Ankle Sprain

Ankle Sprain – How is it caused?

Ankle sprain is a stretch or tear in one of the tough tissues (ligaments) that connect the bones in your ankle. An ankle sprain can happen when the ankle rolls outward (inversion sprain) or inward (eversion sprain).

Follow these instructions at home:

  • Rest your ankle.
  • Take over-the-counter and prescription medicines only as told by your doctor.
  • For 2–3 days, keep your ankle higher than the level of your heart (elevated) as much as possible.
  • If directed, put ice on the area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • If you were given a brace:
    • Wear it as told.
    • Take it off to shower or bathe.
    • Try not to move your ankle much, but wiggle your toes from time to time. This helps to prevent swelling.
  • If you were given an elastic bandage (dressing):
    • Take it off when you shower or bathe.
    • Try not to move your ankle much, but wiggle your toes from time to time. This helps to prevent swelling.
    • Adjust the bandage to make it more comfortable if it feels too tight.
    • Loosen the bandage if you lose feeling in your foot, your foot tingles, or your foot gets cold and blue.

If you have crutches, use them as told by your doctor.

Contact a doctor if:

  • Your bruises or swelling are quickly getting worse.
  • Your pain does not get better after you take medicine.

Get help right away if:

  • You cannot feel your toes or foot.
  • Your foot or toes look blue.
  • You have very bad pain that gets worse.

Summary

  • An ankle sprain is a stretch or tear in one of the tough tissues (ligaments) that connect the bones in your ankle.
  • To relieve pain and swelling, place ice on the affected ankle, raise your ankle above the level of your heart, and use an elastic bandage. Also, rest as told by your health care provider.

Ankle Sprains: Healing and Preventing Injury

What is a sprain?

A sprain is a stretched or torn ligament. Ligaments connect one bone to another bone at a joint and help keep the bones from moving out of place.

The most common site of sprains is the ankle. An ankle sprain can happen when you fall, when you suddenly twist your ankle too far, or when you force the joint out of its normal position (for example, when you land awkwardly on your foot after jumping). Most ankle sprains happen during sports activities or when walking or running on an uneven surface.

The signs of an ankle sprain can include:

The severity of an ankle sprain depends on how badly the ligaments are stretched or torn. If the sprain is mild, there may not be much pain or swelling, and the ligaments may only be stretched. If the sprain is severe, one of more ligaments may be torn, and the join may be severely swollen. A severe sprain can also be extremely painful.

  • pain or tenderness
  • swelling
  • bruising
  • coldness or numbness in the foot
  • inability to walk or bear weight on the joint
  • stiffness

How are ankle sprains diagnosed?

Your doctor will usually be able to tell if you have a sprain by asking you some questions about how the injury occurred and by examining your ankle. You doctor may also want to take an X-ray of your ankle to make sure that it’s not fractured or broken.

How can ankle sprains be treated?

Many doctors suggest using the RICE approach– Rest, Ice, Compression, Elevation–for treating ankle sprains (see the box below).

Will I need to wear a brace?

This will depend on how serious your sprain is, if you have other ankle injuries and how your doctor thinks your sprain should be treated. You may need to wear a brace or padded plaster, plastic or fiberglass splint for 10 days to 6 weeks. A brace or splint keeps the bones and injured ligaments from moving, which provides protection, reduces pain and speeds healing.

How long before I can use my ankle?

This depends on how serious your sprain is. If your sprain is mild, your doctor may suggest that you start trying to use your ankle again fairly soon–from 1 to 3 days after your injury.

Special exercises are sometimes needed to regain strength and to help reduce the chance of ongoing problems. Your ankle may need to be supported by taping or bracing to help protect it from re-injury.

What about medicine for pain?

If you need medicine to ease the pain, try acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin, Nuprin).

What is the best way to use ice?

Putting ice on your ankle can be very helpful, but you also need to be careful. The cold can damage nerves if the ice is left in place too long.

Ice can be left on your ankle for up to 20 minutes at a time. When your skin feels numb, it’s time to remove the ice. Use ice treatments every 2 to 4 hours for the first 3 days after your injury. Ice treatments can consist of ice packs, ice slush baths or ice massages.

To use ice packs, partly fill a plastic bag with crushed ice. Wrap a thin, wet cloth around your injury. Place the ice pack over this and then wrap an elastic bandage around the ice pack to hold it in place.

For ice slush baths, fill a large bucket with water and ice. Place your ankle in the bucket until the skin gets numb.

Ice massagescan work well for small areas. Freeze water in 4- to 8-ounce styrofoam (coffee) cups. Tear the top part of the cup away from the ice. Hold the covered end and slowly rub the ice over the sprained area with a circular motion. Don’t hold the ice on one spot for more than 30 seconds.

