If you have ever participated in an athletic activity, then you have either had an ankle sprain yourself, or have seen it first hand on someone else. Ankle sprains are very painful, and often are stiff and achy for a long period of time following the injury. Like most injuries, ankle sprains have an extensive spectrum, and I will discuss most to the key points along this spectrum. As always, I will go over the anatomy, mechanisms of injury (how the sprain occurs), types of injuries, and treatments (including surgical) for ankle sprains.
 Anatomy: When we are talking about ankle sprains, most of the time we are referring to what is called, "lateral" ankle sprains. In other words, they are sprains that occur on the outside of the foot and/or ankle. However, in some instances, we can get "medial" ankle sprains, or ones that occur on the inside of the foot and/or ankle. With this in mind, we need to take a look at most of the anatomy around the entire ankle. Your ankle joint is made up of 3 bones, the tibia (which is the main bone in the lower leg), the fibula (which is also in the leg, it helps lock the ankle joint together), and the talus (which is the small bone in the foot that provides motion to the ankle joint) The picture to the right shows these 3 bones...
The muscles, tendons, and ligaments around this joint are
 extremely important and typically what are injured when one sprains their ankle. The muscles that support the ankle are numerous, but since the majority of the ankle sprains are lateral, or outside of the ankle, ankle sprains, I am going to concentrate on those muscles that affect this area...Those muscles are the peroneus brevis and longus. These two muscles start on the outside of the leg, travel down, cross the ankle, and insert into the foot. The brevis inserting on the outside of the foot, and the longus travelling on the underside of the foot and inserting on the inside aspect near the "medial" arch. These are shown in the picture to the right. The ligaments that attach and support around the ankle are also numerous, so I will discuss just a few of the main one that when injured result in what is called "ankle joint instability." The main one, which is most commonly injured is the anterior talofibular
 ligament. It connects the fibula and the talus. The other ligament is the calcaneofibular ligament, it connects the fibula and the calcaneus (the heel bone.) These are shown in the picture to the right.
It cannot be failed to be mentioned that there is also a nerve (sural nerve) that travel along the route of the peroneal muscles. During an ankle sprain, this nerve can become stretched and injured...hence pain and even possible numbness of the outside of the foot and/or the 4th and 5th toes.
Mechanism of Injury: The act of an ankle sprain is rather simple...it often occurs when the foot rolls inwardly underneath the leg, straining and forcing the ligaments, muscles, and tendons on the outside of the foot and ankle. With the structure and formation of the bones in the foot and ankle, the foot is more apt to roll underneath the leg when the foot is pointed downward. This is why it is
 common in basketball and with receivers in football. When they jump in the air and come down, their toes are pointed downward, hit the ground first, and the foot rolls under. When this happens the anterior talofibular ligament can tear (the most common one to do so), with the straining of the calcaneofibular ligament, and the straining of the peroneus longus and brevis. This will result in severe pain and swelling. In the most severe cases the fibula can even fracture. Diagnosing an ankle sprain is usually clinical, an xray will only rule out a fracture, and only if surgery is being considered, the MRI can be used.
Treatment: Treatment for ankle sprains are as numerous as the ligaments, muscles, and tendons that surround the ankle. The mainstay treatment for an ankle sprain is RICE (rest, ice, compression, and elevation.) The use of anti-inflammatories such as ibuprofen are always recommended. Compression is usually applied with an ACE wrap. There are many different theories on the amount of rest that one needs, but recent studies show that early walking and weight-bearing on the affected ankle decreases the time out of competition, and decreases the time with pain. Occasionally, individuals that complain of recurrent ankle sprains will require some surgery. This basically involves reattaching the torn ligaments and using tissue around the tendons of the peroneal muscles to tighten them up. Severe ankle sprains resulting in fractures require surgery, which usually involves placing of screws and plates to repair those fractures of the fibula and/or tibia.
It was asked earlier, what is a high ankle sprain. Well, this is simply a more severe sprain that actually causes the peroneus longus and brevis to become strained up in the lower leg. So, on top of the ligament strain and/or possible tears, you have a muscle strain in the lower leg as well, resulting in a longer recovery. I would say that athletes with severe ankle sprains, expect a 4 week recovery period. One with surgery, consider it nearly season ending, you are talking 4 months or more to be fully recovered. Individuals with ankle injuries are recommended to wear ankle braces for long term following recovery from the injury.
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The pictures used were taken from www.eorthopod.com
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I love these things, keep them coming. There is a dull ZZZZZZZZing in my mind as all the big latin words swarm together, but i dont mind it.
My ankle hurts just looking at that....Plantar fascitis is my vote for the next one!
This was actually the play that he broke his leg on...game winning catch I do believe as well.
That picture is absolutely horrendous.
good stuff again - thanks
Seeing this brings back awful memories from the HPER and SRSC for me.. From one that has been known to sprain an ankle or both this hurts just to look at. Hopefully this doesn't happen again this pickup season
I think this guy was out like 12 days with this 'ankle injury', no?
I was looking for a good ankle "sprain," and I couldn't find one anywhere....so instead, I went with a sweet ol' broken leg...
mmm broken leg, reminds me of the time one of our bulls came though a fence and put me through the wall of the barn. I was so surprised, I didn't even notice when he stomped my head into a skull fracture.
Lets to dislocations next. Shoulders are great, fingers are a particular point of interest for me.
Green acres is the place to be
Farm living is the life for me...
I'm all for discussing the AC Joint seperation/ligament tear, as this happened to me a couple of months ago. I even have some nice pictures detailing the injury.
Send me those pics....and it will be done...
Hi there. I broke my talus in '04 playing basketball, but unfortunately was initially misdiagnosed with a high ankle sprain. I went thru 7 months of intensive rehab before we realized i wasn't showing any improvement and needed another opinion. Long story short I ended up having surgery to repair it. As of now its much better but still causing a lot of problems. I have a lot of pain after exercise and or working out. I was wondering if you thought HGH might be helpful in recovering and strengthing a 4 year old injury.
ok so yours is one of many sites I've been researching, and I'm very familiar with the anatomy, mechanisms, etc, I study the body extensively. However I am unable as of yet to correct my ankle dysfunction following a sprain. I've sprained both of my ankles before, years ago. My left side sustained a significant 2nd degree sprain in 2003, but it healed up fine after a while. My right side was a 1st degree sprain in 2005, which also healed fine within a short amount of time. However, approximately 2 months ago I sprained my right ankle again - I should mention that all 3 were done with the same mechanism, rolling the foot medially and spraining the lateral ligaments. For the most recent one I immediately iced and braced it, kept it raised, used crutches for 2 weeks, but also made sure to put some weight on it throughout the day so it wouldn't tighten up too much. Basically I did everything I was supposed to, and it's not healed. It's not terrible, I can walk just fine, and could probably run if I needed to, but the pain returns immediately when I invert my foot even slightly - again, not excruciating, but worrisome. I know what a serious sprain feels like, so I'm very confident that it wasn't a 2nd or 3rd degree, the more acute pain had subsided within a day or 2 of the injury, but I'm getting scared. It still feels like it did after the first 2 weeks and doesn't seem to be improving... I take ibuprofen daily, and ice it periodically, but neither seems to have any impact, and while I do wear my brace everyday I'm not sure thats helping either. It is still swollen even, not dramatically but it's noticeable when you are looking for it. I cannot imagine any reason for this, I go easy on it... and I am entirely against surgery, it is way too mild to require that in my estimation, plus I don't have health insurance so either way its moot, I could never afford it.
Have you any suggestions? I'm becoming a bit despondent - I can't run, can't practice my kung fu much, and have to be careful with each step I take... not a happy camper as you can imagine. Any insight you might have would be greatly appreciated.
thanks much!
g
graham,
As a physical therapist, with what you've done in the past and with how you've treated your ankle so far, I would recommend an exercise program to strengthen the lateral muscles around your ankle joint. And it definitely wouldn't hurt anything to go ahead and strengthen all of your ankle muscles. The stronger those muscles are, the more additional support and firmness your ankle will have. The damage to the ligaments has essentially been done already, and your ligaments will likely have that laxity for the rest of your life. But if you can strengthen the muscles around the joint, you can compensate for the lax ligaments. It might not be bad to see a PT for a few sessions to be properly shown some exercises you can do, or you can search the web for a handful of strengthening exercises for your feet. Something with resistive band/tubing would be best, covering all the primary foot motions: inversion, eversion, dorsiflexion, and plantarflexion. Ice and ibuprofen can help with swelling and pain relief, but they don't solve the structural damage your ankle(s) have sustained.
Kelper
This is a great article, I broke my fibula 3 weeks ago and this article has been really helpful.
I appreciate the help your site has given me. I am currently dealing with a level three sprain. its going on two weeks now. My doc gave me a boot that allows me to walk but without it its impossible. I was wondering with a 21 year old diabetic will it heal slower than average? Do not want to get the idea it will be healed in about 3 weeks when it might take a two months.