An Ankle sprain is one of the most common musculoskeletal injuries. Patients typically describe an episode where they roll their ankle to the inside (Figure 1), which creates tearing of the ligaments on the outside aspect of the ankle. Patients typically have significant pain and swelling (Figure 2), and usually limp. However, quite often they are able to bear weight, unlike an ankle fracture where weight bearing is extremely difficult. With the ankle swollen over the outside (lateral) aspect, there is often associated redness due to the increased blood flow to this area.
Physical examination will reveal swelling over the outer aspect of the ankle and tenderness over the outer front aspect of the ankle (Figure 3). Unlike ankle fractures, there is usually no major tenderness over the posterior outside aspect of the ankle. Usually there is no tenderness on the inside of the ankle (medially). It is important to assess for other areas of tenderness and potential injury, as the same mechanism that creates an ankle sprain can also lead to other injuries (ex. fracture of the anterior process of the calcaneus, talar osteochondral injury).
In the emergency room, x-rays are often taken, however, they are not always indicated. In a patient with an ankle sprain, x-rays will not identify any bony abnormalities and the ankle joint will be well located. If there is no tenderness posteriorly, and the patient is able to take 4 steps, then according to the Ottawa ankle rules, the patient does not require x-rays.
Ankle sprains are typically classified as mild, moderate, and severe. It is often difficult to tell exactly which category the ankle sprain is.
Treatment of an ankle sprain includes:
Once the symptoms associated with the initial ankle sprain have started to improve, patients will benefit from exercises designed to improve their:
Surgery is not indicated for the treatment of ankle sprains. The exception would be if there is a displaced cartilage and bone fragment in the ankle joint due to an osteochondral injury to the talus (lower bone of the ankle joint).
Patients who have recurrent ankle sprains due to ankle instability may be candidates for an ankle ligament stabilization procedure.