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Understanding ankle sprain

Understanding ankle sprain

An ankle sprain is one of the most common sports injuries. It occurs when the ligaments around the ankle are overstretched or torn due to twisting or turning motion

Ankle sprain grading

Grade I 
  • Due to mild stretching of a ligament with no tears.
  • Mild swelling and tenderness around the ankle.
  • No joint instability on examination.
  • Patient would be able to walk with minimal pain.

Grade II 
  • Ligament is partially torn.
  • Moderate pain, swelling, and tenderness around the ankle.
  • On examination, there is mild to moderate joint instability with restricted range of motion and loss of function.
  • Painful to walk or bear weight.

Grade III 
  • Ligament is completely torn.
  • Severe pain, swelling, and tenderness around the ankle.
  • On examination, there is significant joint instability with significant loss of function and range of motion.
  • Patient may not be able to walk or bear weight.

Seek medical attention if you suspect a Grade II or III ankle sprain because these injuries may require immobilisation, physical therapy, or surgery to completely heal.

Ankle sprain symptoms

  • Pain at rest and during activity
  • Swelling, bruising, and tenderness
  • Ankle instability, or feel that the ankle is giving way

Ankle sprain diagnosis

Your doctor would first question your general health and symptoms before conducting a thorough physical examination.

Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Ankle injuries are not evaluated with X-rays routinely because the majority of ankle sprains are caused by ligament problems, which do not show up on x-rays. If an X-ray is done, it is to look for fractures.

In some cases, stress x-rays may be done to evaluate the severity of the sprain.

Magnetic Resonance Imaging (MRI) scan is done to look for an injury to the ligament.

Ankle sprain treatment

All ankle sprains can be treated similarly in the acute phase. Initial management is to reduce pain and swelling while maintaining a range of motion prior to gradually introducing exercises.

  1. P.R.I.C.E. - Protection, Rest, Ice, Compression, Elevation is a common approach for the first two or three days.
    • Protection (P) is applied with the usage ofprotective support such as an elastic bandage, splint, or cast, depending on the extent of the injury. 
    • Rest (R) by limiting weight bearing and use a crutch for assistance.
    • Apply ice (I) packs to the affected area for at least 15 to 20 minutes, every two to three hours until swelling improves.
    • Use elastic bandages for compression (C) to reduce swelling.
    • Elevation (E) can be done bykeeping the ankle above the level of the heart to reduce swelling.
  2. Pain and swelling can be managed with oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs). 
  3. Range of motion exercises (physiotherapy only after the acute pain and swelling have subsided.
  4. Immobilisation and bracing can be donedepending on the grade of sprain.
    • Grade I: A few days of treatment with an elastic bandage or compression sleeve.
    • Grade II: Combination of an elastic wrap and an Aircast, a functional splint, a stand-alone brace, or a figure-eight brace. 
    • Grade III: Usage of non-weightbearing cast.

Make an appointment at Gleneagles Hospitals

If you have difficulty bearing weight on the ankle or if it remains swollen or painful for more than 3 to 5 days despite PRICE, you need to be evaluated by an orthopaedic specialist to ensure that there is no fracture or to determine if your sprain is severe enough to require special care.

Please seek immediate medical attention at the Accident and Emergency (A&E) department at your nearest Gleneagles Hospital in case of severe ankle pain.

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