How to diagnose your own injuries: Ankle sprains

THE ANKLE SPRAIN SELF-TREATMENT SERIES:

• How to diagnose your ankle sprain (this article)

• How to know if you've broken your ankle

• How to treat your ankle sprain

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Ankle sprains are very common and most people reading this blog would have twisted their ankles at some stage in their lives. The patients we see in our online clinic describe a wide range of causes - some as innocuous as stepping off a curb - while others are sustained through high-impact collisions on the sports pitch.

Recovery times can vary from 4 weeks for a mild ankle sprain to more than 12 weeks if you have done a proper job of it. Being able to walk in a near normal way within 48 hours is usually a sign that you will make a good recovery. The recovery time of an ankle sprain is heavily dependent on what structures you've injured and the quality of your rehab programme.

In this article:

• What happens when I sprain my ankle?

• How do I know if I have torn a ligament of the ankle?

• How do I know if I have torn a muscle in my ankle?

• Should I go to A&E for a sprained ankle?

What happens when I sprain my ankle?

The ankle joint consist of three bones (tibia, fibula, talus) which are held together by a strong capsule and ligaments. The joint surfaces are covered with articular cartilage. The tendons of the muscles that control the different movements of the foot also cross the ankle joint on all sides.

Which structures are injured when you roll your ankle, depend on what direction you twist the foot into. In most cases you will stretch the ligaments and muscles on one side of the ankle while you compress the joint surfaces on the opposite side. You can even cause the bone to bruise or fracture if the movement is forceful enough.

The joints and ligaments of the rest of the foot can also be injured during an ankle sprain.

Ankle Sprain: How do I know if I have torn a ligament of the ankle?

You can be pretty sure that you've at least partially torn an ankle ligament if there's some local swelling and bruising in the area of the ligament and it is painful to press on it (see picture below).

There are 3 grades of ligament tears:

Grade 1: You have only torn a few of the fibres of the ligament. It is painful to stretch the ligament but there's no noticeable laxity (i.e. the ligament still stops the joint from moving too far). There is usually only a mild area of swelling.

Grade 2: You have torn a significant number of fibres, but not all of them.  There is usually a lot of swelling. It is painful to stretch the ligament and the joint is moving slightly further than what it should.

Grade 3: You have fully torn the ligament. There is usually significant swelling in the area. It may not be painful to stretch the ligament (since there is nothing left to stretch) and the joint moves a lot further than what it should when you compare it to the uninjured side.

Grade 3 tears will require an extended period of protection (in a brace or boot) and may even require surgery, while you can usually walk with a pretty normal gait after sustaining a Grade 1 ankle ligament tear.

Picture 1: Lateral ligaments of the ankle

Picture 2: Medial ligaments of the ankle

Ankle Sprains: How do I know if I have torn a muscle in my ankle?

You have likely torn a muscle or tendon if it is painful to press on it and if it hurts to actively contract that muscle against resistance. For instance, use your hand to try and turn your foot inwards while you actively resist the movement with your foot. The net effect should be that the foot stays in the same position. If it hurts when you do this or if you are unable to keep your foot in the same position, you may have torn your peroneal muscles. The movement you use during testing will depend on which muscle you want to test.

Picture 3: Some of the muscles of the foot and ankle

Should I go to A&E for a sprained ankle?

You should go to A&E if you suspect that you may have broken a bone in your foot or ankle.  I know, you're not a doctor, but you can use the Ottawa Rules to help you decide. You can find a detailed explanation of how to use the Ottawa Rules to diagnose an ankle fracture in this blog post. Steph also explains it very well in the video below.

You should also go to A&E if your ankle swells up very quickly, within 30 minutes of injuring it, or you are unable to walk on it for four steps (walking with a limp counts). Swelling that occur this quickly is usually indicative of an injury to the cartilage or bone inside the ankle joint and it is good to have it investigated further.  These types of ankle sprains are typically the ones that take 12 or more weeks to recover from.

If, however, you can walk on the foot and it gradually swells over a few hours, I would rather consult a physiotherapist. Knowing exactly what structures you've injured and how to strengthen them will speed up your recovery. This is something that our team of sports physios can easily help you with via an online consultation. Research has shown that a physical examination carried out 4 or 5 days after an ankle injury produces more accurate results than if it is done on the day of injury. You can read more about how to treat ankle sprains in this blog post or if you find that you're stuck in a cycle of recurring ankle sprains, then this article may be of use.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate

References:

1. Kerkhoffs, G. M., van den Bekerom, M., Elders, L. A. M., van Beek, P. A., Hullegie, W. A. M., Bloemers, G. M. F. M., et al. (2012). Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British Journal of Sports Medicine, 46(12), 854-860.

2. Tayeb, R. (2013). DIAGNOSTIC VALUE OF OTTAWA ANKLE RULES: SIMPLE GUIDELINES WITH HIGH SENSITIVITY. British Journal of Sports Medicine, 47(10), e3.