An ankle sprain is the most common injury to the ankle. The most common type of injury which causes ankle sprain is inversion (twisting) where the ankle rolls over on the outside of the foot. This twisting action causes stretching and tearing of the ligaments which hold the ankle together. Occasionally the ankle can twist on the inside of the foot with similar consequences.

Any action that causes the ankle to twist can result in an ankle sprain. These injuries are most common during sporting activities, running. jumping, walking on uneven surfaces or landing on the feet from a height. When the ankle twists, it causes the ligaments on the outside of the ankle to stretch and possibly tear.

Some individuals are more prone to ankle sprain than others. Individuals who never exercise, those who are obese, those with lax joints, those with decreased sensation in their feet and those with weak muscles are more prone to ankle sprains.

Ankle sprains are classified into three different degrees.

- there is mild pain, minimal swelling and one can walk on the ankle

- There is more injury and the joint is painful. Swelling is moderate and the individual is unable to weight bear without pain.

- The ankle ligaments are completely torn and the swelling and pain are extensive. The individual is unable to weight bear. The joint is usually very unstable.

The diagnosis of an ankle sprain is usually made by examination of the ankle and x-rays are done to make sure that there is no ankle fracture.

Initially the ankle is swollen and painful. Within a few hours the ankle may turn blue and may show signs of hemorrhage. This bruising and swelling is due to tearing of the blood vessels. The swelling generally persists for 10-20 days and even longer in severe injuries.

The sooner the treatment starts for a sprained ankle, the greater chance to prevent chronic pain and long term instability.

For all ankle sprains, the basic treatment consists of

• Resting the ankle.
• Ice - this helps to keep the swelling down
• Compressive bandages help immobilize the ankle sprain and support the injury
• Elevate the ankle to relieve the swelling.

For severe ankle sprains, ankle splints and or crutches will be required. In addition, pain medications may be required for a few days. Occasionally, cast immobilization is required for 3rd degree ankle sprains for at least 2-3 weeks. Surgery is rarely used in the treatment of ankle sprains.

Physical therapy including ultrasound, friction massage and exercises to strengthen and stabilize the ankle are used once the pain has diminished.

Exercises after the first 48 hours play a major role in the in the rehabilitation of the sprained ankle and prevention of ankle sprains.

The most common cause for long term pain after an ankle sprain is poor rehabilitation of a previous ankle sprain. All causes of chronic pain after an ankle sprain should be evaluation by a health care professional.