There are multiple ligaments in the ankle. Ligaments in general are those structures that connect bone-to-bone. Tendons, on the other hand, connect muscle-to-bone and allow those muscles to exert their force. In the case of an ankle sprain, there are several commonly sprained ligaments. An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle (ATFL). This is an extremely common injury which affects many people during a wide variety of activities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break).
Most commonly, however, it occurs in isolation.
These injuries occur when the ankle is twisted underneath the leg, called inversion. Risk factors are those activities, such as basketball and jumping sports, in which an athlete can come down on and turn the ankle or step on an opponent's foot.
Some people are predisposed to ankle sprains:
People with a hindfoot varus, which means that the general nature or posture of the heels is slightly turned toward the inside. This is because it is easier to turn on the ankle
People who have had a severe sprain in the past, it is also easier to turn the ankle and cause a new sprain. Therefore, one of the risk factors of spraining the ankle is having instability
Those who have weak muscles, especially those called the peroneals which run along the outside of the ankle
Those with hyperlaxity' meaning over flexibility of the ligaments in their joints
Patients suffering an ankle sprain report:
Pain due to an inversion injury, which means the foot rolls underneath the ankle or leg
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
Decreased range of motion at the ankle joint
Surgery is not required in the vast majority of ankle sprains. Even in severe sprains, these ligaments will heal without surgery. The grade of the sprain will dictate treatment. Sprains are traditionally classified into several grades. Perhaps more important, however, is the patient’s ability to bear weight. Those that can bear weight even after the injury are likely to return very quickly to play. Those who cannot walk may need to be immobilized.
In general, treatment in the first 48 to 72 hours consists of resting the ankle, icing 20 minutes every two to three hours, compressing with an ACE wrap, and elevating, which means positioning the leg and ankle so that the toes are above the level of patient’s heart. Those patients who cannot bear weight are better treated in a removable walking boot until they can comfortably bear weight.
Physical therapy is a mainstay. Patients should learn to strengthen the muscles around the ankle, particularly the peroneals, increasing range of motion gradually, and improving neuromascular control and balance.