by Boyd W. Haynes III, MD
Frequently referred to as “rolling” or “twisting” your ankle, sprained ankles are a very common occurrence for patients coming into OSC. Thousands of people experience sprains every day. It commonly occurs in athletes, but also in children and adults. Ankle sprains can be caused by jumping for a rebound in a basketball game or by simply stepping onto an uneven surface. The bone isn’t actually broken, so what actually makes a sprained ankle so painful?
The ligaments in the ankle hold the bones and joints in the correct position, as well as protect the ankle from irregular movements. Ligaments stretch as far as they can to protect the ankle, and then revert back to their original position. The sprain is caused by these ligaments being stretched or torn due to the ankle rolling inward (inversion sprain) or outward (eversion sprain) beyond their normal range of motion. Sometimes if the force is strong enough, you may even hear a pop when the ligament is torn. The results of a sprain are pain, swelling and bruising, and the severity of the injury depends on the amount of force used when it occurred.
There are three types of sprains:
• Grade 1: Ligaments stretched minimally and some damage to the fibers of the ligament
• Grade 2: Ligament is partially torn
• Grade 3: Ligament is completely torn
Sometimes it is hard to differentiate a sprain from a fracture, so patients will require an x-ray to determine the severity of the injury. Often times, a broken bone will have symptoms similar to a sprain. You may even have an MRI (Magnetic Resonance Imaging) scan done if I suspect the injury is severe. There are both nonsurgical and surgical treatment options depending on the sprain and how severely the ligament was affected.
For Grade 1 and Grade 2 sprains, the Protection, Rest, Ice, Compression, Elevation (PRICE) cycle can be used, although Grade 2 will require more time for the sprain to heal. It is important to use your ankle by putting pressure on it in the initial healing stage (If the sprain is significant enough, a lace up ankle support will be used). While you are relatively resting the ankle, ice the area for 20-30 minutes approximately four times per day to reduce the swelling. Compression wraps will help to support the injured ankle by keeping it in place. Finally, elevate your foot above your heart for the first 48 hours after the injury. A Grade 3 sprain may require a larger brace called a CAM Walking boot or the standard lace up ankle brace.
Rehabilitation of the ankle will prevent future chronic ankle problems. There are a few stages in the rehabilitation process for a sprained ankle. The first stage will include relative resting and keeping your ankle moving with elevation to reduce swelling. The second stage will work on strengthening the ankle and increasing your range of motion through various ankle exercises. The final stage involves returning to activities that won’t turn your ankle sharply, followed by a gradual return to activities that twist and turn the ankle. During the rehabilitation process, NSAIDs (Non-steroidal anti-inflammatory drugs) can be used to reduce pain and swelling.
Typically, I won’t perform surgery for a sprained ankle. However, if after nonsurgical treatment options have been exhausted and the patient is still experiencing instability, I will look towards either arthroscopic or reconstruction surgery. Arthroscopic surgery uses state-of-the-art instruments to look inside of the joint and clearly view the issue. The surgery will involve inserting an arthroscope into the joint to examine the area for abnormalities, such as loose pieces of bone or the ligament caught in the joint. By directly viewing the area with the arthroscope, I will be able to provide you with an accurate diagnosis and proper treatment. This type of surgery is much less-invasive and will result in a quicker recovery time than other procedures. If the sprain is so severe that it can’t be resolved with arthroscopy, I can perform reconstructive surgery on the damaged area. The ligament can be repaired with stitches or other ligaments in the foot or ankle.
There are a few steps you can take during physical activity to prevent an ankle sprain:
• Warm up by stretching or doing a light jog before sports to warm up the muscles. Make sure to stretch or jog at the end of high intensity activity, as well.
• Wear athletic shoes that match your foot type. For example, those people with low arches should buy shoes that support the foot right under the arch.
• Condition your body for the activity. You should gradually increase the amount of time you spend on an activity to strengthen your muscles and get your body familiar with certain movements.
• Avoid uneven surfaces. Running or playing sports outside requires extra attention to avoid terrain that could cause you to twist or turn your ankle in an abnormal way.
Boyd W. Haynes III is a Fellowship-trained, Orthopaedic Sports Medicine physician who practices at Orthopaedic & Spine Center in Newport News, Virginia. Dr. Haynes was voted a Hampton Roads “Top Doc” in 2011, 2012, 2013, 2014 and 2015. To learn more about Dr. Haynes and his practice call 757-596-1900 for an appointment.
Ankle Sprains: Causes, Recovery, Prevention
by Boyd W. Haynes III, MD