A sprained ankle is one where one or more ligaments around the ankle are damaged or torn. This is a very common injury and it is estimated that in America, at least 25,000 people a day sprain an ankle.

The main causes of sprains are sporting activities and falls. Movement that involves twisting, turning and rolling of the foot may encourage them. Factors that will increase the risk are:

1. Running or walking on uneven surfaces

2. High-heeled shoes, as they will cause instability at the ankle.

3. Shoes with poor heel support.

4. Weak muscles, tendons and ligaments around the ankle joint.

5. Poor proprioception, which is the sense of joint position.This is usually caused by an underlying neurological condition.

Sporting sprains usually occur when someone begins to take part in a sport and their muscles aren’t used to the physical stresses involved. Professional or experienced athletes may push themselves so hard that they end up with sprains. Sprinters, long-distance runners, footballers, and basketball players, among others, commonly get this type of injury.

We classify sprains into three categories.

Grade 1: This is a mild sprain and occurs when you overstretch a ligament. It may result in a small amount of swelling, bruising and pain, but the patient should be able to weight-bear.

Grade 2: This is a moderate sprain. Here the ligament may be partially torn. The swelling and pain will be moderate and it will be difficult to weight-bear.

Grade 3: This is a severe injury where a ligament is completely torn. The swelling and pain will be severe and any form of weight-bearing will result in extreme pain.

TYPES OF SPRAIN

Inversion ankle sprains are the most common. Here the ligaments on the outside of the foot are overstretched.

Eversion ankle sprains are a less common injury where the ligaments on the inner-side of the foot are overstretched.

High ankle sprains affect the larger ligaments above the ankle joint that join the two long bones of the lower leg. This kind of sprain is often found in track, basketball and football, which are cutting and contact sports.

DIAGNOSIS

Taking a history of the injury and a physical examination will usually be enough for the diagnosis of a minor sprain. In more severe cases, X-rays may be needed to determine how bad the injury is.

TREATMENT

Once diagnosed, “PRICE” therapy should be carried out.

P: PROTECT the injured area from further damage. Wear supportive shoes like sneakers.

R: REST and reduce all activities on the affected foot for at least 72 hours. Use crutches if necessary.

I: ICE the area for the first 48-72 hours. This should be applied by wrapping ice in a damp towel and holding it to the affected area for 15 minutes. This should be done every two to three hours during the day. The ice should not come into direct contact with the skin and should not be left on while asleep.

C: The C stands for COMPRESSION to limit the swelling that can occur. Elasticated tubular bandage can be used or ankle supports can be purchased from the pharmacy. When asleep the bandage should be removed and while on, it should hold the ankle firmly but not so tight that it cuts off the circulation.

E: ELEVATING the limb will help to reduce the swelling.

In the early stages of injury (first 72 hours) certain things should be avoided and we call these “HARM”.

H: Avoid HEAT eg, warm baths, saunas, heat packs, heat creams or lotions.

A: Avoid ALCOHOL as this increases bleeding and swelling.

R: Avoid RUNNING or any type of exercise that can lead to further damage.

M: Avoid MASSAGING the limb as this can increase the bleeding and swelling.

Painkillers can be purchased from the pharmacy or the doctor may prescribe something stronger. Using anti-inflammatory gels and creams may also help.

In the case of a severe sprain, a cast may be applied to the affected limb for about 10 days to immobilise it and aid healing. Once the patient can stand on the ankle again, the doctor or physiotherapist can teach a range of gentle exercises to improve joint function and strengthen the muscles, tendons and ligaments.

The recovery from a sprained ankle depends on how bad it is. Most minor sprains will improve significantly within two weeks. Severe sprains may take a lot more rehabilitation before normal function is achieved. Some people will still have instability and discomfort after a year and re-injury is quite common.

To prevent further sprains, follow this advice.

1. Do strengthening exercises for the ankle.

2. Wear ankle supports when exercising.

3. Warm up before exercise.

4. Avoid wearing high heels.

5. Be aware of your surroundings and pay attention to the surfaces on which you walk.

6. If you are tired, slow down your activities.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.