Anyone who has sprained their ankle knows the feeling of helplessness as the ankle goes over, pulling dangerously at the ligaments. There may even be an accompanying sound along with the excruciating pain; that sound could be a cry from the unfortunate victim.
Ankle sprains are among the most common of all joint injuries. Because ankles must withstand great stress, they are surrounded by strong ligaments that provide stability. Unfortunately, that is sometimes not enough. Jumping or running can put three or four times your weight on the joints, and if the foot lands on uneven ground or twists even slightly, the resulting force can cause a sprain.
Most ankle sprains arise with the foot rolling inwards, overstretching the outside ligaments. When these ligaments are forced beyond their capacity, an ankle sprain is the result. Although ligaments are tough and flexible, all it takes is a sudden twist for them to stretch too far, or snap entirely.
Sprains are graded based on how much damage has occurred to the ligaments. A grade 1 (mild) sprain will have slightly stretched the ligaments and there may be microscopic tearing. Grade 2 or moderate sprain results from partial tearing of the ligament and will lead to tenderness and swelling around the ankle. The most serious sprain, grade 3 or severe, is when there is a complete tear of the ligament. In these cases, significant pain and swelling occurs around the ankle; it will be difficult or impossible to put weight on that foot.
Ankle sprains are notorious for leading to… more ankle sprains. Indeed, a previous incident is one of the risk factors for a new sprain, especially if it has not healed fully before being put to the test. Walking, running or playing on uneven surfaces or wearing shoes with poor support can all precipitate a sprain. And of course, sports that demand sudden changes in direction such as floor hockey, racquet sports, soccer and basketball can all put too much demand on the ankle.
In treating a sprained ankle, think RICE. That is, Rest the joint for 24 to 48 hours by keeping weight off the foot; get mobile as soon as you can bear more weight on the foot. Ice the ankle as soon as possible to reduce pain and inflammation; repeat for 20 minutes every two hours until swelling subsides. Step 3 is Compress the ankle by wrapping it with an elastic bandage — start at the toes and wrap towards the lower leg. Finally, elevate your foot as often as possible whether sitting or lying down.
Even if you start to feel better, do not return to your old level of physical activity until you can move your ankle as freely as the uninjured one. It may feel strong and pain-free, but ease into new stress cautiously. The ankle needs to fully heal before too much demand is put on it. Depending on the individual, an ankle sprain will take four to six weeks to heal, but some may take longer.
As with any injury or disease, the best practice is one of avoiding it in the first place. Avoiding an ankle sprain means stretching leg muscles before and after exercise, especially the calf muscle. Always wear supportive shoes, not those ‘comfortable’ but ratty old ones you like so much, and maybe avoid high heels altogether?
Written by Dr. Paul Martiquet, Medical Health Officer for the Sunshine Coast and Powell River.