What Is An Ankle Sprain

A sprain is an injury to the ligaments of the ankle, usually as a result of improper foot movement. With the exception of severe sprains, most heal without complication.

brief description

An ankle sprain is a trauma to the external ligaments of the ankle, most often following an inward movement of the foot at the same time as an outward (“inversion”) movement of the ankle.

The degree of severity of the sprain depends on the number of injured anatomical structures. This can range from a simple stretching of the external ligaments (mild case), to their rupture, associated (or not) with a tear in the envelope of the joint, that is to say the articular capsule (case severe).

An accurate diagnosis is essential, because the sprain is sometimes associated with a fracture of the bone of the ankle joint, or even of a distant bone in the foot or leg. Sometimes one of the tendons surrounding the ankle can also rupture.

In general, a careful examination and the help of an X-ray are enough to make the correct diagnosis.

Symptoms

Symptoms of an ankle sprain may include:

  • the ankle is painful
  • the ankle is swollen (oedema)
  • the support on the foot is difficult, even impossible
  • a hematoma is visible under the skin of the ankle.

Sometimes, when the sprain is more serious:

  • the ankle is dislocated (dislocation), in this case a deformation is clearly visible
  • the ankle is bleeding, because the skin on the ankle has broken open
  • the foot is numb or seems sleepy.

Not all of these symptoms are necessarily present at the same time.

Cause

A sudden imbalance of the foot on the ground can put excessive tension on the ligaments that protect the ankle. If the energy of the imbalance is too high, the ligaments will stretch or even break. The excess force occurring during the imbalance movement (the sprain movement) is therefore the cause of the lesion of the ligament and that of the other structures possibly also affected.

Risk factors

Certain situations increase the risk of a sprain:

  • contact sports (basketball, football, etc.)
  • pivot sports, in which changes of direction are sudden (tennis, basketball, etc.)
  • ground in poor condition (risk of slipping) or whose surface is irregular (jogging in nature for example)
  • unstable shoes (high heels), poorly adapted to the activity, or worn (especially on the outside of the shoe).

Other risk factors are related to the person himself:

  • a misaligned rearfoot skeleton (heel inward rather than outward)
  • age: active people aged 15 to 40 are the most affected
  • proprioception disorders (altered unconscious and automatic perception of articulation in space, resulting in a reduced reflex ability to correct a bad position or restore balance)
  • coordination problems due to fatigue or the consumption of alcohol or other substances

Treatment

Treatment depends on the severity of the sprain.

Immediately:

  • To relieve pain, ice should be applied locally wrapped in a towel (or a washcloth) to avoid direct contact with the skin and therefore any risk of frostbite. Ice should be applied three times for 20 minutes a day for the first two days
  • elevate the leg and put the ankle at rest
  • Avoid placing all of your body weight on the injured ankle.

Regarding ankle immobilization, the choice of system also depends on the severity of the sprain.

  • in mild sprains (so-called grade I), the joint will be immobilized with an elastic band that offers relative support. The use of canes in addition can relieve the ankle a little more.

Wearing a splint (or semi-rigid brace) may also be prescribed for minor sprains. This will stabilize the joint, limit the         movements that caused the accident, while allowing the movements of walking.

  • in severe sprains (grade II and III), the doctor will rather recommend strict immobilization using a leg splint (until below the knee) made of plaster or resin. This device, molded directly on the ankle, allows complete resting of the damaged ligament structures. The ankle is immobilized in a neutral position, the foot square to the leg.

If canes are required, the physician will provide guidance on their use.

Paracetamol-based painkillers (Dafalgan, Panadol) provide pain relief provided that the person is not allergic to the drug or any of its components. Depending on the situation, the doctor may also prescribe anti-inflammatories.

Surgical treatment is only justified when an acute sprain progresses to chronic instability of the ankle, itself a source of repeated sprains. The operation, never performed in an emergency, aims to repair the ligaments.

Surgical treatment may also be indicated when a severe sprain is associated with bone damage.

Prevention

To avoid a first sprain:

  • wear suitable, good quality, unworn shoes
  • engage in regular physical activity, warm up gradually and avoid “straining” untrained joints

To avoid further sprains:

  • wear a semi-rigid orthosis when practicing a sports activity
  • do physiotherapy sessions, prescribed by the doctor, with the aim of strengthening proprioception (unconscious and automatic perception of the articulation in space, allowing to correct a bad position or to restore balance) by exercises of balance and tendon stimulation
  • avoid states of great fatigue and exhaustion
  • do not walk or play sports under the influence of alcohol.