Q&A Resources
Ask Dr. Pribut

Q. I just twisted my ankle what immediate care should I give it?   And by the way please tell me a bit more about ankle sprains.

Sue / West Virginia

A. Ankle sprains are more common in athletes participating in sports with side to side movement than that with straight ahead motion.Court sports such as Basketball, Tennis and Raquetball all create a fair share of ankle sprains. Running on level ground does not often result in an ankle sprain but cross country running, trail running and stepping in a pot hole all could potentially lead to an ankle sprain.

The most frequent ankle sprain is an inversion ankle sprain. This can injure the outer structures of the ankle.

Anatomy: The ankle includes the Talus or ankle bone and the ankle mortise created by the lower Tibia (inner ankle bone, leg bone) and fibula (outer ankle, leg bone). There are three main outer ankle ligaments. The anterior talo-fibular ligament, the calcaneo-fibular ligament and the posterior talo-fibular ligament. Other structures in this area which your doctor will want to examine which can also be injured in an inversion injury include the peroneal tendons (which can sublux or move out of place), the calcaneo-cuboid ligament, and the base of the 5th metatarsal (which can break).

Most Common Injury:

The most common injury resulting from an inversion ankle injury is a partial tear of the anterior talo-fibular ligament. This ligament may also tear completely. The next most frequently injured ligament is the calcaneo-fibular ligament and least injured is the posterior talo-fibular ligament. On occasion the fibula itself may be fractured or the talar dome is injured.

As already mentioned, the other structures on the lateral side of the ankle should always be carefully examined to make sure they are not injured.

The grading of ankle sprains is officially done on an inadequate 3 point scale. Grade 1 is a mild "stretch" of the ligaments, Grade 3 is a complete tear of the ligament and Grade 2 is everything in between. In my office I use a subjective 10 point scale to finer grade the ligament injury for the benefit of the patient.

Treatment For Minor Sprain:

It is impossible to guess via the Internet how badly injured you are. If you have doubts or your ankle swells very rapidly you should head for the emergency room. Immediate treatment should consist of R.I.C.E.:

The ice should be applied for about 15 minutes at a time and then off for about the same. Avoid damaging your skin with the chemical bags you can place in your freezer. Frozen corn or peas works just fine.

If the ankle does not respond quickly to this treatment, it is probably best to visit your sports physician for an evaluation and treatment. This way you'll avoid having your sprain be worse than a break.

Frequently for Grade 2 sprains, I'll recommend a plastic splint such as that made by Air Cast - Air Splint. This holds the ankle quiet as it heals and prevents most inversion and eversion. On occasion crutch walking for a few days (or longer) is needed. The first exercise I recommend after the ankle is starting to feel better is dorsiflexion - plantarflexion or just plain moving the ankle up and down. After more improvement small circles, painting the alphabet with your toes and other exercises can be done. Later still a theraband or other elastic band can be used to strengthen the muscles that help hold the ankle stable. Beam balance exercises and figure 8 running are also possible exercises later in recovery.

I recommend avoiding forcing your ankle to move in pain too soon. I also recommend avoiding weight bearing or walking in pain early in the course of an ankle sprain. There is no reason to start testing your ankle until it has had time to heal. Slow and easy gets more gain than rushing into painful exercises.

A Sports Podiatrist or Orthopedist and Physical Therapist can team together to make sure you have a speedy recovery.

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© 1998 Stephen M. Pribut, D.P.M. All rights reserved. Materials copyrighted by Stephen M. Pribut may be reprinted for personal use only. Permission to reprint or electronically reproduce any document in part or in its entirety for any other reason is expressly prohibited, unless prior written consent is obtained from Dr. Pribut.