Ankle injuries are often thought of as sports injuries. But you don’t have to be an athlete or even a “weekend warrior” to turn your ankle and hurt it. Something as simple as walking on an uneven surface can cause a painful, debilitating sprain.
Ankle injuries can happen to anyone at any age. However, men between 15 and 24 years old have higher rates of ankle sprain, compared to women older than age 30 who have higher rates than men. Half of all ankle sprains occur during an athletic activity.The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle. But you can also tear or strain a tendon.
What Kinds of Ankle Injuries Are There?
Sprains, Strains, and Fractures
Ankle injuries are defined by the kind of tissue — bone, ligament, or tendon — that’s damaged. The ankle is where three bones meet — the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion. Tendons attach muscles to the bones to do the work of making the ankle and foot move, and help keep the joints stable.
A fracture describes a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.
Muscle and tendon strains are more common in the legs and lower back. In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of a tendon is called tendinitis. Microscopic tendon tears that accumulate over time, because of being repeatedly over stretched, and don’t heal properly lead to a condition called tendinosis. Tendons can also rupture. Subluxation refers to a tendon that slips out of place
Ankle Injuries: Causes and Treatments
What Causes Ankle Injuries?
An ankle injury occurs when the ankle joint is twisted too far out of its normal position. Most ankle injuries occur either during sports activities or while walking on an uneven surface that forces the foot and ankle into an unnatural position. The unnatural position of the ankle in high-heeled shoes or walking in unstable, loose-fitting clogs or sandals is also a factor that may contribute to ankle injuries. In addition to wearing faulty footwear, an ankle injury can happen as a result of:
- Tripping or falling
- Landing awkwardly after a jump
- Walking or running on uneven surfaces
- A sudden impact such as a car crash
- Twisting or rotating the ankle
- Rolling the ankle
Are There Different Signs for Different Ankle Injuries?
The symptoms of a sprain and of a fracture are very similar. In fact, fractures can sometimes be mistaken for sprains. That’s why it’s important to have an ankle injury evaluated by a doctor as soon as possible. The signs include:
Pain, often sudden and severe
Inability to walk or bear weight on the injured joint
With a sprain, the ankle may also be stiff. With a fracture the area will be tender to the touch, and the ankle may also look deformed or out of place.
If the sprain is mild, the swelling and pain may be slight. But with a severe sprain, there is much swelling and the pain is typically intense.
Tendinitis and acute tears of the peroneal tendon result in both pain and swelling. In addition, the ankle area will feel warm to the touch with tendinitis. With an acute tear, there will be a weakness or instability of the foot and ankle.
What Should Someone Do After an Ankle Injury?
You can apply first aid for an ankle injury by remembering R.I.C.E: rest, ice, compression, elevation.
Rest. It’s important to rest the ankle to prevent further damage and keep weight off of it.
Ice. Using ice will help slow or reduce the swelling and provide a numbing sensation that will ease the pain. Proper icing includes icing within 48 hours of an injury, never leave ice on for longer than 15 minutes to 20 minutes at a time to prevent frostbite. Wait 40 minutes to 45 minutes before applying ice again to allow tissues to return to normal temperature and sensation, and repeat as needed. You can apply an ice compress using a plastic freezer bag filled with ice cubes and water to mold to your ankle or use a frozen bag of veggies like corn or peas, (don’t eat them after you use them and refreeze them), use a layer of towel between your skin and the plastic bag.
Compression. Wrapping the injured ankle with an elastic bandage or off-the-shelf compression wrap will help keep it immobile and supported. Be sure not to wrap the ankle too tightly. If your toes that turn blue, get cold or lose sensation the wrap is too tight.
Elevate. Elevating the injured ankle to at least the level of your heart will reduce swelling and pain.
Fractures and sprains that are ignored or aren’t treated properly can lead to long-term chronic problems with the ankle, such as repeated injury, ankle weakness, and arthritis.
Treatment of Sprains
The treatment for sprains depends on the severity of the injury. They are graded as mild, moderate, or severe. Surgery is not usually a treatment option unless the damage is extensive, involves more than the ligaments, or when other treatment options fail.
Mild sprains — called grade 1 — are treated with the RICE approach for several days until the pain and swelling improve. With a mild sprain, you won’t need a splint or a cast. Your doctor will tell you to put weight on the ankle fairly soon — within one to three days — as long as you can tolerate it and will prescribe range of motion, stretching, and strengthening exercises.
If your sprain is classified as moderate, or grade 2, the doctor will use the RICE approach but allow more time for healing to occur. The doctor may also use a device such as a boot or a splint to immobilize the ankle. You will be given exercises to do first to improve range of motion and then to stretch and strengthen the ankle.
Grade 3 or a severe sprain involves a complete tear or rupture of a ligament and takes considerably longer to heal. It’s treated with immobilization of the joint followed by a longer period of physical therapy for range of motion, stretching, and strength building. Occasionally, especially if the sprain does not heal in a reasonable time, surgery will be considered for reconstructing the torn ligaments.
On average, the initial treatment of a sprain, includes resting, and protecting the ankle until swelling goes down for about one week. That’s followed by a period of one to two weeks of exercise to restore range of motion, strength, and flexibility. It can take several more weeks to several months to gradually return to your normal activities while you continue to exercise.
Can Ankle Injuries Be Prevented?
Avoid exercising or playing sports when you are tired or in pain.
Keep muscles strong by eating a well-balanced diet.
Maintain a healthy weight.
Try to avoid falling.
Wear shoes that fit well and that are appropriate for the activity you are doing.
Don’t wear shoes that have heels worn down on one side.
Exercise every day.
Maintain the proper conditioning for whatever sport you are playing.
Warm up and stretch before exercising or playing a sport.
Wear the proper equipment for whatever sport you play.
Run on flat surfaces.
Living Your Life Pain-Free
To Your Health & Wellness,