Dealing with an ankle sprain

What should I do if I sprain my ankle?

Most ankle sprains are fairly minor injuries which will get better with simple self-care treatment. The word RICE reminds us of the basic treatment of a sprained joint:

Rest take the weight off the injured joint as much as possible for a day or two
Ice an ice pack (a small bag of frozen peas or corn is ideal) can be applied for 10-15 minutes 3-4 times a day to reduce swelling
Compression a firm bandage or strapping will help to get swelling down
Elevation resting with the ankle above the height of the body will allow swelling to drain away into the bloodstream

Although a couple of days rest is useful, it is best to start taking some weight on the injured ankle reasonably soon after injury, usually within 2-3 days. Also start to exercise and stretch the injured ankle as soon as possible after the injury.

Normally a sprained ankle will recover within 6-8 weeks, although it may tend to swell for a few weeks longer.

When should I go to casualty?

Basically, if you have a severe ankle injury it is best to get professional advice immediately. Things that suggest a severe injury include:

your ankle is so painful you cannot bear any weight on it
the ankle seems deformed
the skin over the ankle is broken
the injury was caused by a severe force such as a fall from a height or a blow from a heavy object
the pain and swelling seem to get worse rather than better over the first 3-4 days (the bruising often gets worse for a week or more before it starts to fade)

Should I have physiotherapy?

Most simple sprains get better without any special treatment. However, if you have a severe injury or the initial injury does not recover normally, it is usually best to see a physiotherapist. The hospital casualty or orthopaedic department, your own GP or your sports club can arrange this. Physiotherapists also advertise in Yellow Pages and local papers.

How would ankle instability be diagnosed?

Your doctor or physiotherapist will listen to your complaints about your ankle and examine you. They will try to see if there is anything, which makes you more liable to ankle instability than average. They will look for any sign that you have some other problem around your ankle, such as damage to the joint surface. They will stretch your ankle in various directions to see if the ligaments are abnormally weak.

An Xray will usually be taken to see if there is any damage to the bones of your ankle. Ligaments do not show on Xrays. Ligament damage can be shown by taking Xrays with your ankle stretched in various directions ("stress views"), by injecting dye into your ankle or around a neighbouring tendon, or with a magnetic (MRI) scan. However, these special tests are usually not needed at first.

What can be done about ankle instability?

As most people with ankle instability have proprioceptive nerves which are not working properly, the first treatment is a physiotherapy programme to re-train these nerves how to respond to movements of the ankle, by doing various exercises and activities. If your ankle or Achilles tendon are stiff, you will also be shown exercises to stretch these, and the strength of the muscles around the ankle will be increased by exercises. If your foot shape makes you prone to extra stress on the ankle ligaments, a moulded insole may be advised for your shoe to reduce these stresses.

Many people will find their ankle much more stable and comfortable after physiotherapy. However, in some people problems continue. At this point the opinion of an orthopaedic foot and ankle surgeon would be helpful. If you have not already had the special tests mentioned above, these may be done now. The surgeon may also suggest an exploratory operation on your ankle (arthroscopy) to check on the state of the joint. If these tests suggest weakness of the ankle ligaments, an operation may be advised.

Will I need an operation?

Most people with ankle instability will not need an operation. Even if your ankle still feels unstable after physiotherapy, you could try a brace rather than having an operation to tighten up or replace the ligaments.

However, if no other treatment makes your ankle comfortable and tests show that the ligaments are weak, an operation may help. There are two main types of operation:

the damaged ligaments are tightened up and re-attached to the bone - often known as the Brostrum procedure. This is suitable when the instability is not too severe. Its main advantage is that it causes less stiffness than the other type of repair, as it aims to achieve an anatomical repair of the ligaments.
another piece of tissue, usually part of one of the nearby tendons, is borrowed and stitched between the bones where the ligaments should be. This is suitable when the instability is severe or you may put severe stresses on the repair. It is very strong but often causes quite a lot of stiffness in the ankle afterwards.

You would usually be in a plaster or brace for several weeks after an operation and would need further physiotherapy to help regain normal function.

The other problems which may occur after a ligament reconstruction operation include:

pain in the ankle, either because of damage at the time of the original injury or because the ankle is now tighter than before
numbness or tingling down the side of the foot due to stretching of one of the nerves either at the time of the original injury or the operation
persistent swelling of the ankle

I sprained my ankle three months ago but it's still painful and swollen. Why?

Your ankle may be just taking longer than usual to recover. However, there may be some other damage to the ankle if it is still causing trouble three months after injury. It would be worth consulting your GP or physiotherapist.