An overview of ankle sprain:

ankle sprain


Ankle sprain is stretching, twisting, or sometimes complete tear of ankle ligaments. A ligament is a tough band of connective tissue attached to different bones and provides stability to the joint. In our foot, there are many small ligaments that are responsible to provide stability at the ankle joint. whenever our foot suddenly twisted or moved in awkward position ligaments are prone to stretch or tear which causes severe pain in the foot on weight-bearing. Small tears can be treated conservatively at home and complete tears with the bone fracture may require surgery.

Ligaments of ankle joint.

What is the meaning of ankle sprain?

The ankle joint is composed of a combination of three bones, two lower leg bones such as tibia and fibula, and one talus bone present in the foot. These bones are connected through small ligaments. Tears of these ligaments occur when the foot accidentally twisted or suddenly moved in an awkward position. The injury of these ligaments is known as ankle sprain. The most commonly injured ligament at the ankle joint is the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL).

Ligaments of ankle joint:

There are two main divisions of ligaments that provide stability at the ankle joint.

Lateral ligament:

Lateral ligament originates from a bony prominence called lateral malleolus present at the fibula 

And inserts on the bones of the foot called talus and calcaneus. It resists excessive movements at the lateral side of the foot such as inversion of the foot and is composed of three separate ligaments:

  • Anterior talofibular ligament proximally attached to the lateral malleolus and distally to the lateral side of the talus.

  • The posterior talofibular ligament starts from the lateral malleolus and ends at the posterior aspect of the talus.
  • The calcaneofibular ligament originates from lateral malleolus and inserts on the calcaneus.

Medial ligament:

On the medial side of the foot, a strong fan-shaped ligament is presently called the deltoid ligament. It attaches proximally to the medial malleolus of the tibia and distally to the talus,calcaneus, and navicular bones.


 It resists excessive movement during eversion of the foot, also a combination of four ligaments.

  1. Anterior tibiofibular ligament
  2. Tibiocalcaneal ligament
  3. Posterior tibiofibular ligament
  4. Tibionavicular ligament

Movements of the foot:

Four types of movements are possible at foot:

  1. Dorsiflexion 
  2. Plantarflexion
  3. Inversion
  4. Eversion 

Sign and symptoms of ankle sprain:

  • Severe pain at the time of injury and bearing weight on foot.
  • Mild to severe tenderness on the basis of grades of the torn ligament (when you touch the area it hurts).
  • Swelling and inflammation.
  • Bruising ( black and blue marks due to damaged capillaries).
  • Popping sensation or a loud pop felt at the time of injury.
  • Loss of active range of motion.
  • Feeling of instability at ankle joint.
  • Discomfort 

Causes of ankle sprain:

An ankle sprain occurs due to the following reasons:

  • Movement at the ankle out of its normal range.
  • Sudden twisting at the ankle joint.
  • The foot moves into over inversion and eversion accidentally.
  • Awkward movement while landing or after jumping.
  • Someone forcefully stepped on your foot while playing sports.
  • Foot excessively moved inward or outward direction unexpectedly.

Risk factors of ankle sprain:

There are different factors that are responsible for ankle sprain such as:

  • Improper footwear. When shoes are not properly fit there are more chances of sprains or strains because enough stability at the ankle joint is not properly maintained which leads to injury.
  • Slippery or uneven surface.  Movements on rough surfaces increase the risk of injury especially during sports activities when someone is walking or running on uneven surfaces is more vulnerable to ankle sprain.
  • Past history of sprains and strains.when you have a past history of sprain, strain, or any other injury at foot then you are at greater risk of sprain again.
  • Weakness of muscles and ligaments. Weak ankle structures like muscles and ligaments provide less stability and make the ankle more prone to sprain. 
  • Athletes having poor conditioning. Athletes having a poor physical condition such as poor muscular strength and endurance likely have more chances to tear ligaments.
  • Overweight . either bodyweight or carrying other weights put more stress on the joints and prone the joint to sprain
  • Female athletes  over age 30.  Female athletes over age 30 are at greater risk due to some musculoskeletal,biomechanical, hormonal factors and  improper landing techniques.

Grades of ankle sprain:

On the basis of torn ligament and severity of symptoms, ankle sprain is divided into 3 grades.

  •  Grade 1: 

Slight stretching or tearing of some fibers of ligaments having mild pain,swelling, and tenderness. Walking is possible with mild pain.ligament easily heals with some protection and home-based treatment.

  • Grade 2:

 This grade is also called partial ligament tear as half of the ligament fibers rupture. There is an incomplete tear characterized by moderate pain, mild to moderate tenderness,swelling, and bruising. The joint becomes painful on weight-bearing so walking is usually painful and can be possible using assistive devices.

