It’s a feeling all too familiar to many people; you’re midway through a jog, basketball game, or maybe just going for a walk, when you feel your ankle suddenly buckle and give out, followed by a sharp burst of pain. Ankle sprains are one of the most common sports injuries today, and according to the American College of Sports Medicine, affect up to 9 million Americans every year. This injury frequently occurs in athletes or anyone with an active lifestyle. There is also an increased probability of sustaining an ankle sprain with certain types of footwear such as high heels, those who work on uneven terrain, or people with certain foot types such as high arches. While these injuries may be traditionally thought of as only minor, recent studies have shown that they may be frequently misdiagnosed, or lead to a host of other long-term complications and painful conditions.
Most ankle sprains occur by means of inward rolling of the foot underneath the ankle, also known as inversion. With this mechanism of injury, there can be severe stress placed on the ligaments and soft tissue structures to the outside of your foot and ankle. If stressed too much this can lead to tendon and ligament sprains, ruptures, or even broken bones. Most frequently injured is the anterior talofibular ligament, or ATFL, which runs from the outside of the ankle to the top of the foot. This ligament functions primarily to keep your ankle in alignment and prevent excessive inward rolling of the ankle. When injured, however, it can stretch, tear, or even completely rupture, predisposing you to chronic instability and repeat injuries down the road.
Following injury, one may experience immediate pain, swelling, bruising, limping or inability to walk, and pain to touch. Less severe cases may be managed with simple methods such as rest, ice, compression, and elevation. However, there can be a wide range of severity, so to help categorize the level of injury and guide the treatment plan.
A classification system that organizes the types of ankle sprains as follows:
Grade 1 ankle sprains are when you mildly roll your ankle. You may have some mild swelling, bruising and pain.
Grade 2 sprains, which are the most common, result in a tear of some of the ankle ligaments. These result in more swelling, bruising and pain.
Grade 3 sprains are the most severe, where all the ligaments are torn. Ankle fractures are sometimes misdiagnosed as Grade 3 sprains, as they are harder to detect with the amount of swelling and pain present.
High ankle sprains are also common in athletes. You can sprain the ligament that is above the ankle joint and between the two lower leg bones, which often takes longer to heal.
Although classically diagnosed based solely upon physical examination and x-rays, there is increasing evidence that many of these injuries may be misdiagnosed, or at the very least underestimated in severity. These injuries can have a wide variability, ranging from resolving on their own in 4-6 weeks or taking months to years to improve. There has also been unpredictability in the long-term outcomes, ranging from an uneventful and full return to activity or long-term pain and disability. One study found that up to 33% of patients continue to have pain at 1 year after an acute ankle sprain, and over 34% of patients have a repeat ankle sprain within 3 years1. It is this inconsistency in outcomes that has led researchers to recommend more aggressive imaging and work up to ensure that more severe injuries aren’t missed. A study published this month in the Journal of Foot and Ankle Surgery found that out of 171 patients with ankle sprains who received an MRI within 3 weeks of the injury, 65% were found to have more serious injuries that may have otherwise been missed. These injuries included ligament ruptures, fractures, tendon tears, and cartilage damage2.
Based on this increasing body of evidence, the doctors at Kansas City Foot and Ankle recommend seeking prompt medical attention for your ankle sprain, as this could be more serious than originally thought and lead to an array of long-term consequences. Our doctors utilize cutting-edge diagnostic modalities to help ensure your accurate diagnosis. We specialize in state-of-the-art conservative and surgical treatment methods to help with your timely return to comfort and activity. So, if you think you may be suffering from an ankle sprain, give our office a call at 816-943-1111 to get started on the right path to your recovery!
- Van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, BiermaZeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 121:324–331, 2008.
- R. Miller et al. Diagnostic Value of Early Magnetic Resonance Imaging After Acute Lateral Ankle Injury. J Foot & Ankle Surg 56 (2017) 1143–1146.