Ankle Sprains: How to Know if it's Serious

Ankle sprains are classified into three grades:

Grade I is a minor stretching of one or more ligaments, accompanied by minimal swelling and pain. Individuals with a grade I sprain will walk with a normal gait and may experience mild stiffness at the ankle joint. 

Treatment will be RICE – Rest, Ice, Compression, and Elevation and patients will be able to resume full activity in 2 -4 weeks.

Grade II tears involve partial tearing of the ligament and there will be more swelling, pain, and bruising. 

Patients with a grade II sprain will also require RICE along with a course of physical therapy. A walking boot or rigid ankle support is used for ambulation during the initial healing phase.

Grade III ankle sprains are much more severe because the ligament is fully torn. You may hear a popping sound when the injury occurs and there will be massive swelling and bruising. 

It will be difficult or impossible to walk and the joint is very unstable. A complete tear of the ligament may require surgical repair known as a lateral ankle ligament reconstruction.

It’s important to differentiate between an ankle sprain and a broken bone. Oftentimes, the inability to put weight on your foot may indicate a more severe problem such as a fracture and your doctor may recommend an x-ray or MRI.

How do I know if my ankle is sprained or broken?

A fracture or broken bone of the distal end of the tibia (shin bone), fibula (other bone of the lower leg), or the talus (ankle bone) can occur in severe sprains. 

In this instance, patients will feel intense pain and there will be massive swelling and bruising. Walking will be difficult and painful. Patients will need crutches for a couple of weeks and will use a walking boot for ambulation once crutches are discharged. 

The affected foot needs to be stabilized and protected during the initial and mid phases of recovery. Healing time is longer and patients will require physical therapy. 

Imaging studies are needed to confirm whether or not you have a fracture. Surgical intervention is rare but may be necessary if patients cannot achieve full recovery with conservative treatment.

What is a High Ankle Sprain?

A high ankle sprain, also known as a syndesmotic sprain, occurs when the syndesmosis is injured in an external rotation movement of the ankle. This will often occur in contact sports where the ankle is forcibly rotated outward. 

The syndesmosis is comprised of four ligaments and is located between the two lower leg bones, the tibia and fibula. It functions to stabilize these bones during weight-bearing activities such as walking, running, and sports. It also prevents the two bones from separating apart.

These sprains are much less common than the lateral ankle sprains that we commonly see and take longer to heal.

How do I know if I have a high ankle sprain?

•  Point tenderness over anterolateral tibiofibular joint (just above the ankle joint or lower shin)
•  Pain with weight-bearing
•  Pain with passive dorsiflexion
•  Pain with passive external rotation
•  Mild to moderate swelling in the lower leg above the ankle

What should I do If I Sprain My Ankle?

If you think you sprained your ankle immediately stop what you are doing and ice your foot. You should stay off it until you get to see a physician or physical therapist. 

A doctor may recommend nonsteroidal anti-inflammatory drugs, provide you with a walking boot and prescribe physical therapy.

What activities can I continue to do If I sprain my ankle?

A sprained ankle doesn’t always mean that you have to stop all physical activity. After the initial period of rest and icing 24-48 hours, some patients can perform non-weight bearing exercises such as the stationary bike. 

Also, upper body exercises and core strengthening are allowed as long as you do not put excessive strain on your ankle. Many exercises can be performed in sitting or lying. 

It’s a good idea to consult with a physical therapist for treatment and to have them outline an exercise program that you can continue to do while recovering from the sprain.

How to Treat a Sprained Ankle?

RICE – Rest, Ice, Compression, Elevation is always the initial treatment for an ankle sprain whether severe or mild. A period of immobilization in a short leg cast, walking boot, or supportive brace is often prescribed. 

Physical therapy will help to decrease swelling, increase range of motion and strength, and restore you to your prior level of function. 

Your therapist will also work on proprioception and balance exercises to improve the ankles/lower kinetic chains’ ability to adapt to changes in terrain and position sense when playing sports or walking down a crowded sidewalk.

Minor sprains often heal on their own. Initially RICE: Rest, Ice, Compression, Elevation is all that is needed. Your doctor may recommend a brace or splint for a few weeks and then slowly wean off as pain and swelling reduce. Minor ankle sprains can take anywhere from 2-4 weeks for recovery before returning to sports.

Severe sprains will take longer to heal, anywhere from 6 -16 weeks. Prolonged pain, swelling, bruising, and weakness will often characterize a severe sprain. Patients are put in a walking boot to keep the ankle joint immobilized and to allow healing to occur. Physical therapy will be prescribed.

Without proper treatment, you may wind up with chronic instability and are at risk for repeated ankle sprains. Getting proper care for your ankle injury is key for a full recovery and getting back to sports. 

If you have suspected that you sprained your ankle, contact Paspa Physical Therapy to have one of our experienced physical therapists evaluate your ankle and recommend treatment.