Ankle sprains are very common injuries and may happen to anyone. Some people think of them as sports injuries but that is not always true. Anyone can sprain their ankle especially when walking on uneven surface and/or wearing uncomfortable, impractical, inappropriate footwear. In this article we will explain the nature of ankle sprains and focus on the symptoms that indicate their occurrence. Even though most ankle sprains are minor injuries, you should know that it is important to see your doctor as soon as possible in case of a sprained ankle, especially if your ankle is very swollen.
What does it mean to sprain your ankle?
In our bodies, we have some tissues that connect our bones together and stabilize our joints. They are called ligaments and are strong and fibrous. Here are the two most important ligaments in our ankles (sadly, as a rule, they are the ones that get strained):
- Calcaneal fibular ligament (CFL) – the ligament that connects the fibula or calf bone (a leg bone on the lateral side of the tibia, the shinbone) with the calcaneus bone (heel bone)
- Anterior talofibular ligament (ATFL) – the ligament on the outside of our ankles, which connects the talus bone (also called ankle bone) with the fibula
So, to sprain your ankle means to tear one or more of its supporting ligaments. When there are only tiny tears in the fibers of the ligaments, the sprain is not severe, but if it is, the tear goes all the way through the tissue. The most usual situation is when you roll your ankle inward and thus injure your anterior talofibular ligament (inversion sprain). A more serious ankle injury that requires immediate medical help happens when you roll your ankle outward (eversion sprain). The pain can be felt along the inner side of the ankle.
What is the difference between a sprain and a strain?
While sprains are an injury to a ligament, strains are injuries to a muscle and/or a tendon (soft but flexible tissue structures that connect our muscles to our bones – while the muscle is fleshy and elastic, the tendons are dense and fibrous). One typically strains the muscles or tendons in his or her back, foot or leg. Like sprains, a strain may be mild, moderate or severe. This depends on the level of damage to the muscle or tendon. There may be a partial or complete tear, like in ligaments. The symptoms of a strain are similar to the symptoms of a sprain.
What are the symptoms of an ankle sprain?
- Pain is the first indicator that something is wrong. The pain could be mild or more severe, depending on whether or not the ligaments have been completely torn;
- After the pain develops a swelling and also bruising (if there is bleeding under the skin);
- At times the ankle may get very tender to touch;
- In the more serious of cases, the ankle becomes unstable due to joint dislocation – the result of severe ligament tissue tear;
- Restricted range of motion – if you cannot move you ankle at all, this most probably means that you have sprained it;
- Inability to put weight on the ankle that is affected – if you have serious trouble walking and your ankle is very swollen, contact your doctor immediately;
- Skin discoloration – sometimes, when an ankle is sprained, you break some of the blood vessels and they bleed into the tissue, creating a bruise. Thus, your skin may become discolored for some time and there may also be different colors coming as it starts healing – blue, green, purple.
- Stiffness – a stiff, swollen ankle cannot move much. Your doctor may try moving your ankle in different directions to determine whether or not it has been sprained. This physical examination will most probably be painful, if your ankle is sprained. He or she may also palpate (examine by touching), carefully pressing around the injured ankle to evaluate the seriousness of the condition and exactly which of the ligaments have been torn;
- If the ligaments have been severely torn, you may also hear or feel a certain “pop” when the sprain takes place;
- The symptoms of a severe ankle sprain are very similar to the symptoms of a broken bone and they require quick and efficient medical evaluation.
Based on your symptoms, your doctor will determine the severity of the ankle sprain, that is, the grade of the sprain, after he or her has performed the physical examination and the needed tests. Here are some of them:
- X-rays – they may be ordered if your doctor has doubts as to whether or not you have a broken bone (as the symptoms of a broken bone are similar to those of a sprain, like we stated earlier)
- MRI scan (magnetic resonance imaging) – your doctor may find this test useful for the evaluation of your health situation if he or she suspects that the ligaments have been completely and severely torn or if he or she thinks there may be damage to the cartilage or bone of the joint surface. However, this scan is only performed after the initial swelling and bruising have passed.
- Ultrasound – this provides for a direct ligament observation (while your doctor moves your ankle) and helps your doctor in his or her evaluation of the stability the certain ligament provides to your ankle;
- Stress x-rays – these may be ordered as an addition to plain x-rays. They are particularly useful if your doctor wants to see if the ankle is moving abnormally due to damaged ligaments. So, while these scans are performed, the doctor gently pushes the ankle in different directions.
After that, a treatment plan will be given to you, depending on the seriousness of the situation. Sprains are graded based on how much damage has occurred to the ligaments.
- Grade 1 sprain (mild) – it is associated with minimal tenderness and swelling around the sprained ankle. The ligaments are not completely torn; they are only slightly stretched and have microscopic tears.
- Grade 2 sprain (moderate) – it is associated with partial tearing of the certain ligaments. There is moderate tenderness and swelling around the ankle and the ankle joint seems abnormally loose if moved in certain ways.
- Grade 3 sprain (severe) – it is associated with total ligament tear. There is some significant swelling around the hurt ankle and also some significant tenderness to touch present. The ankle is even more instable than with Grade 2 sprain and that can be observer when the doctor pushes or pulls on the joint of the ankle.
You should call your doctor if you suspect that you have sprained your ankle, especially if you have severe symptoms because this means that you may have broken a bone in your ankle. He or she will evaluate the situation and tell you whether or not you will do with home treatment. Maintaining your muscle flexibility, balance and strength is very important if you wish to prevent any possible future sprained ankles. You also have to learn to recognize the signals your body is sending you, that is, pay attention to its warning signs, take a break when you start feeling fatigue or pain. Be sure to buy proper footwear and avoid uneven surfaces. Remember that it is of vital importance to treat your ankle properly and give it time to heal, if an injury occurs nonetheless. With proper treatment and rest, most patients are able to resume their daily activities after a short period of time.