Ankle Pain

Ankle sprains are one of the most common orthopedic injuries. A sprain is defined as a tearing of a ligament. A ligament is a dense piece of tissue that holds two bones together at a joint. The majority of ankle sprains are “inversion” sprains, when the foot turns inward. This type of sprain usually injures two ligaments on the outside of the ankle, the anterior talofibular ligament and the calcaneofibular ligament. Occasionally, a ligament over the front of the ankle complex, called the anterior tibial fibular ligament, is injured as well. The ligaments on the inside of the ankle can be injured as well, although this less frequently.

A physician or therapist attempts to grade the level of a sprain with a grade I having damaged up to 1/3 of the ligament, a grade II having damaged up to 2/3 of the ligament and a grade III having led to a complete tear of the ligament. A physician will also commonly order x-rays to be taken of the injured ankle to ensure that there is no bony involvement, such as a fracture. An ankle brace may be applied at this time as well to limit movement of the ankle and to support the ankle in protection of further injury.

Although it is always best to be examined by a physician, most mild sprains can be treated at home. For at least the first 48 hours it is best to apply the RICE principle. This involved Rest, Ice, Compression and Elevation. Rest implies that you decrease weight bearing and mobility. If you are unable to walk without a limp you should use an assistive device such as crutches or a walker. Once you can walk without a limp or increased pain you no longer require the need of an assistive device.

Ice implies just that. You should apply an ice pack directly to the painful part of the ankle for 10 to 15 minutes every other waking hour. A bag of frozen peas placed in a pillow case is an excellent ice pack. Compression implies using some form of an elastic wrap around the ankle. It is important that this wrap be applied in a figure of 8 manner starting at the toes and ending above the ankle. If you notice any tingling, numbness or increased swelling in your toes, foot, or ankle you need to remove the bandage immediately as it is either too tight or poorly applied. Elevation implies lying down with your foot positioned above your knee and hip. If your ankle is elevated above your heart and your leg is essentially straight your swelling will be minimized. This is also a good position in which to sleep.

Mild ankle sprains should not be painful to walk on within several days. If your ankle is still painful after several days you should be seen by a physician and a physical therapist. The role of the physical therapist in the treatment of your ankle sprain is to assist you in controlling the swelling and pain, improve your range of motion and ambulation ability, and eventually to develop a strengthening and proprioceptive re-training program for you. Proprioception is a neurological feedback system that allows the brain to keep track of the position of our joints in space. This system is always damaged in an ankle sprain because the nerve fibers of the proprioceptive system are located in the ligaments around our joints. It is the failure of this system that typically leads to chronic ankle sprains and instability if not restored through physical therapy intervention.