Know if You've Sprained Your Ankle

An ankle sprain is one of the most common injuries. It is stretching or tearing of the ligaments that support the ankle. Sprains occur most commonly in the ATF (anterior talofibular) ligament because it runs along the outside of your ankle. The outer ligaments are not as strong as the inner ligaments. Through the forces of physics, gravity and our own body weight we stretch the ligament beyond its normal capacity. This causes tears in the ligament and surrounding small blood vessels. A sprain is like a rubber band pulled and stretched too tightly, causing tears along the surface, making it unstable.

Steps

Examining the Ankle

1. Recall the moment of injury. Try to remember what happened at the moment that you were injured. This may be difficult, especially if you are in a great deal of pain. However, your experience at the moment of injury may provide clues.
   • How fast were you moving? If you were moving at a very high speed (e.g., skiing or running at top speed), there is a chance your injury is a bone fracture. This will require professional medical attention. A lower speed injury (e.g., rolling your ankle while jogging or walking) is more likely a sprain that may heal on its own with proper care.
   • Did you feel a tearing sensation? In many cases you will, in the case of a sprain.
   • Was there a popping or snapping sound? This can occur with a sprain. It is also common with a bone fracture.
2. Look for swelling. In the case of a sprain, your ankle will become swollen, usually immediately. Examine your ankles side-by-side to see if the injured one looks larger. Pain and swelling will usually occur in ankle sprain or fracture.
   • Foot or ankle deformity and unbearable pain usually indicate ankle fractures. Make sure to use crutches and go to your doctor immediately.
3. Look for bruising. A sprain also often causes bruising. Examine the ankle for signs of discoloration resulting from bruises.
4. Feel for tenderness. A sprained ankle will often feel tender. Gently touch the injured area with your fingers to see if it is painful to the touch.
5. Put weight gently on the ankle. Stand up and gently put some weight on the injured ankle. If it is painful to put weight on the ankle, it could be sprained or fractured. Get medical attention immediately and use crutches.
   • Feel for a "wobbliness" in the ankle. A sprained ankle often feels loose or unstable.
   • In the case of a severe sprain, you may not be able to put any weight on the ankle at all, or use that foot to stand. Doing so will cause too much pain. Use crutches and seek medical attention immediately.

Determining the Grade of a Sprain

1. Recognize a grade I sprain. Ankle sprains come in three different grades. Treatment options will be determined based on the severity of the injury. The least severe is a grade I sprain.
   • This is a minor tear that doesn't affect your ability to stand or walk. While it might be uncomfortable, you can still use your ankle normally.
   • A grade I sprain may result in minor swelling and pain.
   • In a minor sprain, swelling will usually go away in a few days.
   • Self-care is usually enough for a minor sprain.
2. Recognize a grade II sprain. A grade II sprain is a moderate injury. It is an incomplete but substantial tear of a ligament or ligaments.
   • In a grade II sprain, you will not be able to use your ankle normally and will have trouble putting weight on it.
   • You will experience moderate pain, bruising, and swelling.
   • The ankle will feel loose and may look as if it has been pulled forward somewhat.
   • For a grade II sprain, you will need medical attention and may need to use crutches and an ankle brace for a while to walk.
3. Recognize a grade III sprain. A grade III sprain is a complete tear and loss of the structural integrity of the ligament.
   • With a grade III sprain, you will be unable to put any weight on the ankle and will be unable to stand without help.
   • Pain and bruising will be severe.
   • There will be significant swelling (more than 4 cm) around the fibula (calf bone).
   • There may be notable foot and ankle deformity and high fibular fractures just below the knee, which can be determined by a medical examination.
   • A grade III sprain requires the immediate attention of a doctor.
4. Recognize the signs of a fracture. A fracture is a bone injury that is especially common with high-speed ankle injuries in the healthy population or minor falling injuries in the elder population. The symptoms are often similar to a grade III sprain. A fracture will require X-rays and professional treatment.
   • A fractured ankle will be very painful and unstable.
   • A minor or hairline fracture may be identical in symptoms to a sprain, but only a trained medical professional with X-rays can diagnose or rule this out.
   • A popping sound at the moment of injury may be evidence of a fracture.
   • An obvious foot or ankle deformity, such as your foot laying in an unusual position or angle, is definite evidence of a fracture or ankle joint dislocation.

