THE ANKLE SPRAIN SELF-TREATMENT SERIES:
How to diagnose your Ankle Sprain (this article)
Ankle sprains are very common and most people reading this blog would have twisted their ankles at some stage in their lives. The patients I see in my online physiotherapy 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.
In this article:
What happens when I sprain my ankle?
How do I know if I have torn a ligament?
How do I know if I have torn a muscle?
When should I go to A&E?
What happens when I sprain my ankle?
The ankle joint consist of 3 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?
You can be pretty sure that you've at least partially torn a 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.
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.
Ankle Sprains: How do I know if I have torn a muscle?
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.
Ankle Sprain: When should I go to A&E?
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.
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 hobble 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 I 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.
No time for a visit to the physio? Sports Injury Physio is an online physiotherapy practice that provides online diagnosis and treatment via Skype at times that suit you.
Let me know if you have any questions.
About the Author
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.