Acute ankle injuries are sudden onset sprains, strains, and fractures. An ankle sprain is an injury to the ligaments in the ankle, a fracture or broken ankle is an injury to the bone, and a strain is a tear of any of the tendons which attach muscles to bone and enable movement. If the injury is severe or a fracture is suspected always seek medical advice as soon as possible.
On this page:
- When should I see a doctor?
- Eversion ankle sprain
- High ankle sprain
- Ankle fractures
- Complications of ankle sprains and other injuries
- Immediate first aid for ankle injuries
When should I see a doctor?
The majority of ankle injuries can be treated at home. However, if you have severe ankle pain, severe swelling, a pop or crack, locking, and altered sensation you should seek further medical assistance. Professional advice should also be sought if you have followed the P.R.I.C.E. principles for 3 days and still have severe pain, or if you still have weakness or ankle pain or ongoing discomfort that lasts more than 2 weeks.
An ankle sprain is one of the most common sports injuries and is also one of the most frequently recurring sports injuries if correct rehabilitation exercises are not performed. You often know instantly if you have sprained your ankle. The foot turns inwards under the weight of the body, causing instant pain around the ankle joint, specifically on the outside of the ankle where the damaged ligaments are located.
Swelling or bruising can appear immediately or may sometimes take up to 48 hours to develop, depending on the structures damaged and the severity of the sprain. Ankle sprains are graded 1, 2 or 3. A Grade 1 is a mild injury with some pain, but little or no swelling, a grade 2 sprain causes moderate to severe pain and a grade 3 is a complete, or near complete, tear of the ligament.
Treatment involves immediate first applying the PRICE principles (protection, rest, ice, compression, and elevation) to limit swelling and reduce pain. Wearing an ankle brace or taping the ankle can support and protect the joint. After the initial acute period and when pain allows, a full ankle rehabilitation program with ankle exercises to restore mobility, strength, and most importantly proprioception (co-ordination) of the ankle to avoid future re-injury. There are also a number of complications that can arise from a sprained ankle including fractures, avulsion fractures or damage to other structures within the joint.
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Eversion Ankle Sprain
An eversion ankle sprain is rare and occurs when the ankle rolls too far inwards. This type of sprain happens when the ligaments on the inside of the ankle tear, which is often accompanied by a fracture of the fibula bone. It is hard for these inside ligaments to be sprained, it is much more common to damage the outer ligaments.
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High Ankle Sprain
A high ankle sprain is an injury to the anterior tibiofibular ligament which joins the tibia and fibula together just above the ankle. This ankle injury is generally more severe and more complicated to treat than a normal sprain, Read more on the causes, symptoms, and treatment of a high ankle sprain.
Symptoms of a high ankle sprain include pain when pressing in on the tibiofibular ligament which joins the tibia and fibula at the bottom of the leg/top of the ankle. Swelling and bruising will be seen on the front and outside of the ankle. The athlete will have difficulty walking and when the ankle is rotated and dorsiflexed with toes and foot pushed upwards pain will be reproduced.
The most commonly injured ligament in a high ankle sprain is the anterior tibiofibular ligament. Severe injuries can also cause damage to the membrane connecting the Tibia and Fibula (called the syndesmosis). A high ankle sprain is sometimes associated with a fracture of one of the lower leg bones and is often more severe than the normal ankle sprain.
Treatment involves applying principles of PRICE or protection, rest, ice, compression, and elevation as soon as possible after injury to reduce pain and limit swelling. A doctor, physiotherapist or other sports medical professional may prescribe anti-inflammatory and painkilling medication to help reduce pain and swelling. Once the ankle is pain-free, mobility, strengthening and proprioception exercises to restore the ankle to full function should be done.
Read more on High ankle sprain.
Pott's Fracture, Broken Ankle & Dislocations
If you suspect a broken ankle then seek professional medical advice as soon as possible. A Pott's fracture is a fracture to one of the bony parts of the ankle called the malleoli. Fractures can occur to the lateral malleoli on the outside or the medial malleoli on the inside. It can sometimes be difficult to separate a fracture from a sprain, though feeling the ankle with the hands can sometimes indicate if it is a fracture or not. An x-ray can show for sure if it is a fracture.
A dislocated ankle is a severe injury which usually happens in conjunction with a fracture or complete rupture of the lateral ankle ligaments. They are relatively rare as all the ligaments on one side of the ankle have to rupture (normally on the outer side) and medical help is needed immediately.
Read more on ankle fractures & dislocations.
Osteochondral Lesions of the Talus
Osteochondral lesions are fractures of the tough, smooth cartilage which protects the ends of bones. The talus is a bone in the ankle which sits on top of the Calcaneus (heel bone) and is most commonly fractured in combination with an ankle sprain. Because of this, an osteochondral fracture may not be diagnosed immediately but may only be identified later when the sprain fails to heal as expected.
Read more on Osteochondral lesions of the talus.
Ankle Avulsion Fracture
An ankle avulsion fracture occurs when a tendon or ligament comes away from the bone often pulling a small piece of bone with it. Symptoms of an ankle avulsion fracture are very similar to a normal sprained ankle making it very difficult to tell the difference without an X-ray or MRI scan. There will be a pain in the ankle immediately after the injury occurs with immediate swelling. Bruising may develop later and the athlete will most likely have difficulty moving or putting weight on the ankle. Although treatment is often the same whether there is an avulsion fracture or just a sprain, it may depend on the severity of the fracture and also its alignment. Children are more likely to be offered an alternative treatment for a fracture as it could affect their long-term skeletal growth.
Read more on ankle avulsion fractures.
Immediate first aid for ankle injuries
All acute and chronic ankle injuries should be treated using the P.R.I.C.E. principles (protection, rest, ice, compression & elevation). This should be applied at home for at least the first 2 - 3 days.
- Protect - Prevent the ankle from suffering further damage. Stop training or playing immediately and apply cold therapy and a compression wrap. Where applicable, use ankle support or brace.
- Rest - Refrain from exercise and try to reduce the demands of your daily activity to encourage recovery. It not only refers to the time that the athlete will be out of action but also to the immediate period after the injury. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
- Ice - The application of ice or cold therapy to the area of the ankle injury/swelling can assist in reducing the symptoms of pain and inflammation.
- Compression - The use of compression support or compression bandages to the ankle can help reduce swelling and offer support.
- Elevation - Keeping the foot elevated above heart level whenever possible can help reduce swelling due to the effects of gravity.
Read more on PRICE principles.