Treatment of an Ankle Sprain

Copyright (c) 2010 Mitchell Wachtel DPM

Ankle sprains are a very common diagnosis for many people. An ankle sprain causes swelling of the foot and ankle and bleeding develops under the skin, causing a black and blue discoloration. Pain and stiffness are also quite common due to the swelling. Swelling can also cause pressure on the nerves in the joint area, which causes tingling and numbness often times. When an ankle sprain occurs the ligaments are stretched causing the area to become unstable. Ligaments are meant to slow down movement, but when an injury occurs they are no longer able to provide that support, causing the unstableness. A recovery period can vary between people with the deciding factor depending on the grade and level of the injury.

Many scenarios may occur from an ankle sprain. One of the most common is that within the ankle joint a large amount of fluid develops. This can cause pain and swelling on the side of the ankle. The fluid that develops in the ankle joint is caused by a small tear of a ligament inside the ankle joint. Sometimes we will provide patients with a cortisone shot inside the joint to decrease the swelling within the joint. If the inflammation is not decreased, the problem can be exacerbated by the stretching of the tendons on either side of the ankle joint.

When an ankle joint becomes very stiff the patient should try to stay off of their foot. The aim of treating ankle sprains is to decrease the amount of weight the ankle is supporting in order to decrease the swelling. One of the most important things to do if you sprain your ankle is to keep your shoes or sneakers on directly after the traumatic event. Typical treatment for an ankle sprain can be easily remembered with RICE: rest, ice, compression, and elevation. Directly after the traumatic event we recommend putting ice on the ankle for about fifteen minutes, on and off, several times a day. Usually we recommend an anti-inflammatory medication, if your stomach allows, such as Ibuprofen and/or Tylenol. Many times a topical ointment, such as Biofreeze, can be applied to a sprain to help alleviate pain and provide deep heat.

Many times an x-ray should be taken to rule out a fracture as a diagnosis. Sometimes it is necessary to perform more advanced imaging, such as an MRI, to rule out ruptures or special fractures called stress fractures. Stress fractures often cannot be seen on x-rays directly after an injury; however, they may be seen on an x-ray several weeks after the injury.

There are multiple treatments for ankle sprains that depend on the severity of the injury. For a mild sprain a simple ACE bandage wrap can sometimes be the best mode of treatment. Moderate to severe ankle sprains are treated a little more aggressively with either a surgical shoe or a below the knee Cam Walker. A Cam Walker encompasses the foot, ankle, and leg and prevents the patient from bearing weight on their injury, letting the ligaments and/or muscles that were stretched heal properly. Sometimes we apply a soft cast in addition to a removable cast. The soft cast reduces swelling and limits motion at the ankle joint.

When swelling has decreased the patient usually is transitioned to an ankle brace, which does not allow the ankle to move in certain directions, which could injure the joint once again. When the patient is close to healing we usually explain to patients that once an ankle has been sprained, they are more apt to have another sprain. The thought is that the ligament and surrounding tendons are weakened to a degree. Extra support for the foot and ankle is very beneficial to the patient to prevent another injury. The way we provide this extra support is with an orthotic. Most times we recommend a custom orthotic which is molded and casted to the patients' foot and ankle area. We recommend that patients wear the orthotic for many years to provide the correct support.

Shoe gear is something that should also be evaluated after a complex injury, such as an ankle sprain. Shoes with high heels should be avoided. Good walking shoes with a rigid sole is quite important, as well as a shoe that is wide enough to accommodate an orthotic device.

Lastly, providing physical therapy can strengthen the weakened tendons and ligaments. Prompt treatment with a qualified professional can help to decrease a long recuperative period.