  • Grade 3:

 There is a complete tear of the ligament and the ligament is divided into two halves. Severe swelling and bruising are present on the affected foot. The joint becomes completely unstable and walking is impossible.

Diagnosis of ankle sprain:

Clinical history is taken and physical examination  is done by your health care professional to check the ligaments and to confirm which ligament is damaged. While  examining the joint your doctor or physical therapist touches the affected area to check the point of tenderness and move the foot in different directions to determine the range of motion and to check which position or direction leads to pain. To rule out bone fracture and damage of other structures he recommends medical imaging such as x-ray,MRI, CT scan, and ultrasound.

X-RAY:

X-RAY is used to rule out a bone fracture. As ligaments are not seen on x-ray so it is not a diagnostic test for ankle sprain only used to detect if there is any bone fracture present or not.

MRI: 

Magnetic waves are used to detect the clear view of all the structures present in the ankle joint if there is any ligament tear or injury to any other soft tissue such as tendon and joint capsule that can easily be detected on MRI.

CT SCAN:

Computed tomography is used for imaging soft tissues and bones. It gives details that are not visible on x-ray and have less cost than MRI. But MRI is better than CT scan as it gives fine details of soft tissues.

Ultrasound:

It uses sound waves to create a picture but not radiation as used in an x-ray. Ligaments are observed while moving the foot.

Treatment of Ankle sprain :

An ankle sprain can be treated in following ways:

  • Home-based treatment 
  • Medication
  • Physiotherapy 

Home-based treatment :

If you have a grade 1 ankle sprain(minor stretch or tear of a ligament) then you can manage it easily at home and it takes up to two weeks. Home based management for acute ankle sprain.

  • RICE (rest,ice,compression, elevation)
  • All foot movement should be completely stopped at the time of injury and take complete bed rest for one week until the acute sign and symptoms like pain and swelling subsides.
  • Apply ice immediately after injury for 10-20 minutes and then repeat after every two hours to reduce pain and inflammation. Ice can be applied through ice packs easily available in medical stores or by frozen vegetables wrapped in a towel.
  • Compress the area by applying compression bandage to control swelling.
  • Method to apply bandage. Apply compression bandage in figure 8 manner.starts from lateral to medial side anchor the foot to stabilize ligament and then wrap towards ankle going into figure eight manner. Make sure there are no windows or gaps and not wrapped so tightly to impede circulation.This method is important because your ankle joint is still able to move without undone the wrap.
  • Raise your foot by placing two pillows under the foot so that fluid does not accumulate at the injured site. Swelling is reduced by elevating the foot.
  • When tenderness and swelling disappear apply soft massage with your thumb to increase healing of ligament.
  • Do some exercises to strengthen the muscles and ligaments around the ankle joints.

Medications: 

Non steroidal anti inflammatory drugs and over the counter painkillers are used  to reduce pain and swelling but anti inflammatory  medicines  sometimes are not good because inflammation is reduced which is a protective mechanism for healing of ligaments. So use only painkillers to decrease pain.

Physiotherapy: 

Consult a physical therapist for complete treatment of your Ankle sprain. A physical therapist manages ankle sprain by different phases of rehabilitation. Some best exercises for ankle sprain which you can perform at home are given below:

 Best exercises for ankle sprain:

  1. Ankle pumping exercise. Move your foot in a downward position,hold for a few seconds and then move upward and hold this position for a few seconds. Repeat the exercise 10 times with 2-3 sets two times a day.
  1. Ankle stretch with towel or thera band. In a long sitting position place a thera  band or a towel under the palm of your foot and hold the corner of the towel with both hands.Now pull the towel with low force and stretch your foot muscles.
  2. Foot ROM exercise. Write the alphabet with your foot in the space and draw a figure of 8 with your toes.
  1. Toe standing exercise. Stand on your toes and raise your heel up and down. Repeat 3 sets of this exercise ten times.
  1. Standing calf stretch.  Stand in front of a wall, bend your unaffected leg and straight your injured leg, there should be a little distance between both legs. Now place both of your hands on the wall so that the elbow should be straightened and try to push against the wall. Repeat exercise many times, when you feel uncomfortable or fatigued then quit the exercise.
  2. Toe curls. In this exercise place a towel under your foot and try to pick it with your toes.

So in the above article What Are Ankle Sprain, Symptoms, Causes, Risk Factor, and 4 step Diagnosis is discussed. Here we have discussed in video and with images. Plz, do subscribe our blog.