Ankle sprain

What is a sprained ankle?

When you twist your foot, you can sprain your foot. This is called a strain or a sprain.
As you sprain your ankle, the ligaments in the outer part of the ankle are under tension. These ligaments can stretch and small tears can occur.
This usually happens during sports activity.

How to recognize it?

• You feel a sharp pain, usually in the outer part of the ankle.
• Your ankle swells and may turn blue.
• Usually, you can still lean on your foot, but you cannot walk normally.

Can’t lean on your foot anymore? So you might have a fracture ankle.

In any case, consult your doctor. If it’s a sprain, your ankle may be:

• Slightly sprained (slight sprain):
  • In this case, it will take you about 2 weeks to recover;
• Severe stride:
  • In this case, it will take 6 to 8 weeks to recover.

How is the diagnosis made?

To diagnose a sprained ankle, your doctor

• ask you questions;
• examine your ankle;
• if necessary, request an x-ray of the ankle.

Discussion

Your doctor may ask you the following questions:

• How and when did you twist your ankle?
• Could you lean on your foot after the accident?
• What did you do to relieve the symptoms? For example, did you put on ice or ointment, did you take a painkiller, …?
• Have you ever sprained your foot before?
• What medications do you take ? For example, do you take anti coagulants ?
• What is your job ?
• Do you exercise regularly?

Physical examination

Your doctor will examine your ankle:

• He will be particularly attentive to signs that may suggest a crack or a fracture;
• He will apply a rule (the Ottawa criteria) that allows him to:
  • To assess the risk of fracture and ;
  • Decide whether or not an ankle x-ray is needed.
• If he finds no signs of a fracture, he may ask you to come back for a consultation a few days later. The pain and swelling will have decreased. This allows for better evaluation.

What can you do ?

First days after the sprain

During the first 3 days (inflammation phase)

• Let your ankle rest:
  • Do not lean on your ankle unless the symptoms are not too severe;
  • You can temporarily use crutches if the support is too painful.
• If the pain is severe:
  • It can be useful to:
    • Cool the ankle by applying cold (ice) for 15-20 minutes, 1-3 times a day;
    • Elevate the foot;
    • Take paracetamol and apply anti-inflammatory ointment.
  • You can ask your doctor
    • If you can replace the ointment with a anti-inflammatory, such as ibuprofen or naproxen, if your symptoms do not get better enough;
    • If they think a supportive bandage, band, or splint is helpful for you.

First phase of recovery

During the first phase of recovery (from 4^th to 10^th day after the sprain), you can try to move the ankle:

• Stay within the limits of pain;
• Try to unwind your foot normally;
• Avoid limping with a stiff foot: it is not good for recovery.

Subsequent recovery phase

During the subsequent recovery phase (from 11^th day up to 6 weeks after the sprain):

• It is absolutely necessary that you train and do exercises at home at home:
  • Your physiotherapist will give you the necessary advice.
• You may be able to resume your daily activities, depending on the severity of the sprain and the type of work you are doing:
  • This decision is always taken with your doctor, your occupational doctor and, if necessary, your physiotherapist.

After the agreement of your doctor and your physiotherapist, you can gradually resume your sports activities.

What can your doctor do?

A sprained ankle does not require surgical treatment.

Your doctor:

• Prefer to wait and monitor your recovery;
• Will give you advice:
  • To reduce swelling (ice pack);
  • Regarding the drugs you can take to reduce pain (painkillers, anti-inflammatories, …);
    • The anti-inflammatory can suppress or delay the natural healing process. It is therefore important that you discuss this with your doctor.
  • When you can gradually start using your ankle again;
• May prescribe a bandage or splint (support orthosis) if you experience severe pain during the first 10 days;
• May consider an open cast for up to 10 days if you are still not able to support your full weight on your ankle after 3 days;
• Prescribe physiotherapy for a suitable exercise program.

What can you do with your physiotherapist?

Your physiotherapist can help you enormously, even very early in the management of a sprained ankle.

During the different recovery phases, your physiotherapist will discuss with you how you can:

• Relieve symptoms;
• Exercise more appropriately;
• Avoid a new sprain.

Relieve symptoms

For example with:

• A compression bandage for pain and swelling;
• A splint or a sticky bandage (taping) to stabilize your ankle, depending on the severity, swelling and recovery phase;
• Manual mobilizations of your ankle.

Do more exercise appropriately

Exercise more and above all in an appropriate way, depending on your situation (for example, according to your work) and your goals (for example, your sports activities) to:

• That your ankle returns to its normal functioning, as quickly and as well as possible;
• Improve mobility and muscle strength of your ankle;
• Lean more and more on your ankle while limiting possible risks as much as possible;
• Improve the stability of your ankle.

Avoid a new sprain

Avoid, after recovery, a new sprain, for example

• By wearing appropriate footwear according to the circumstances;
• By strengthening the muscles of the lower limbs;
• By working on coordination and balance to improve your stability in your sports and daily activities;
• By applying a sticky bandage (taping) to your ankle or by wearing a splint if you play a risky sport (this can only be done temporarily).

Want to know more?

• Anatomy of the ankle (image) – Larousse

• My child is going to have an X-ray – Plaster
• The radiography, here, Where to find on this page of Saint-Luc University Clinics (UCLouvain)

• Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
• Non-steroidal anti-inflammatory drugs for local use – CBIP – Belgian Center for Pharmacotherapeutic Information

• Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
  • Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
  • Naproxen – CBIP – Belgian Center for Pharmacotherapeutic Information

Sources

• Belgian practice guide ‘Sprained ankle: diagnosis and treatment’ (2013) – KCE – Federal Center of Expertise in Health Care
• Dutch practice guide ‘Ankle injury’ (2006), updated 23.09.2016 – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (summary in French)
• Dutch practice guide ‘Enkelletsel’ (2006), updated 30.09.2017 – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (original)