motion to a level that allows you to return to pre-injury function may take from weeks to months. If appropriate, a foot and ankle conditioning program may also be prescribed.
The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility, as follows:
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