How do I wrap a sprained ankle?

Start by cutting out a horseshoe-shaped pad from 1 x 4- to 3 x 8-inch-thick felt. Put this pad around the outside of your ankle joint on both sides of your foot, with the open end facing up.

Then wrap an elastic bandage, such as an Ace bandage, in a basket-weave “figure-eight” pattern. Leave your heel exposed. Reinforce your wrap with 21 x 2-inch adhesive tape over the elastic bandage.

Ask your doctor to show you how to do this. The ankle shouldn’t be wrapped so tightly that the blood flow is cut off.

How soon can I exercise or play sports?

If you’re an athlete, you’ll probably be able to return to your sport in several weeks, depending on how serious your injury is and what sport you’re involved in. When participating in sports, you may need to keep your ankle braced or wrapped for support and protection.

Bicycling, swimming or even running are usually okay to return to right away if they don’t cause pain during or after exercise. But you’ll still need to avoid pivoting and twisting movements for 2 to 3 weeks.

How can I prevent reinjury?

When your doctor feels you’re ready to exercise again, you can help prevent further sprains and setbacks by wearing a semi-rigid ankle brace when you exercise for another 1 to 2 months.

Special wraps that use hook and loop fasteners, or air-filled or laced braces may also help prevent re-injury. Wearing high-top tennis shoes may also help prevent ankle sprains if your shoes are laced snugly and if you also tape your ankle with a wide, nonelastic adhesive tape. Elastic tape or braces are usually not helpful because the elastic gives too much around the joint.

Once your sprain has completely healed, a program of ankle exercises will also help prevent re-injury by making the muscles stronger, which provides protection to the ligaments. Try the following exercises:

  • Ankle Circles: Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do 5 to 10 circles in each direction at least 3 times per day.
  • Alphabet Letters:Using your big toe as a “pencil,” try to write the letters of the alphabet in the air. Do the entire alphabet 2 or 3 times.
  • Toe Raises:Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.
  • Heel Raises: Point your toes away from you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times .
  • In and Out: Turn your foot inward until you can’t turn it anymore and hold for 15 seconds. Straighten your leg again. Turn it outward until you can’t turn it anymore and hold for 15 seconds. Do this 10 times in both directions.
  • Resisted In and Out: Sit on a chair with your leg straight in front of you. Tie a large elastic exercise band together at one end to make a knot. Wrap the end of the band around the chair leg and the other end around the bottom of your injured foot. Keep your heel on the ground and slide your foot outward and hold for 10 seconds. Put your foot in front of you again. Slide your foot inward and hold for 10 seconds. Repeat at least 10 times each direction 2 or 3 times per day.
  • Step Up:Put your injured foot on the first step of a staircase and your uninjured foot on the ground. Slowly straighten the knee of you injured leg while lifting your uninjured foot off the ground. Slowly put your uninjured foot back on the ground. Do this 3 to 5 times at least 3 times per day.
  • Sitting and Standing Heel Raises:Sit in a chair with your injured foot on the ground. Slowly raise the heel of you injured foot while keeping your toes on the ground. Return the heel to the floor. Repeat 10 times at least 2 or 3 times per day. As you get stronger, you can stand on your injured foot instead of sitting in a chair and raise the heel. Your injured foot should always stay on the ground.
  • Balance Exercises:Stand and place a chair next to your uninjured leg to balance you. At first, stand on the injured foot for 30 seconds. You can slowly increase this to up to 3 minutes at a time. Repeat at least 3 time a day. To increase the difficulty, repeat with your eyes closed.

RICE approach

  • Rest:You may need to rest your ankle, either completely or partly, depending on how serious your sprain is. Use crutches for as long as it hurts you to stand on your foot.
  • Ice: Using ice packs, ice slush baths or ice massages can decrease the swelling, pain, bruising and muscle spasms. Keep using ice for up to 3 days after the injury.
  • Compression:Wrapping your ankle may be the best way to avoid swelling and bruising. You’ll probably need to keep your ankle wrapped for 1 or 2 days after the injury and perhaps for up to a week or more.
  • Elevation: Raising your ankle to or above the level of your heart will help prevent the swelling from getting worse and will help reduce bruising. Try to keep your ankle elevated for about 2 to 3 hours a day if possible.

Ankle Sprain, Phase I Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your lower leg and ankle. These exercises also help to relieve pain and stiffness.

Exercise A: Gastroc and soleus stretch

  1. Sit on the floor with your left / right leg extended.
  2. Loop a belt or towel around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
  3. Keep your left / right ankle and foot relaxed and keep your knee straight while you use the belt or towel to pull your foot toward you. You should feel a gentle stretch behind your calf or knee.
  4. Hold this position for __________ seconds, then release to the starting position.

