Ankle Sprains & Strains
An ankle sprain is an injury to one or more ligaments in the ankle. The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.
A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.
Ligaments are bands of tissue, like rubber bands, that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. Most ankle sprains occur on the outer aspect of the ankle.
Some ankle sprains are worse than others. The severity of an ankle sprain depends on whether the ligament is partially or completely torn and on the number of ligaments involved. Ankle sprains are not the same as strains which affect muscles rather than ligaments.
Cause & Symptoms
If there is a severe in-turning or out-turning of the foot relative to the ankle, the forces cause the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments can tear.
You may lose your balance when your foot is placed unevenly on the ground. You may fall and be unable to stand on that foot. When excessive force is applied to the ankle’s soft tissue structures, you may even hear a “pop”. Pain and swelling result.
The amount of force determines the grade of the sprain:
A mild sprain is a Grade 1.
A moderate sprain is a Grade 2.
A severe strain is a Grade 3.
Grade 1 Sprain:
Slight stretching and some damage to the fibers (fibrils) of the ligament.
Grade 2 Sprain:
Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
Grade 3 Sprain:
Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.
High Ankle Sprain
This condition occurs when the sprain injures the large ligament above the ankle that joins the two bones of the lower leg, the tibia and fibula, together. The fibula and the tibia are joined together by the syndesmotic ligament which runs from the knee down to the ankle.
See your doctor to diagnose a sprained ankle. He or she may order X-rays to make sure you don’t have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling.
The injured ligament may feel tender. If there is no broken bone, the doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain and bruising.
The physical exam may be painful. The doctor may need to move your ankle in various ways to see which ligament has been hurt or torn.
If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. If this occurs, it is possible that the injury may also cause damage to the ankle joint surface itself.
The doctor may order an MRI (magnetic resonance imaging) scan if he or she suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip or other problem. The MRI can make sure the diagnosis is correct. The MRI may be ordered after the period of swelling and bruising resolves.
The amount of pain depends on the amount of stretching and tearing of the ligament. Instability occurs when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
Great Lakes Physical Therapy
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