How to Recognize the Signs of an Ankle Sprain

Ankle sprains are among the most common injuries. A sprain occurs when the ligaments supporting the ankle become stretched or torn. The majority of sprains affect the ATF ligament (anterior talofibular ligament), as it runs along the outer side of the ankle. This outer ligament is generally weaker than the inner ligaments. Due to physical force, gravity, and body weight, the ligaments can be stretched beyond their normal capacity, resulting in tears and damage to surrounding blood vessels. A sprain is similar to an overstretched rubber band, causing a tear on the surface and instability in the ligament.

Recall the moment of the injury. It's important to remember what happened during the injury. This might be difficult, especially if you are in severe pain, but recalling the experience or sensations at the time of the injury may help.

• How fast were you moving? If you were moving at high speed (for example, skiing or running fast), you may have a fracture and need professional medical attention. An injury from lower-speed movements (such as twisting an ankle while jogging or walking) is more likely to be a sprain that can heal with proper care.
• Did you feel a ligament tear? In many cases of sprains, you'll feel the ligament tear.
• Was there a cracking sound? The ankle may produce a cracking sound if it is sprained or fractured.

Check for swelling signs. If you have a sprain, the ankle will swell, usually right away. You should examine both sides of the ankle to see if there's significant swelling. Swelling and pain often occur in cases of sprains or fractures.

• If the foot or ankle appears deformed and the pain is severe, it may indicate a fracture. In this case, you should use crutches and seek immediate medical attention.

Look for bruising signs. Sprains often lead to bruising. Check the ankle for any skin discoloration caused by bruising.

Check for pain. Ankle sprains are usually quite painful. You can press your fingers gently on the injury site to see if it hurts.

Apply moderate weight on the ankle. You can try standing up and gently putting some weight on the injured ankle. If you feel pain, this could be a sign of a sprain or fracture. Use crutches and visit a doctor right away.

• Feel for "looseness" in the ankle. A sprained ankle often feels loose and unstable.
• If the sprain is severe, you may be unable to put weight on the ankle or stand at all. Putting weight on it or standing may cause intense pain. In this case, you should use crutches and see a doctor immediately.

Identifying a Grade 1 Sprain. Ankle sprains are classified into 3 grades. The treatment method depends on the severity of the injury. The least severe is a Grade 1 sprain.

• This is a minor tear that doesn't affect your ability to stand or walk. While slightly inconvenient, you can still use the ankle as usual.
• A Grade 1 sprain may cause minor swelling and slight pain.
• For a Grade 1 sprain, swelling typically subsides within a few days.
• A Grade 1 sprain can heal with self-care.

Identifying a Grade 2 Sprain. A Grade 2 sprain is a moderate injury. It involves significant but not complete tearing of one or more ligaments.

• With a Grade 2 sprain, you won't be able to use your ankle normally and will find it difficult to put weight on it.
• You will experience moderate pain, swelling, and bruising.
• The ankle will feel somewhat loose and may appear slightly pulled forward.
• For a Grade 2 sprain, you will need medical care, crutches, and ankle protection for a period of time to walk.

Identifying a Grade 3 Sprain. A Grade 3 sprain is a severe injury where the ligament is completely torn, losing all structural integrity.

• With a Grade 3 sprain, you will be unable to put weight on the ankle and won't be able to stand without assistance.
• Swelling and pain will be severe.
• The area around the fibula will swell significantly (over 4 cm).
• Medical examination may reveal clear deformity of the foot and ankle or a fracture of the fibula just below the knee.
• A Grade 3 sprain requires immediate medical attention from a doctor.

Identifying Bone Fractures. A fracture is an injury to the bone, especially common in healthy individuals who suffer ankle injuries from high-speed movements, and in older adults from minor falls. The symptoms often resemble a Grade 3 sprain. A fracture requires an X-ray and professional treatment.