Repeat the exercise with your knee bent. You can put a pillow or a rolled bath towel under your knee to support it. You should feel a stretch deep in your calf or at your Achilles tendon.

Repeat each stretch __________ times. Complete these stretches __________ times a day.

Exercise B: Ankle alphabet

  1. Sit with your left / right leg supported at the lower leg.
    • Do notrest your foot on anything.
    • Make sure your foot has room to move freely.
  2. Think of your left / right foot as a paintbrush, and move your foot to trace each letter of the alphabet in the air. Keep your hip and knee still while you trace. Make the letters as large as you can without feeling discomfort.
  3. Trace every letter from A to Z.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your ankle and lower leg. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Dorsiflexors

  1. Secure a rubber exercise band or tube to an object, such as a table leg, that will stay still when the band is pulled. Secure the other end around your left / right foot.
  2. Sit on the floor facing the object, with your left / right leg extended. The band or tube should be slightly tense when your foot is relaxed.
  3. Slowly bring your foot toward you, pulling the band tighter.
  4. Hold this position for __________ seconds.
  5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Plantar flexors

  1. Sit on the floor with your left / right leg extended.
  2. Loop a rubber exercise tube or band around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
    • Hold the ends of the band or tube in your hands.
    • The band or tube should be slightly tense when your foot is relaxed.
  3. Slowly point your foot and toes downward, pushing them away from you.
  4. Hold this position for __________ seconds.
  5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Evertors

  1. Sit on the floor with your legs straight out in front of you.
  2. Loop a rubber exercise band or tube around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
    • Hold the ends of the band in your hands, or secure the band to a stable object.
    • The band or tube should be slightly tense when your foot is relaxed.
  3. Slowly push your foot outward, away from your other leg.
  4. Hold this position for __________ seconds.
  5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Ankle Sprain, Phase II Rehab

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your lower leg and ankle. These exercises also help to relieve pain and stiffness.

Exercise A: Gastroc stretch, standing

  1. Stand with your hands against a wall.
  2. Extend your left / right leg behind you, and bend your front knee slightly. Your heels should be on the floor.
  3. Keeping your heels on the floor and your back knee straight, shift your weight toward the wall. You should feel a gentle stretch in the back of your lower leg (calf).
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Soleus stretch, standing

  1. Stand with your hands against a wall.
  2. Extend your left / right leg behind you, and bend your front knee slightly. Both of your heels should be on the floor.
  3. Keeping your heels on the floor, bend your back knee and shift your weight slightly over your back leg. You should feel a gentle stretch deep in your calf.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your lower leg. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Heel walking (

dorsiflexion)

Walk on your heels for __________ seconds or ___________ ft. Keep your toes as high as possible.

Repeat __________ times. Complete this exercise __________ times a day.

Balance exercises

These exercises improve your balance and the reaction and control of your ankle to help improve stability.

Exercise D: Multi-angle lunge

  1. Stand with your feet together.
  2. Take a step forward with your left / right leg, and shift your weight onto that leg. Your back heel will come off the floor, and your back toes will stay in place.
  3. Push off your front leg to return your front foot to the starting position next to your other foot.
  4. Repeat to the side, to the back, and any other directions as told by your health care provider.

Repeat in each direction __________ times. Complete this exercise __________ times a day.

Exercise E: Single leg stand

  1. Without shoes, stand near a railing or in a door frame. Hold onto the railing or door frame as needed.
  2. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.

Exercise F: Inversion/eversion

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

  1. Stand on a non-carpeted surface near a countertop or wall.
  2. Step onto the balance board so your feet are hip-width apart.
  3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles to move the board, do one or both of the following exercises as told by your health care provider:
    • Tip the board side to side as far as you can, alternating between tipping to the left and tipping to the right. If you can, tip the board so it silently taps the floor. Do notlet the board forcefully hit the floor. From time to time, pause to hold a steady position.
    • Tip the board side to side so the board does not hit the floor at all. From time to time, pause to hold a steady position.

Repeat the movement for each exercise __________ times. Complete each exercise __________ times a day.

Exercise G: Plantar flexion/dorsiflexion

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

  1. Stand on a non-carpeted surface near a countertop or wall.
  2. Step onto the balance board so your feet are hip-width apart.
  3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles to move the board, do one or both of the following exercises as told by your health care provider:
    • Tip the board forward and backward so the board silently taps the floor. Do notlet the board forcefully hit the floor. From time to time, pause to hold a steady position.
    • Tip the board forward and backward so the board does nothit the floor at all. From time to time, pause to hold a steady position.

Repeat the movement for each exercise __________ times. Complete each exercise __________ times a day.

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