Ankle injuries occur commonly and the most common type is ankle sprain which can vary in severity from being relatively benign to the very serious. If not managed appropriately ankle sprains can result in long term complications for the individual.

Dr. Brett Hodge

What is an ankle sprain?
An ankle sprain results when ligaments (fibrous bands) that connect the bones in the foot, ankle and lower leg are stretched or torn. Sprains can occur while people are doing normal movements, but the vast majority occurs when individuals make rapid shifting movements with their foot planted on the ground or floor. This commonly occurs while playing certain sports like football. Ankle sprains are graded according to their severity with grade three being the most severe (resulting in a complete tear of the affected ligament or ligaments accompanied by severe swelling and bruising). Grade one is the least severe. An ankle sprain may occur with a fracture but the majority of ankle sprains occur in the absence of a bone fracture.

How do you know you have an ankle sprain?
You usually feel a sharp pain at the site of stretching or tear in the ligament. Very often the ankle begins to swell and bruising develops. The affected ankle becomes painful when you touch it.
In some ankle sprains you may feel or hear a tearing sensation and a pop or snap in the affected ankle. You may also experience pain in the ankle and have difficulty walking or even putting weight on your foot.

Diagnosis
Your doctor should be able to make the diagnosis. Your doctor will often take a detailed history, including asking questions on how the injury occurred and about prior injuries. An examination of the ankle will be done. If a sprain is mild, X-rays may not be needed. In severe cases an X-ray is done to rule out a fracture of the surrounding bones. X-rays are strongly recommended in children with injuries to the ankle.

Treatment
The majority of sprains are managed by family doctors with the most severe cases being referred for specialist care. The use of a protective brace is recommended to support the ankle, along with a compression wrap, such as an elastic ACE bandage, for the first 24 to 36 hours following the injury.
Rest is important and individuals should use crutches until walking is not painful without them.
Immediate application of ice is strongly recommended for at least 24 to 72 hours or until the swelling goes down. Direct ice should not be applied to the ankle. An ice pack or towel with ice should be used for 10 or 20 minutes every one or two hours during the day.
Non-steroid anti-inflammatory drugs should be used as directed-not only when you have the pain. These medications should be used for the first few days as prescribed.
Compression wraps such as elastic ACE bandage, should be applied to help decrease swelling.
Elevation of the ankle above the level of your heart for 2 to 3 days will markedly decrease swelling around the ankle.
After this initial treatment rehabilitation exercises are crucial for ankle sprains successful recovery.
Surgery is a treatment option in severe ankle sprains or when the ankle remains unstable after rehabilitation.
Most sprains heal completely within a few weeks. Appropriate treatment help individuals with ankle sprains avoid chronic ankle pain or arthritis in later life. If ankles are not correctly treated it can lead to the ankle joint becoming very unstable and prone to further injuries in the future.

Things to avoid after an ankle sprain
Immediately after an ankle injury it is important to decrease the amount of swelling around the ankle joint. The following should be avoided:
You should not take hot showers.
Avoid heat rubs like “Ben Gay” (your grandmother may disagree) and hot packs.
Aspirin should be avoided as it may affect blood vessels around the ankle joint resulting in increase bruising.

Conclusion
Early and appropriate treatment is very important in the successful treatment of ankle sprains. Ankle sprains are usually managed very successful by a family doctor, but some can be very severe requiring specialist care and prolonged treatment. Rehabilitation exercises which can be started as soon as the pain subsides are critical for the ankle to heal completely.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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