Sprained ankles are the most frequent type of musculoskeletal injuries seen by primary care physicians. Ankle injuries are common with sports and falls. There are ligaments, tendons, and bones that support the sides of the ankle that can be injured. These bones which make up the ankle are the Tibia, Fibula, and Talus. The ligaments provide bone to bone connections. The talus is the top bone of the foot. The outer bump of the ankle is the lateral malleolus. The inner bump of the ankle is the medial malleolus. Though ankle injuries are common sport injuries they can happen in every day activities. A twisting motion of the ankle joint can happen when the foot is plantar flexed or in a tip-toed position and force is applied to either side of the ankle joint when the plantar flexed foot is rotated inward or outward (inverted or everted). Uneven ground or partially stepping on something can easily cause this twisting motion. The tendons in the ankle connect the muscles to the bones of the ankle. Because these muscles control the motion at the ankle, extreme stress can cause stretching or tearing of theses tendons and ligaments. The chronic inflammation of the stressed or torn tendons is called tendonitis. Tendons that are pulled off the bones of the ankle are called avulsions injuries.
The most common injuries to the ankle are to the ligaments. The most common ligament injured is the Anterior Talofibular. Activities which may cause uneven planting of the foot are running, jumping stepping up or down, and stepping in or on an uneven surface. Athletes are very often injured due to these inversion or eversion injuries. Inversion injuries, when the foot rolls inward are more common than eversion injuries, when the foot rolls outward. Eversion injuries are also referred to as High Ankle sprains.
Tissue injury and inflammation occurs when an ankle is sprained. Blood vessels become leaky, and allow fluid to escape into the soft tissue surrounding the ankle joint. The immune response is triggered sending WBC (white blood cells) to the area, which create the inflammation in the injured area and an increase in blood flow. In short, the signs of an ankle sprain include swelling due to increased fluid in injured tissue, pain due to the increase fluid surrounding the nerves creating a more sensitive area, and redness due to the increased blood flow.
We should be consulted when the pain is uncontrolled or the injured individual is unable to walk. Treatment consists of x-rays to rule out a fracture, keeping weight off the injured ankle, compression of the ankle that also provides support, and ice that counteracts the increased blood flow to the injured tissue.