Ankle sprain

A woman was exercising on an uneven surface which she had not noticed. When she jumped during her aerobic routine, her foot twisted and she fell to the ground. She experienced severe pain, and within the next 30 minutes she noticed a swelling on the outside of the ankle. She consulted the doctor who diagnosed it as severe ankle sprain.

About Ankle Sprains

The ligaments are tough elastic bands of fibrous tissue. They help in stabilizing the bones, connecting one bone to the other and prevent excess movement. When there is excess force that makes the ligaments go beyond their normal range and get damaged, this is called as a sprain. A movement like a twist, turn or roll can cause a stretch or tear in the ligament causing a sprain. An ankle sprain is the most common sprain that one comes across in which there is an injury to the ligament on the outside of the ankle.

There may be a visible swelling along with pain in the sprained area. Pain is mild, if the sprain is not severe. In case of a severe sprain, swelling and severe pain occurs. The movement of the ankle may be restricted. The person may find the sprained area, cold and numb. It might become difficult to bear the body weight on the affected leg.

Consult your doctor immediately when you observe the above symptoms.

Right way to use ice pack

Ice has to be placed not more than 20 minutes at a time on the affected part of the ankle. The minute the person feels numb, the ice has to be removed. Ice should be used once in every 2 to 4 hours for the first 3 days after sprain. The ice pack can be made by crushing ice and placing it in a plastic bag. After placing the ice pack one must wrap an elastic band around it to hold it in place. For a good ice massage, ice should be first frozen in a Styrofoam cup (4 to 8 ounce). The top part of cup is torn to expose the ice and then it is massage on to the affected area for not more than 30 seconds. For an ice slush bath, one must fill the bucket with ice and water, and then place the ankle in it till it gets numb.

Returning to sports

Returning to sports activities depends on the severity of the injury. For activities like swimming and bicycling one can return to it immediately, if there is no pain. For participating in other sports one should always wear an ankle brace support.

To avoid an ankle sprain one must always wear shoes that fit properly. Warm up before any sports activity is important and one should take care not to exercise on uneven ground. By taking necessary precautions one can avoid a serious ankle sprain.

  • For diagnosing an ankle sprain, an X-ray may be taken to capture images of the internal structure of the ankle.

  • A bone scan may be conducted in which a radioactive substance is injected intravenously into the bone. This radioactive substance gets attached to the damaged bone which is clearly seen in the scan as bright spots.

  • The Magnetic resonance imaging (MRI) scan is done in which radio waves and a magnetic field is used to produce good images of the internal structure of the ankle.

  • To get cross sectional images of the ankle, a computerized tomography (CT scan) is done.

According to the RICE approach, one must rest the ankle sufficiently and use crutches, if needed. To decrease swelling, muscle spasms, bruising and pain, ice packs should be applied for at least for 3 days after injury. Compressing the ankle with ankle wrap helps in preventing bruising and swelling. A horse shoe shaped thick pad (1x4 to 3x8 inch) thick is placed on both sides of the ankle with open end facing upwards. Elastic bandage is wrapped around the foot in a figure ‘8’ pattern leaving the ankle exposed. One must make sure that it is not wrapped so tightly that the blood flow is stopped. With adhesive strips one can attach the elastic bandage firmly. The ankle wrap can be kept in place for up to a week. To prevent the swelling from getting worse, one must raise the ankle above heart level and keep it that way for 2 to 3 hours every day.

The medications used for reducing swelling include acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), naproxen (Aleve).

Physical therapy is given after swelling comes down. This increases the balance, flexibility, motion and strength of the ankle. A cast or a walking boot may be necessary for proper healing of ankle joint. Surgery is needed for ligament tear.

To prevent re-injury one must exercise the ankle to make the muscles stronger. One needs to wear a semi rigid brace on the ankle to prevent further sprains for 1 to 2 months.

  • To exercise the ankle, the person should make circles with the ankle while sitting on the floor with legs stretched. Around 5 to 10 circles can be done thrice a day moving the ankle up and down and side to side.

  • One can try writing alphabets in the air with the toe which is a good exercise.

  • Pulling toes towards one self and pointing them away, holding in such a position for 15 seconds is another exercise that one can do around 10 times in a day.

  • The other exercises include step up; resisted in and out and sitting and standing heel raises.

  • To improve balance one can try standing on the injured leg for 30 seconds and slowly increase the duration. Placing a chair in front will provide support. One can repeat this exercise thrice daily.