FOOT & ANKLE

Ankle Sprain & Ligament Injury

Ankle sprains or ligament injuries are common amongst people of all ages and activity levels. Ankle sprains occur due to a sudden fall, twist or landing of your foot in an awkward position after a jump causing the ligament to stretch or tear. Around 90% of ankle sprains involve an inversion injury (foot turns inward) to the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments - the lateral ligaments on the outside of the ankle. More severe sprains also known as ‘high-ankle sprain’ can result in injury to syndesmotic ligaments, or even ligaments on the inside of the ankle (medial or deltoid ligament sprain).

Symptoms

Symptoms experienced are dependent on the degree of injury. Some may include:

  • Pain, both at rest and with weightbearing or activity
  • Swelling
  • Bruising
  • Tenderness to touch
  • Instability of the ankle, or feeling that the ankle is giving out



Causes

Patients often recall a twisting injury to their foot or ankle as the primary cause of ankle sprains or ligament injuries. If the sprain is severe causing a tear of the ligaments, you may also hear or feel a pop. Ankle ligament injuries are most common during sports activities, or when you jump or run on an irregular surface.

Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and often confirmed by X-ray of the injured area. An X-ray may be beneficial as severe ankle sprains can have similar degree of pain, bruising and swelling as a fracture making it difficult to distinguish the two.

An MRI may be ordered by your doctor to evaluate other structures such as cartilage and tendons around the ankle, or if you exhibit signs of a high ankle sprain where injury is suspected to structures connecting the bones in the lower leg.

Upon consultation your sprain will be graded depending on the extent of damage to the ligaments.

Grade I (Mild)

  • Minimal stretch with microscopic ligament tear
  • Mild swelling and tenderness around ankle
  • No instability on examination
  • Typically no pain with weightbearing 


Grade II (Moderate)

  • Partial ligament tear
  • Moderate swelling and tenderness around ankle
  • Slight instability on examination
  • Mild pain with weightbearing


Grade III (Severe)

  • Complete ligament tear
  • Significant swelling and tenderness around ankle
  • Substantial instability in examination 
  • Severe pain with weight bearing

Treatment Options

Non Operative Treatment

Most isolated ligament injuries can often be managed without surgery, even grade III complete ligament tears. It is important to initiate the R.I.C.E. method to help treat and prevent excessive swelling:

  • Rest the knee to prevent further damage and pressure on the injury.
  • Ice packs can be applied to the injured area to reduce swelling and pain. Ensure to wrap the ice in a towel and apply to the affected area for 15-20 minutes, four times a day for several days.
  • Compression on the knee by wrapping it with an elastic bandage or compression stocking can help minimise swelling and support the knee.
  • Elevate the foot above heart level to help reduce swelling and pain.


If indicated, anti-inflammatory pain medications may be prescribed to help reduce pain and control inflammation.


During your recovery, rehabilitation exercises are recommended to strengthen and improve range of motion in your foot. A brace or wrap to support and protect your ankle during sports may be required. Pivoting and twisting movements should be avoided for 2 to 3 weeks. Most patients will recover within 6-8 weeks.


Surgery

Surgery for ankle sprains or ligament injuries is rare and only required in patients who have chronic instability or recurrent sprains. Two surgical techniques to treat ankle sprains or ligament injuries are:

  •  Arthroscopy - minimally invasive surgery keyhole surgery that involves inserting a small telescope (arthroscope) to help diagnose and/or treat the injury. 
  • Reconstruction - surgical repair of the ligament or replacement with a graft.


Find out about Ankle Ligament Reconstruction.

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