• A fractured ankle will be extremely painful and unstable.
• Minor fractures may have similar symptoms to a sprain, but only medical experts can diagnose or rule them out through X-ray imaging.
• A cracking sound at the time of injury may indicate a bone fracture in the ankle.
• Visible deformity of the foot or ankle, such as the foot being positioned at an abnormal angle, is a sure sign of a fracture or dislocated ankle.

See a Doctor. Regardless of the severity of the sprain, it's best to visit a doctor if the swelling and pain last for more than a week.

• If you notice signs of a fracture and/or a Grade 2 or 3 sprain, you should see a doctor immediately. In other words, if you can't walk (or have difficulty walking), experience numbness in the ankle, have severe pain, or hear a cracking sound during the injury, you need an X-ray and professional evaluation to determine the proper treatment.
• Minor sprains may heal with self-care. However, untreated sprains can lead to prolonged swelling and pain. Even if it's just a Grade 1 sprain, seeing a doctor for advice is a good idea.

Rest the Ankle. While waiting to see a doctor, you can care for the injury at home using the RICE method (Rest, Ice, Compression, and Elevation). For a Grade 1 sprain, the RICE method may be sufficient. The first step is to allow the ankle to rest.

• Avoid moving the ankle and try to immobilize it if possible.
• If available, you can create a temporary splint using a hard board to prevent further injury. Make sure to keep the ankle in a stable position.

Ice the Ankle. Applying ice to the ankle can help reduce swelling and discomfort. Apply ice to the injured area as soon as possible.

• Place ice cubes in a bag and gently apply it to the joint. Use a cloth to protect your skin from cold burns.
• Frozen peas can also be used as an alternative to ice packs for cooling.
• Apply ice for 15-20 minutes every 2-3 hours for the first 48 hours.

Bandage the Ankle. For a Grade 1 sprain, wrapping the ankle with an elastic bandage can help stabilize it and reduce the risk of further injury.

• Wrap the bandage around the ankle in a figure-eight pattern.
• Do not wrap it too tightly to avoid increasing swelling. You should be able to insert a finger between the bandage and your skin.
• If you suspect a Grade 2 or 3 sprain, consult a doctor before applying a bandage.

Elevate the Foot. Raise the foot above the level of the heart by propping it up on two pillows. This helps reduce blood flow to the foot and can minimize swelling.

• Raising the foot with gravity's assistance helps reduce swelling and alleviate pain.

Take Medication. To manage swelling and pain, you may take non-steroidal anti-inflammatory drugs (NSAIDs). Common over-the-counter NSAIDs include Ibuprofen (brand names: Motrin, Advil), Naproxen (brand name: Aleve), and Aspirin. Acetaminophen (also known as Paracetamol or the brand name Tylenol) is not an NSAID and does not reduce inflammation but can help alleviate pain.

• Follow the instructions on the packaging and do not take NSAIDs for pain relief for more than 10-14 days.
• Do not give Aspirin to children under 18 to avoid the risk of Reye's syndrome.
• For severe pain and/or Grade 2 or 3 sprains, a doctor may prescribe narcotic pain medication for the first 48 hours.

Use Assistive Devices or Ankle Supports. A doctor may recommend medical devices to help you walk around and/or stabilize your ankle. For example:

• You might need crutches, a walking cane, or a foot brace. The choice depends on your balance and which device is safest for you.
• Depending on the injury severity, your doctor might suggest an ankle wrap or a support brace to stabilize the ankle. In severe cases, an orthopedic surgeon might place the ankle in a cast.

• It is essential to ensure that your ankle heals completely after a sprain. Failing to do so can result in a recurring sprain, causing prolonged pain and swelling that doesn't go away.
• Feeling cold in the foot, complete numbness in the foot, or a sensation of tightness in the leg due to swelling could indicate a more serious issue. Seek medical attention immediately as you may need emergency surgery if there's damage to nerves, arteries, or compartment syndrome.