Ankle Sprain

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What is it?

The ​an ankle sprain is an injury caused by a twisting motion where the ankle and foot turn inward, known as "inversion." This twist can lead to the tearing of the external ligaments, and in some cases, the internal ones as well. ​

Ligaments are key structures that hold bones in place within a joint, limiting improper movements and allowing proper functionality. A sprain occurs when these ligaments are stretched beyond their capacity, causing a partial or complete tear.

Symptoms

The symptoms of an ankle sprain vary depending on the severity of the injury, but the most common include:

  • Pain Intense pain at the time of injury. When bearing weight on the foot, discomfort can range from mild to incapacitating, depending on the degree of damage.
  • Popping sound Many patients describe a sound similar to a tear during the twist.
  • Tenderness to touch Especially on the outer part of the ankle.
  • Swelling It usually appears shortly after the trauma.
  • Bruises Caused by internal bleeding of the damaged tissues.
  • Increased pain when moving the foot Especially when performing movements such as extension (pushing forward) or inversion (inward).
  • Instability Sensation of weakness or the ankle “giving way” easily when stepping on uneven surfaces.

Causes

Ankle sprain occurs when one or more ligaments are partially or completely torn. Some of the most common causes include:

  • Twisting injuries caused by a fall.
  • Jumps or turns with improper landing.
  • Walking or exercising on uneven surfaces.
  • Being stepped on during sports activities.

It is important to note that, for a sprain to occur, there must be trauma that stretches the ligaments to their limit. If there is no specific event causing the injury, it is likely not a sprain.

Risk Factors

Some factors that increase the likelihood of experiencing an ankle sprain include:

  1. Sports activities: This is the most common injury in sports involving jumps, quick changes of direction, or sudden efforts, such as basketball, running, or football.
  2. Uneven surfaces: Walking or running on rough terrain increases the risk.
  3. Previous injuries: An ankle previously injured is more likely to suffer another sprain.
  4. Poor physical condition: Lack of flexibility, insufficient muscle tone, or weakness in the peroneal muscles reduces the ability to respond to a twist.
  5. Inadequate footwear: Poorly fitting or unstable shoes increase the strain on the ligaments.
  6. Anatomical factors: High arches (cavus feet) may predispose to frequent twists and hinder injury recovery.

Complications

Although many consider an ankle sprain a minor injury, it can become complicated in up to 40% of cases,making it one of the most frequent visits to orthopedic emergency services

Complications may include:​

  • Chronic ankle pain.
  • Persistent joint instability.
  • Osteochondral injuries (cartilage damage), which can progress to arthritis.
  • Fractures in the surrounding bones (talus, calcaneus, malleoli), which are difficult to diagnose with conventional X-rays.

Prevention

To prevent ankle sprains, consider the following recommendations:​

  • Warm-up: Always warm up before exercising or playing sports.
  • Caution on uneven terrain: Walk or run carefully on unstable surfaces.
  • Treatment of previous injuries: If you've had a sprain before, ensure you follow a proper and complete treatment.
  • Use appropriate footwear: Choose shoes designed for the activity you're going to perform, avoiding high and thin heels.​
  • Good physical condition: Improve flexibility and strengthen the stabilizing muscles of the ankle.​
  • Foot supports: If you have high arches, use insoles to improve alignment and prevent injuries.​
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Diagnosis

The initial diagnosis of a sprain generally does not require complex tests.

  1. Physical examination The description of the trauma, together with a detailed assessment, is usually enough to determine the injury.
  2. X-rays: In acute cases or when a fracture is suspected, plain or stress X-rays may be requested.
  3. Ultrasound: Useful for evaluating soft tissues in the early stages.
  4. MRI or CT scan: Used only in specific cases or when pain persists over time.

Treatment

Initial treatment for a sprain follows the PRICE protocol: PRICE:

  1. Protection: Use functional bandages, taping, or stabilizing ankle braces to protect the injured ligaments.
  2. Rest: Limit physical activity and use crutches if necessary. Complete rest is not required, but avoid activities that strain the ankle.
  3. Ice: Apply local cold to reduce inflammation and pain.
  4. Compression: Use elastic bandages or compression socks to control swelling.
  5. Elevation: Keep the foot elevated to reduce edema.

It is recommended to avoid intense physical activity for at least 3 weeks after the injury, especially if there are clear signs such as bruising.

Is Surgery Necessary?

In acute injuries, even in severe sprains (Grade III, with complete rupture of lateral ligaments), surgery is usually not required.

However, in patients with chronic complications such as persistent pain, instability, or osteochondral injuries, ankle arthroscopy is an effective option. This minimally invasive procedure allows for the treatment of injuries that previously required open surgeries.

Conclusion

An ankle sprain is a common but potentially disabling injury if not properly diagnosed and treated.Follow prevention recommendations and seek medical attention if you suffer a sprain to avoid long-term complications.