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Ankle sprains: Overview

Last Update: April 23, 2014; Next update: 2017.

Introduction

If you twist your ankle, it may swell up and hurt. This is usually a sign that the ankle is sprained. In other words, one or more ligaments of the ankle and the surrounding tissue are injured.

Ligaments are tough elastic bands of connective tissue that join bones in the joint to each other. Because the ankle joint is made up of many bones, there are also several ligaments that stabilize it.

Symptoms

Ankle sprains are among the most common of injuries. When an ankle is twisted, the ligaments are overstretched. In the worst case, they might tear. Small blood vessels tear too, which is what causes the swelling around the ankle.

The following grades of severity are used to describe sprains:

  • Mild sprain (Grade I): This is the most common and least severe form. The ligaments are stretched but not torn. The ankle is still stable.
  • Moderate sprain (Grade II): This injury is more severe and more painful, and one or several ligaments are partially torn. The ankle joint is a little unstable.
  • Severe sprain (Grade III): One or several ligaments are torn and the ankle is unstable.

If you can put weight on your foot and walk immediately after having twisted your foot, it is very unlikely that you have broken anything. If the ligaments have only been slightly stretched, you will usually be able to move your foot normally again after a few days. But even minor ankle sprains can be painful.

Illustration: Foot bones (outer side) with Grade I, II and III sprains - as described in article

Foot bones (outer side) with Grade I, II and III sprains

Causes

Our ankle joints make it possible for us to move our feet upwards, downwards and sideways. Our feet tend to turn inwards rather than outwards, so your ankles are more likely to twist inwards if, for instance, you land awkwardly on your foot after jumping. That is why the ligaments that run along the outside of the ankle are the most commonly affected in ankle sprains. They are called outer or lateral ligaments. The ligaments on the inside of the ankle (inner or medial ligaments) are less likely to be overstretched.

Some people have very weak ligaments and are therefore more likely to have sprains. Ankle sprains are also more common in people who have high foot arches or muscle weakness. Athletes have a greater risk too: One quarter of all sports injuries are ruptures of the outer ankle ligaments.

Outlook

Most ankle sprains without ligament tears will have largely healed after two weeks: Even if you are not able to put your full weight on the foot, it will usually not hurt anymore.

If ligaments are torn or partially torn, it can take weeks for the ankle to work normally again. In some people who have more serious ligament injuries, it can even take two to three years for the ankle to become as strong and as mobile as before.

Effects

About 1 to 2 out of 10 people with severe ankle sprains develop chronic ankle instability. This is where the joint gives way too easily: it is unstable. People who have a chronically unstable ankle are more likely to twist and sprain their ankle again.

1 out of 3 people with a sprained ankle will hurt their ankle joint again in the years following the initial sprain. The risk is particularly high in people who put a lot of strain on their joints – for instance, when playing soccer or basketball.

Chronic ankle instability and frequent twisting and spraining can also increase wear and tear of the cartilage in the ankle joint. Cartilage is a smooth tissue that covers and protects joints. If there is too much damage to the cartilage, it may lead to osteoarthritis.

Diagnosis

The doctor will first ask you about your accident and symptoms, and then examine your foot to see how severe your injury is. The foot might be x-rayed afterwards to find out if the ankle is broken. If the ankle sprain symptoms do not improve considerably after a few days, you might have a torn ligament. An MRI scan (magnetic resonance imaging scan) may be done too. This is because it is often easier to see ligaments and surrounding tissue better with MRI scans than with conventional x-ray scans.

Prevention

Some people wear bandages or ankle braces when they do sports, to try to stabilize their ankle and prevent further injuries.

Strength and coordination exercises are particularly suitable for preventing chronic ankle instability or strengthening the joint again. However, these exercises typically have to be done for weeks or even months to have a benefit. Common exercises include training on a balance board. This involves standing on one leg on a board that easily tips sideways, while trying to stop the board from tipping and keeping your balance. This forces the foot to counterbalance different strains and movements without the joint giving way.

Treatment

Sprained ankles swell up quickly, and start to hurt just as quickly. Immediate measures to reduce pain and swelling include keeping your foot elevated, cooling the ankle and wrapping it in an elastic compression bandage to put mild pressure on it. These measures are usually enough to relieve mild ankle injuries.

After a few days, the foot can be stabilized if necessary by taping it tightly or using a splint. There is good reason to believe that starting gentle exercises early on, and not keeping your foot still for too long, helps. Surgery is rarely needed, even for ankle sprains with one or more torn ligaments.

Sources

  • de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Interventions for treating chronic ankle instability. Cochrane Database Sys Rev 2011; (8): CD004124. [PubMed: 21833947]
  • Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Sys Rev 2007; (2): CD000380. [PubMed: 12137612]
  • MacAuley Dm, Best TM. Evidence-based sports medicine. London: BMJ Books. 2007.
  • Maughan KL. Ankle sprain. UpToDate. Juli 2013.
  • Struijs P, Kerkhoffs G. Ankle Sprain. Clinical Evidence 2010; 05:1115.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)

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