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Sprained ankle

A sprained ankle (twisted ankle, rolled ankle, turned ankle, etc.) is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports such as basketball, volleyball, football, and tennis.[1]

For the 2015 album by Julien Baker, see Sprained Ankle (album).
Right foot, housed in an air brace, has become swollen as a result of a more severe 2nd degree sprain to the ankle.

Right foot, housed in an air brace, has become swollen as a result of a more severe 2nd degree sprain to the ankle.

Right foot, 3rd degree sprain. One day after injury.

Right foot, 3rd degree sprain. One day after injury.

Knowing the symptoms that can be experienced with a sprain is important in determining that the injury is not really a break in the bone. When a sprain occurs, hematoma occurs within the tissue that surrounds the joint, causing a bruise. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well.[2] Along with this inflammation, swelling and pain is experienced.[1] The nerves in the area become more sensitive when the injury is suffered, so pain is felt as throbbing and will worsen if there is pressure placed on the area. Warmth and redness are also seen as blood flow is increased.[1] There is also decreased ability to move the joint.[1]

Weak muscles/tendons that cross the ankle joint, especially the muscles of the lower leg that cross the outside, or lateral aspect of the ankle joint (i.e. peroneal or fibular muscles);

Weak or lax ligaments that join the bones of the ankle joint – this can be hereditary or due to overstretching of ligaments as a result of repetitive ankle sprains;

Inadequate joint (i.e., sense of joint position);

proprioception

Slow neuron muscular response to an off-balance position;

Running on uneven surfaces;

Shoes with inadequate heel support; and

Wearing high-heeled shoes – due to the weak position of the ankle joint with an elevated heel, and a small base of support.

Movements – especially turning, and rolling of the foot – are the primary cause of an ankle sprain.[3]


The risk of a sprain is greatest during activities that involve explosive side-to-side motion, such as tennis, skateboarding or basketball. Sprained ankles can also occur during normal daily activities such as stepping off a curb or slipping on ice. Returning to activity before the ligaments have fully healed may cause them to heal in a stretched position, resulting in less stability at the ankle joint. This can lead to a condition known as chronic ankle instability (CAI), and an increased risk of ankle sprains.[4]


The following factors can contribute to an increased risk of ankle sprains:


Ankle sprains occur usually through excessive stress on the ligaments of the ankle. This can be caused by excessive external rotation, inversion or eversion of the foot caused by an external force. When the foot is moved past its range of motion, the excess stress puts a strain on the ligaments. If the strain is great enough to the ligaments past the yield point, then the ligament becomes damaged, or sprained.[5][6]

Ensure proper warm-up prior to stretching and activity;

When running, choose level surfaces and avoid rocks or holes;

Ensure that shoes have adequate heel support;

If high-heeled shoes are worn, ensure that heels are no more than two inches in height, and avoid heels with a narrow base.

Prognosis[edit]

Most people improve significantly in the first two weeks. However, some still have problems with pain and instability after one year (5–30%). Re-injury is also very common.[36] The risk of recurrence can reach one-third of cases.[37] There are currently no published evidence-based criteria to inform RTS (return to sport) decisions for patients with a lateral ankle sprain injury. Return to sport decisions following acute lateral ankle sprain injury are generally time-based.[38]


Mild sprains (Grades 1-2) relating to over stretching or partial tears typically begin to feel better in a few days to a week and heal by six weeks. More severe ankle sprains (Grades 2-3) involving a full tear or rupture could take more than a few weeks or months to fully recover.[39] The mean time patients return to sports is 12.9 weeks. Average time to return to work after injury range from less than one week to two months.[40]

Doherty C, Bleakley C, Delahunt E, Holden S (January 2017). (PDF). British Journal of Sports Medicine (Review). 51 (2): 113–125. doi:10.1136/bjsports-2016-096178. PMID 28053200. S2CID 37194066.

"Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis"

McGovern RP, Martin RL (2016). . Open Access Journal of Sports Medicine (Review). 7: 33–42. doi:10.2147/OAJSM.S72334. PMC 4780668. PMID 27042147.

"Managing ankle ligament sprains and tears: current opinion"

Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D (2013). . Journal of Athletic Training (Review). 48 (4): 528–45. doi:10.4085/1062-6050-48.4.02. PMC 3718356. PMID 23855363.

"National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes"

Kerkhoffs GM, van den Bekerom M, Elders LA, van Beek PA, Hullegie WA, Bloemers GM, de Heus EM, Loogman MC, Rosenbrand KC, Kuipers T, Hoogstraten JW, Dekker R, Ten Duis HJ, van Dijk CN, van Tulder MW, van der Wees PJ, de Bie RA (September 2012). . British Journal of Sports Medicine. 46 (12): 854–60. doi:10.1136/bjsports-2011-090490. PMID 22522586.

"Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline"