Ankle Sprains
At Timonium Foot and Ankle Center, our doctors have extensive experience evaluating and treating ankle sprains and other ankle injuries. Because fractures, tendon injuries, cartilage damage, and other conditions can cause similar symptoms, treatment starts with an accurate diagnosis and determining the severity of the injury.
Many ankle sprains can be treated without surgery. Treatment may include bracing or immobilization, activity modification, medications, physical therapy, and other conservative treatments based on the severity of the injury and your individual needs.
If you've injured your ankle or continue to have pain, swelling, or instability after an ankle sprain, call our office or request an appointment online. We'll determine the extent of the injury and develop a treatment plan based on your diagnosis, activity level, and goals.
What is an ankle sprain?
An ankle sprain is an injury to one or more of the ligaments that stabilize the ankle joint. Ligaments are strong bands of tissue that connect bones and help prevent excessive movement of the joint. An ankle sprain most commonly occurs when the foot twists or rolls beyond its normal range of motion, causing the ligaments to stretch or tear.
Ankle sprains vary in severity. A mild or low-grade sprain involves stretching and microscopic injury to the ligament. A moderate sprain involves a partial ligament tear, while a severe sprain may involve a complete ligament tear and significant ankle instability.
Most ankle sprains involve the ligaments along the outside of the ankle, but they can occur on the inside of the ankle or even above the joint. Although many sprains heal successfully with appropriate treatment, a more significant ligament injury or an ankle sprain that does not heal properly can lead to persistent pain, weakness, recurrent sprains, or chronic ankle instability.
What are the symptoms of an ankle sprain?
Symptoms of an ankle sprain vary depending on the severity of the ligament injury.
- Pain and tenderness: Pain is typically present over the injured ligament and may worsen with standing, walking, or movement of the ankle.
- Swelling: Swelling around the ankle can develop shortly after the injury and may vary depending on the severity of the sprain.
- Bruising: Bruising, also known as ecchymosis, may develop around the ankle and sometimes extend into the foot.
- Joint pain and stiffness: The ankle may feel painful or stiff, particularly after swelling develops or following a period of rest.
- Difficulty walking: Putting weight on the injured foot may be painful, and more significant sprains can make walking difficult or impossible.
- Popping sensation: Some patients feel or hear a pop at the time of injury, particularly with more significant ligament injuries.
- Ankle instability: Severe ligament injuries may cause the ankle to feel unstable or give way. In very severe injuries, joint dislocation may occur.
How is an ankle sprain diagnosed?
An ankle sprain is diagnosed through a comprehensive foot and ankle examination. Our doctors evaluate the location of pain and swelling, areas of tenderness, ankle motion, ligament stability, and the patient's ability to bear weight.
X-rays may be obtained to rule out a fracture or other bone injury. Because ankle injuries can also involve tendons, cartilage, or other structures within the joint, additional imaging such as an MRI may be recommended when symptoms or examination findings suggest a more significant injury or when pain persists despite appropriate treatment.
Determining the extent of the ligament injury and identifying any associated injuries are important for developing the appropriate treatment plan and reducing the risk of chronic ankle instability.
How is an ankle sprain treated?
The severity of the ankle sprain dictates the recovery time. Low-grade sprains can generally improve in 3-6 weeks. Moderate sprains generally take 6-8 weeks to improve, while severe sprains can take 3-6 months to improve. Early treatment of ankle sprains is important to reduce the incidence of chronic pain, stiffness, and swelling and to prevent chronic ankle instability and re-injury. Conservative treatments includes immobilization, icing, compression therapy, physical therapy, and therapeutic laser.
Although we can never offer a 100% guarantee, the majority of our patients improve with conservative (non-surgical care).
How is an ankle sprain treated?
Treatment for an ankle sprain depends on the severity of the ligament injury and whether other structures in the ankle have also been injured. Mild ankle sprains may improve within approximately 3–6 weeks, moderate sprains may require 6–8 weeks, and severe ligament injuries can take 3–6 months or longer to fully recover.
Early and appropriate treatment is important to restore motion and stability and reduce the risk of persistent pain, swelling, stiffness, recurrent sprains, and chronic ankle instability. Most ankle sprains can be successfully treated without surgery.
Conservative treatment options
- Immobilization, AFOs, and bracing: Depending on the severity of the injury, treatment may include a cast and crutches, walking boot, hinged ankle-foot orthosis (AFO), or lace-up ankle brace to protect the injured ligaments while they heal.
- Rest and activity modification: Activities that place excessive stress on the injured ankle may need to be temporarily limited while the ligaments heal.
- Supportive footwear: Properly fitted, supportive shoes can help protect the ankle during recovery. Barefoot walking and poorly supportive shoes may increase stress on the injured ankle.
- Ice and elevation: Ice and elevation can help reduce pain and swelling, particularly during the early stages of an ankle sprain.
- Compression therapy: Compression, including prescription compression stockings when appropriate, may be used to help control persistent swelling.
- Therapeutic laser: Therapeutic laser may be used to help reduce pain and inflammation and promote healing of the injured tissues.
- Physical therapy: Physical therapy may be started early when appropriate to restore ankle motion, strength, balance, and stability and reduce the risk of recurrent ankle sprains.
- Medications: Anti-inflammatory medications (NSAIDs), acetaminophen (Tylenol), or other medications may be recommended when appropriate to help manage pain and inflammation.
When is surgery considered for an ankle sprain?
Surgery is not necessary for most ankle sprains. However, surgical treatment may be considered for severe ligament injuries with significant ankle instability, certain high-level athletes, or patients who develop persistent pain or chronic ankle instability despite appropriate conservative treatment.
The surgical procedure depends on the ligaments involved, the severity of the injury, the quality of the remaining ligament tissue, and the individual patient's activity level and needs.
Surgical treatment options
- Primary ligament repair: The damaged or torn ankle ligament is surgically repaired using the patient's existing ligament tissue.
- Ligament reconstruction with allograft: Donor tissue may be used to reconstruct a severely damaged ligament when a direct repair is not appropriate.
- Ligament reconstruction with autograft: In selected cases, the patient's own tendon tissue may be used to reconstruct the damaged ankle ligament.
At-home exercise: Heel Rises
Heel rises rebuild calf strength and ankle stability after a sprain. Dr. Stewart describes how to do the exercises safely at home.
Exercises are general guidance. Follow the plan you were given at your visit and stop if you feel sharp pain.
At-home exercise: Ankle Range of Motion
Ankle range of motion exercises improve strength in the foot and ankle. Follow along with Dr. Stewart's guidance.