Treating Ankle Sprains

1. Call your doctor. Regardless of the degree of your injury, it is a good idea to contact your doctor if the pain and swelling continues for more than one week, to determine the best treatment.
   • If you see any evidence of a fracture and/or a grade II or grade III sprain, you must see a doctor. In other words, if you cannot walk (or experience significant difficulty doing so), have a numb feeling in the area, are suffering extreme pain, or heard a pop at the time of the injury, see a physician. You will need X-rays and a professional examination to determine treatment.
   • Self-care is often adequate for a minor sprain. But, a sprain that doesn't heal properly may lead to ongoing pain or swelling. Even if you only have a grade I injury, contacting your doctor for advice is the best course of action.
2. Rest the ankle. While waiting to see a doctor, you can use a self-care regimen referred to as RICE (Rest, Ice, Compression splinting, and Elevation). This is an acronym that stands for the four treatment actions. For a grade I sprain, RICE may be all the treatment you need The first step is to rest the ankle.
   • Avoid moving the ankle, and immobilize it if possible.
   • If you have cardboard handy, you can fashion a temporary splint that will protect the limb from any further injury. Try to splint your ankle so it's set in a normal anatomical position.
3. Ice the injury. Putting ice on the injury can reduce swelling and discomfort. Get something cold to put on the ankle as soon as you can.
   • Place some ice in a bag gently on the joint. Cover it with a washcloth or towel to avoid possible frostbite on your skin.
   • A bag of frozen peas also makes a good ice pack.
   • Ice the injury for 15-20 minutes at a time, every 2-3 hours. Continue icing the injury in this way for 48 hours.
4. Compress the ankle. For a grade I sprain, compressing the injury with an elastic bandage can help provide stability and reduce the risk of another injury.
   • Wrap the area with bandage using a "figure-eight" pattern around the ankle.
   • Don't wrap it too tight, or you may worsen swelling. You should be able to get a finger between the bandage and your skin.
   • If you believe you have a grade II or grade II sprain, seek a doctor's advice before applying compression.
5. Elevate your foot. Elevate the limb above your heart. Place your foot up on two pillows. This will decrease blood flow to the area and allow the swelling to improve.
   • Elevation will assist gravity in clearing the swelling, and help the pain.
6. Take medication. To help manage the pain and swelling, you can take NSAIDs (non-steroidal anti-inflammatory drugs). Common over-the-counter NSAIDs include ibuprofen (trademarked names include Motrin, Advil), naproxen (trademarked as Aleve), and aspirin. Acetaminophen (also called Paracetamol or trademarked Tylenol) is not an NSAID and does not manage inflammation, but it can help reduce pain.
   • Take only as directed on the packaging, and don't take NSAIDs for pain for more than 10-14 days.
   • Do not give aspirin to children under the age of 18 due to the risk of developing Reye syndrome.
   • For severe pain and/or a grade II or III sprain, your doctor may prescribe a narcotic to take for the first 48 hours.
7. Use a walking aid or immobilizer. Your doctor may suggest a medical device to help you move around and/or immobilize your ankle. For example:
   • You may need crutches, a cane, or a walker. Your level of balance will determine which is best for your safety.
   • Depending on the level of injury, your doctor may recommend using a bandage or ankle brace to immobilize the ankle. In severe cases, an orthopedic surgeon may put your ankle in a rigid cast.

Tips

• Start RICE treatment immediately for any ankle injury.
• If you can't walk on it, consult a doctor immediately.
• Keep off your feet as much as you can if you believe your ankle is sprained. Do not walk. Use crutches or wheelchair. If you continue to walk on your ankle and do not rest it, even the mildest sprain will not be able to heal.
• Try to attend to the sprain as soon as possible and put on a bag of ice for short periods of time in multiple intervals.
• Look at the injured ankle compared to the other one, and see if there is swelling.
• Make sure you tell a parent or guardian for assistance.
• Keep your feet still until the doctor tells you to move.
• Compare your injured ankle to the normal one. If it's a grade 2 or 3 sprain, the injured foot would have swollen and bruised quite a lot.

Warnings

• It is important that your ankle heals completely after a sprain. If it does not heal properly, another sprain may be more likely to occur. You can also end up with persistent pain and swelling that does not go away.
• If you experience coolness in the limb, feeling total numbness of the feet, or tightness as a result of the swelling, this may be the sign of a much more serious condition. Seek immediate medical attention as you may need emergency surgery for major nerve and artery injury or compartment syndrome.

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• Climb with an Ankle Injury
• Wrap a Sprained Ankle
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Sources and Citations

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