activities involving side to side movements like tennis, basketball soccer or dance, but includes trail hiking, running and even walking, especially misstepping off a street curb. It many times occurs along with an ankle fracture during the same type of ankle sprain movement. Thankfully, 95% of the time, it is primarily a ligament and/or soft tissue injury.
What Causes an Ankle Sprain?
As noted above, these injuries almost always occur when the ankle is twisted underneath the leg. Rick factors are those activities listed above in which an athlete comes down on and turns the ankle or steps on an opponent's foot.
Some people are more predisposed to ankle sprains. In people with a high arch or especially if a person has an anatomical leg length difference where the person tends to land more on the outside of the short leg's foot, these injuries are more common.
What is an Ankle Sprain?
An ankle sprain involves the tearing of the ligaments and other soft tissue structures of the ankle. The most common ankle sprain occurs on the outside part of the ankle. This extremely common injury occurs when the person "turns, twists or rolls their ankle," medically described as an "inversion sprain." It affects many peolpe during
Dr. Paul R. Copeskey, DC, CCFC
How I Diagnose an Ankle Sprain:
Ankle sprains can be diagnosed fairly easily given they are common injuries. The location of the pain on the outside of the ankle with tenderness and swelling in a patient who has an inversion injury is very suggestive. In these patients, normal X-rays also suggest that the bones have not been broken and instead the ankle ligaments and/or tendons have been torn or sprained. Ruling out a fracture may also be done with a tuning fork, ultrasound, MRI or bone scan. It is very important, however, not to simply regard any injury as an ankle sprain because other injuries can occur as well. For example, the peroneal tendons mentioned above can be torn. There can also be fractures in other bones around the ankle including the cuboid, fifth metatarsal, talus and even the heel bone (calcaneus). In very severe cases, an MRI may be warranted to rule out other problems.
How I Treat an Ankle Sprain
The practice of Chiropractic includes the maintenance of the structural and functional integrity of the human body. A doctor of Chiropractic may manipulate any and all of the body's joints, muscles and connective tissues. During the course of treatment many physical agents, modalities, techniques and therapies are available to me to assist in your treatment. Adjustments to the sprained ankle can be incredibly valuable to a quick recovery, as the movements that create the ankle sprain many times misalign several foot bones. If these bones remain out of alignment, the time taken to heal can be very protracted and many times, they may be the source of recurring ankle sprains.
1. Treatment in the first 24 to 72 hours consists of resting the ankle, icing 20 minutes every other hour with a ziplock baggie of crushed ice placed on top of a paper towel, compressed against the ankle with an ace bandage or athletic tape and elevating the foot so it is above the heart if possible to reduce swelling.
2. Physical therapy modalities including ultrasound in the water (hydrosound) can be very effective. Pulsating electrical muscle stimulation and laser therapy can also reduce swelling and pain.
4. Natural anti-inflammatory supplements:
a. White willow bark
b. Citrus bioflavonoids (1000mg/tab)
c. Essential fatty acids
5. Exercises to strengthen the supporting muscles on the outside of the ankle (peroneals) will help hasten the recovery and prevent future ankle sprains.
6. Dr. Paul's custom orthotics with a special correction for the "true" anatomical short leg are the best long term approach to prevent future ankle sprains.
Surgery is rarely required in 98% of ankle sprains. Even in severe sprains, these ligaments will almost always eventually heal without surgery. Sprains are traditionally classified into several grades- mild, moderate or severe. Those who can bear weight on the injured foot after the injury are usually classified as mild to moderate and are likely to return to 100% within a week or two. Those who cannot walk on the injured foot may need to be immobilized with a boot or use crutches.
In those who have had a significant or severe sprain in the past, it is easier to turn the ankle and cause a new sprain. Therefore, one of the risk factors of spraining the ankle is having instability due to the looser, stretched ligaments which never shrink back to their original length after an "inversion sprain." This is also similar with the plantar fascia ligament under the foot that is overstretched when symptoms develop and why the ligament will never shrink to its pre-stretched state. Those who have weak outer ankle muscles, especially the peroneals, may be more predisposed to ankle sprains as well.
What are the Symptoms of an Ankle Sprain?
Patients will commonly complain of pain on the outside of their ankle and various degrees of swelling and bleeding under the skin (i.e. bruising). Technically, this bruising is referred to as ecchymosis. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot. These images show the most common ligaments and soft tissues injured in the ankle sprain. Image 1 shows the most common ligament sprained on the outside of the ankle, the anterior talofibular ligament. Image 2 shows the sheath covers surrounding the tendons on the outside of the ankle, the peroneal tendon sheaths.