Sprains Overview

By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

The ankle is a complex joint allowing the foot to move primarily up and down. When the foot turns down and in excessively, an injury to the ankle ligaments has likely occurred. Twisting the ankle can come not only from participating in sports but also falling off of a high-heeled shoe or stepping down off of a step and turning the foot under. When an injury to a ligament occurs it is important to have immediate care so that the ligament heals and chronic pain and instability are voided.

GRADE I (MILD) – The ligaments have stretched, even partially torn. Pain and swelling are present on the outside of the ankle and discoloration may develop. Low-grade diffuse tenderness is present all around the outside ankle bone. Treatment for this includes Rest, Ice and Compression with an ankle brace or boot. When minor this injury may allow the athlete to return to sports but if the pain is present with weight-bearing, immediate care is important.

GRADE II (MODERATE) – Usually due to a more partial or even complete tear of one of the ligaments on the outside of the ankle. More swelling, discoloration and difficulty weight-bearing are present. Treatment should be immediate and includes immobilization in a boot or a cast to allow the injury to heal. These injuries can take from 3-6 weeks to improve. If untreated this can turn into a more chronic condition. 

GRADE III (SEVERE) – More severe injury with complete tearing of the ligament or ligaments on the outside of the ankle. Diffuse swelling, discoloration, and pain are present on the outside and the inside of the ankle. Tenderness is diffuse and there is usually great difficulty weight-bearing as soon as the injury occurs. Treatment should be immediate and includes immobilization in a cast or boot for 4-6 weeks. Physical therapy and prophylactic ankle bracing are necessary to prevent recurrence.

UNTREATED – Untreated injuries usually cause chronic swelling, stiffness, and instability. If present treatment includes aggressive physical therapy. If unresponsive, surgery to clean out the ankle arthroscopically and/or repair the ligaments will allow the athlete to return to full activity. 

This is a picture of the CFL being repaired with suture during peroneal tendon repair

Repair of ATFL for chronic ankle instability