Ankle Sprain

Ankle sprains are among the most common musculoskeletal injuries, affecting people of all ages and activity levels, whether engaging in vigorous activities or everyday tasks. Whether resulting from a sports-related incident, a misstep on uneven ground, or an unexpected twist, an ankle sprain can cause considerable discomfort and hinder daily activities.

Experiencing symptoms of ankle sprain? Consult our ankle sprain specialist for a personalised treatment plan today.

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Dr Dennis Ng Zhaowen
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Different Grades of Ankle Sprain

An ankle sprain occurs when the ligaments that support the ankle joint are stretched or torn. Ligaments are strong bands of tissue that connect bones to each other, providing stability to the joints. Ankle sprains typically happen when the foot twists, rolls, or turns beyond its normal range of motion, causing damage to these ligaments.

There are different grades of ankle sprains, ranging from mild to severe:

  • Grade I - Mild sprain with slight stretching and microscopic tearing of the ligament fibres.
  • Grade II - Moderate sprain with partial ligament tearing, leading to some looseness in the joint.
  • Grade III - Severe sprain with a complete tear of the ligament, resulting in joint instability.

Causes of Ankle Sprain

Ankle sprains can occur for various reasons, often involving sudden or unexpected movements that place excessive stress on the ankle ligaments. Common causes include:

  • Sports and Physical Activities: High-impact sports like basketball, soccer, and volleyball frequently involve jumping, fast turns, and sudden stops, which can cause the ankle to twist or turn awkwardly. Athletes are particularly at risk due to the dynamic movements involved in these sports.
  • Accidents and Falls: Ankle sprains can result from common accidents like tripping over something, slipping on a damp surface, or awkwardly stepping off a curb. These incidents often cause the foot to twist unexpectedly, stretching or tearing the ligaments.
  • Inappropriate Footwear: Shoes lacking proper support or high heels can contribute to ankle instability. Wearing footwear that does not fit well or is not suited for the activity at hand can increase the risk of twisting an ankle.
  • Previous Ankle Injuries: Recurrent injuries are more likely to occur in those who have previously sprained their ankle. The ligaments may be weakened from past damage, reducing the stability of the ankle joint and making it more prone to further sprains.
  • Lack of Conditioning: Muscles and ligaments must be strong and flexible to support the ankle properly. Inadequate physical conditioning or not properly warming up before physical activity can leave the ankle vulnerable to sprains.

Symptoms of Ankle Sprain

Recognising the symptoms of an ankle sprain is important for prompt and effective treatment. The severity of symptoms can vary depending on the extent of the injury, but common signs include:

  • Pain
    Pain is usually immediate and can range from mild to severe, depending on the severity of the sprain. The discomfort is usually concentrated around the ankle joint and might intensify with movement or putting weight on the affected foot.
  • Limited Range of Motion
    A sprained ankle can reduce the ability to move the ankle in its normal range of motion. This stiffness can make activities such as walking, running, or climbing stairs challenging.
  • Bruising
    Bruising may appear around the ankle and foot within hours or days after the injury. This discolouration is due to blood leaking from damaged blood vessels into the surrounding tissues.
  • Instability
    Depending on the severity of the sprain, the ankle may feel unstable or wobbly. This instability can make walking difficult or bearing weight on the affected foot.
  • Swelling and Tenderness
    Swelling around the ankle is a common symptom and occurs due to inflammation and fluid accumulation. The swelling can develop quickly and may cause the ankle to appear puffy and enlarged. The area around the sprained ankle may also be tender to the touch, and pressing on the affected area can cause pain.

Diagnosis of Ankle Sprain

The following are the standard procedures and techniques used by the ankle specialist to identify an ankle sprain:

Medical History

The ankle specialist will ask about the circumstances of the injury, including how it occurred and any previous ankle injuries. They will also inquire about symptoms such as pain, swelling, and difficulty in movement.

Physical Examination

A thorough physical examination of the ankle will be conducted to assess swelling, bruising, and tenderness. The doctor will also check the range of motion and stability of the ankle joint. They may move the ankle in various directions to determine which ligaments are injured and evaluate the sprain’s severity.

Imaging Tests

Imaging tests may sometimes be required to confirm the diagnosis and rule out other injuries, such as fractures. Common imaging tests include:

  • X-rays: X-rays are often taken to ensure that there are no broken bones in the ankle or foot.
  • Magnetic Resonance Imaging (MRI): An MRI can provide detailed images of the soft tissues, including ligaments, tendons, and cartilage, helping to identify the extent of the ligament damage.

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Treatment Options

To restore function and avoid future injuries, ankle sprain treatment must address acute symptoms and long-term healing. The severity of the sprain determines the choice between non-surgical and surgical treatments.

Non-Surgical Treatments

Most ankle sprains can be managed with non-surgical treatments, especially mild to moderate ones. Common non-surgical treatments include:

Rest, Ice, Compression, Elevation (RICE)

This is the first line of treatment for an ankle sprain:

  • Rest: Avoid putting weight on the injured ankle to prevent further damage.
  • Ice: Apply ice packs to the affected area for 15-20 minutes every 2-3 hours during the first 48 hours to reduce swelling and pain.
  • Compression: Use an elastic bandage to wrap the ankle, providing support and reducing swelling.
  • Elevation: Keep the ankle above the heart level to minimise swelling.
Pain Medication

Over-the-counter pain relievers, such as ibuprofen or acetaminophen, help manage pain and reduce inflammation. These medications can be particularly helpful during the initial stages of recovery.

Mobility Support

Depending on the severity of the sprain, using mobility aids such as crutches, walkers, or ankle braces can support the injured ankle and prevent further injury. Ankle braces provide stability and are especially useful during the initial healing phase and physical activities.

Surgical Treatments

Surgery is usually considered only for severe ankle sprains that involve complete ligament tears or for injuries that do not respond to non-surgical treatments. Surgical options include:

Ligament Repair

In cases of severe ligament damage, surgery may be performed to repair or reconstruct the torn ligaments. This procedure aims to restore stability to the ankle joint. Ligament repair surgery typically involves making small incisions around the ankle to access the damaged ligaments. The surgeon will then stitch the torn ligaments back together or use a graft (a piece of tendon from another part of the body or a donor) to reconstruct the ligament.

Arthroscopy

Arthroscopy is a minimally invasive surgical procedure that uses a small camera (arthroscope) to allow the surgeon to view and treat damage inside the ankle joint. During the procedure, the surgeon makes small incisions and inserts the arthroscope and other surgical instruments into the ankle. This method can be used to remove loose fragments of bone or cartilage, repair ligaments, or clean out inflamed tissue. Arthroscopy offers the advantage of smaller incisions, reduced pain and scarring, and a faster recovery time compared to traditional open surgery.

Prevention of Ankle Sprain

Preventing ankle sprains requires strengthening the ankle, improving balance, and avoiding injury-prone circumstances. Here are some effective methods for preventing ankle sprains:

  • Strengthening and Balance Exercises - Regularly exercising ankle muscles may improve stability, support, balance, and proprioception. Calves, shins, and feet should be strengthened using calf lifts, toe raises, and resistance band exercises. Standing on one leg, using a balancing board, or doing yoga helps improve coordination and stability.
  • Warm-Up and Stretching - Always warm up before engaging in physical activities. Gentle stretching and dynamic exercises can prepare the muscles and ligaments for activity, reducing the risk of injury. Focus on stretching the calves, Achilles tendon, and ankles.
  • Gradual Increase in Activity Intensity - Avoid sudden increases in the intensity or duration of physical activities. Gradually increase your fitness level to give your muscles and ligaments time to adapt and strengthen.
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Dr. Dennis Ng is dedicated to understanding your unique needs, focusing on restoring
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Dr Dennis Ng Zhaowen

  • Senior Consultant Orthopaedic Specialist
MBBS (Singapore)
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MRCSEd
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MMED
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FRCSEdOrth (Gold Medal Award)

Before private practice, Dr Dennis Ng was the former Deputy Head of the Shoulder & Elbow Division and Sports Knee Division in National University Hospital.

He completed his fellowship at the prestigious Fowler Kennedy Sports Medicine Centre in London, Ontario, Canada, and has rich experience treating professional athletes and returning them to sports. 

His special areas of interests include management of sports injuries such as ankle sprains, ligament and ATFL tears, achilles tendinitis etc.

 

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    Mount Elizabeth Novena Specialist Centre

    38 Irrawaddy Road #08-41
    Singapore 329563

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    Gleneagles Medical Center

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    Frequently Asked Questions (FAQs)

    How long does it take to recover from an ankle sprain?

    Recovery time depends on the severity of the sprain. Mild sprains (Grade I) may heal within 2-4 weeks, moderate sprains (Grade II) may take 4-6 weeks, and severe sprains (Grade III) can take several months to recover fully.

    Can an untreated ankle sprain lead to other problems?

    If an ankle sprain is not properly treated, it can lead to chronic ankle instability, recurring sprains, and even arthritis. It can also cause ongoing pain and limit mobility, affecting overall quality of life.

    When should I see an ankle specialist for an ankle sprain?

    See an ankle specialist if you experience severe pain, visible swelling, bruising, or cannot bear weight on the injured foot. Additionally, if symptoms do not improve with home treatment or if you have recurrent sprains, seek medical advice.

    +65 9751 1486