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. Every day in the U.S., 25,000 people sprain their ankle. And more than 1 million people visit emergency rooms each year because of ankle injuries. 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.
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 from your leg and the talus from your foot. These are held together at the ankle joint by ligaments, which are elastic bands of connective tissue. These keep the bones in place while stretching to permit normal motion. There are also muscles and tendons that protect the ankle joint, do the work of making the foot move, and help hold the joint in place.
A fracture occurs when there is 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 sprain can range from microscopic tears in the fibers that comprise the ligament to complete tears or ruptures of the ligament. A strain refers to damage done to muscles and tendons, which connect muscles to bones, as a result of being pulled or stretched too far.
Muscle strains are more common in the legs and lower back. But there are two tendons at the ankle that stabilize the ankle and foot and protect them from sprains. These are the peroneal tendons. They can become inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, rupture, or slip out of place.
Acute tears result from repetitive activity or trauma. If the tears are degenerative, meaning they occur over a long period of time as a result of being overstretched, the condition is called tendonosis. The tendons can slip out of place — subluxation — as a result of either a trauma or a variation in the shape of the bone or muscle.
What Causes Ankle Injuries?
Fractures and sprains can result from the ankle joint being twisted too far out of its normal position. This 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
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.
Are There Different Signs for Different Ankle Injuries?
The signs of a sprain and the signs 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, and with a fracture the area will be tender to the touch. With a fracture, the ankle may also be 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.
Tendonitis and acute tears of the peroneal tendon are indicated by both pain and swelling. In addition, the ankle area will feel warm to the touch with tendonitis. With an acute tear, there will be a weakness or instability of the foot and ankle.
Tendonosis may take years to develop. Symptoms include:
- sporadic pain on the outside of the ankle
- weakness or instability in the ankle
- an increase in the height of the foot’s arch
With the subluxation you will notice ankle instability or weakness. You also may notice sporadic pain behind the outside ankle bone and a “snapping” feeling around the ankle bone.
What Should Someone Do After an Ankle Injury?
You can apply first aid for an ankle injury by following the RICE method.
- R stands for rest. It’s important to rest the ankle and not cause further damage by taking all weight off of it.
- I stands for ice. Using ice will help slow or reduce the swelling and provide a numbing sensation that will ease the pain. You can use ice by wrapping an ice pack in a towel and placing it on the site of the injury. Don’t leave the ice on the skin for more than 20 minutes at a time. And allow at least forty minutes before applying ice again to avoid damage from the cold. Do not apply heat to the injury. Heat stimulates blood flow and will cause more swelling and pain.
- C is for compression. Wrapping the injured ankle with an ace bandage will help keep it immobile and supported. Be sure not to wrap the ankle too tightly, though.
- E means elevate. Elevating the injured ankle to at least the level of your heart will reduce swelling and pain.
It is important not to put any weight on the ankle until after it’s been evaluated by a doctor, which should be done as soon as possible. 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.
How Does the Doctor Diagnose an Ankle Injury?
The first thing a doctor will do is ask questions about how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising, and may order an X-ray to determine whether there are any broken bones. The physical examination of the ankle will likely be painful because the doctor needs to move the ankle to evaluate the pain and swelling in order to make a proper diagnosis.
In some cases, for instance if the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there are other injuries. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the injury. This will help the doctor determine whether or not surgery is needed.
For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen. The specific treatment of the injury depends on the type of injury.
Treatment of Fractures
Fractures can be treated either surgically or non-surgically. If only one bone is broken, and if the bones are not out of place and the ankle is stable, the doctor may treat the break without surgery by immobilizing the ankle. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is unstable, the fracture will be treated surgically. Often, the ankle is made stable by using a metal plate and screws to hold the bones in place. Following the surgery, the ankle is protected with a splint until the swelling goes down and then with a cast.
It usually takes at least six weeks for the bones to heal, and your doctor will probably ask you to not put any weight on the ankle during that time. Putting weight on a fracture too soon can cause the fractured bones to slip and cause your operation to fail. After the bones heal, time will still be needed for the ligaments and tendons to heal. It can take as long as two years to completely heal after an ankle fracture, although most people are able to resume their normal daily routine within three to four months.
After the doctor has determined it is safe for you to start moving your ankle, you will need physical therapy and will be given a home exercise routine to help you regain a range of motion in the injured ankle. Eventually, you also will be given strengthening exercises to build the muscles back up. It will probably take several months before you are strong enough to walk without a limp.
Treatment of Sprains
The treatment for sprains depends on the severity — mild, moderate, or severe — of the injury. Surgery is not usually a treatment option unless the damage is extensive and involves more than the ligaments or unless 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. The doctor may also prescribe physical therapy to help you regain full use of your 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 stage of healing a sprain, which involves resting and protecting the ankle until swelling goes down, takes about one week. That’s followed by a period of exercise to restore range of motion, strength, and flexibility that lasts for one to two weeks. Then it takes several more weeks to several months to gradually return to your normal activities while you continue to exercise.
Treatment of Tendon Injuries
Options for treating tendon injuries are similar to options for treating sprains. They include:
- immobilization using a cast or splint
- oral or injected anti-inflammatory drugs to reduce pain
- physical therapy for range of motion, strength, and balance
- a brace to provide support during activities
- surgery to repair the tendon or tendons and sometimes to repair the supporting structures of the foot
Can Ankle Injuries Be Prevented?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends the following steps for reducing your risk of an ankle injury:
- 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.