Sprained Ankle

This is the most common sports injury. Ankle sprains are categorized into 3 grades based on their severity and involve primarily 2 ligaments, the anterior talofibular and the calcaneofibular ligament. Please visit your physician in order to determine what grade sprain you are suffering from and how many ligaments are involved. This will help determine the appropriate care you should recieve and maximize your healing rate.

Risk Factors

  • bad shoes
  • poor surface conditions
  • past history of ankle sprains / injuries
  • poor biomechanics

    Symptoms
    Grade I

  • symptoms due to slight stretching and/or minimal tearing of the anterior talofibular ligament
  • slight to moderate pain with little to no functional loss
  • some joint swelling and stiffness with minor bruising (ecchimosis)
  • plan on missing about 4 to 7 days of sports activity

  • Grade II
  • symptoms due to more severe stretching and tearing of the anterior talofibular ligament however not a complete rupture
  • moderate joint instability
  • moderate to severe pain, weight bearing causes severe pain
  • joint swelling and stiffness with ecchimosis
  • plan on missing 7 to 10 days of sports activity

  • Grade III
  • symptoms due to complete tear of the anterior talofibular ligament and may also involve the calcaneofibular ligament
  • severe joint instability with loss of function
  • initially severe pain, then may be followed by period of no pain
  • severe swelling and stiffness with ecchimosis
  • plan on missing 2 to 3 weeks of sports activity with single ligament involvement
  • plan on missing 5 weeks or so of sports activity with double ligament involvment
  • Treatments
    No matter what grade of sprain you have, it is very important in the first 24 hours to minimize activities that can increase the swelling such as: hot showers/packs, heat rubs, drinking alcohol, and use of Aspirin (Aspirin decreases clotting time, and therefore allows more bleeding into the ankle).

    For single ligament injuries (anterior talofibular ligament)
    Grade I

  • rest
  • ice
  • compression wrap (for approximately first 72 hours)
  • elevate the ankle
  • weight bearing as tolerated, may use crutches
  • no splinting or casting required
  • soft tissue therapies / massage
  • stretches and strengthening exercises as tolerated
  • warm baths / whirlpool after 72 hours, once a day

  • Grade II*
  • rest
  • ice
  • compression wrap (for approximately 5 days)
  • elevate the ankle
  • use crutches
  • soft tissue therapies / massage
  • warm bath / whirlpool after 5 days, once a day

  • Grade III*
  • rest
  • ice
  • compression wrap initially, then a semi-rigid cast (for approximately one week)
  • elevate the ankle
  • soft tissue therapies / massage
  • warm bath / whirlpool after 10 days, twice a day, with range of motion exercises performed while in whirlpool
  • following a week of whirlpool baths, begin stretching exercises
  • *Once full range of motion has returned with Grade II and II sprains, strengthening exercises may be initiated

    For 2 ligmanet injuries (anterior talofibular and calcaneofibular ligament)
    Grade III

  • After first 24 hours, use a walking cast, set at a 90 degree angle and keep using it for approximately 3 weeks
  • 2 warm soaks per day
  • as soon as possible, begin a series of exercises to regain ankle mobility
  • over next 6 months, ankle tape support should be used with every activity
  • Prevention

  • wear high top sneakers
  • tape ankles prior to sports activity or wear an ankle brace / support
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