Ankle sprain

Introduction

An ankle sprain refers to an injury to one or more ligaments that stabilize the joint. It occurs during a sudden and excessive movement, most commonly an inversion twist (the ankle twisting inward). It is one of the most common injuries seen in consultations. Sprains are classified into three grades depending on the severity of the ligament damage. While most heal within a few weeks, inadequate initial management can lead to chronic instability and recurrent sprains.

If you have just twisted your ankle and are experiencing intense pain, significant swelling, or an inability to put weight on your foot, first contact your primary care physician. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our app available on the App Store and Google Play.

Who is at risk?

Anyone can get a sprain, but certain groups are more exposed. Athletes (basketball, football, running, hiking, dancing) are the most affected. Women wearing high heels, people who have already had a sprain (very high risk of recurrence), patients with chronic instability, ligamentous hyperlaxity, proprioceptive deficit, or who are overweight also have an increased risk. Irregular terrain, poor lighting, and unsuitable footwear are classic triggers.

Symptoms of an Ankle Sprain

Symptoms appear immediately after the injury. Their intensity reflects the severity of the ligament damage.

Main Symptoms

• Sharp pain at the time of the injury, sometimes accompanied by a cracking sound.

• Swelling: rapid swelling of the ankle, often located on the outer side (the most commonly affected ligament is the anterior talofibular ligament).

• Bruising (initially resembling a "goose egg" and then turning blue) which appears within the following hours.

• Functional impairment : difficulty or inability to put weight on the foot, or to walk.

• Sensation of instability or giving-way of the ankle.

• Joint stiffness and limited movement.

When to seek emergency care?

Emergency medical consultation is necessary in the following situations:

• Total inability to put weight on the foot or to take four steps (a major criteria suggesting a fracture).

• Bone tenderness upon palpation of the medial or lateral malleolus (Ottawa rules).

• Massive swelling, visible deformity, skin tear.

• Loss of sensation or paleness of the skin (neurovascular compromise).

• Sprain in a child, an elderly person, or a patient taking anticoagulants.

• Recurrence in an already unstable ankle.

What to do before calling Docadom? Immediately apply the RICE protocol (Rest, Ice, Compression, Elevation) and first contact your primary care physician. If they cannot be reached or if you need a home doctor outside of business hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone app (App Store and Google Play). In case of a skin tear, major deformity or loss of sensation, dial 144 immediately.

Mechanisms and Classification

The sprain occurs during a sudden twist: the ankle twists inward (inversion, the most common) or outward (eversion, rarer but more severe). The affected ligaments are most commonly the lateral collateral ligaments: anterior talofibular, calcaneofibular, posterior talofibular.

Three Grades of Severity

• Grade I (mild): simple ligament stretching. Moderate pain, mild swelling, walking is possible. Healing in 1 to 2 weeks.

• Grade II (moderate): partial tear. Swelling, bruising, walking is difficult. Healing in 3 to 6 weeks.

• Grade III (severe): complete tear. Significant swelling, inability to bear weight, instability. Healing in 6 to 12 weeks, sometimes requiring surgery.

Diagnosis of Ankle Sprain

The diagnosis is clinical. Imaging tests are guided by the Ottawa rules.

Diagnostic Methods

• Anamnesis: mechanism, intensity of initial pain, history of sprains.

• Clinical examination: palpation of the malleoli and ligaments, assessment of laxity (anterior drawer test, forced varus), weight-bearing evaluation.

• Ankle X-ray : indicated based on the Ottawa ankle rules (specific bone tenderness or inability to take four steps).

• Ultrasound or MRI : in cases of severe sprains, diagnostic uncertainty, or before surgery.

Differential Diagnosis

Several other injuries can be confused with a sprain:

• Fracture of the malleolus or the fifth metatarsal.

• Calcaneal fracture after a fall from a height.

• Osteochondral lesion of the talar dome.

• Tendinopathy or rupture of the Achilles tendon.

• Fibular tendon dislocation.

Treatment of Ankle Sprain

Initial management relies on the RICE protocol: Rest, Ice, Compression, Elevation.

First Steps (First 48 Hours)

• R — Rest: relative rest, avoid painful weight-bearing.

• I — Ice: applying for 15 to 20 minutes every 2 to 3 hours (protect the skin with a cloth).

• C — Compression: bandage or elastic brace.

• E — Elevation: elevating the ankle higher than the heart to limit swelling.

Medical Treatment

Paracetamol as first-line treatment. NSAIDs (ibuprofen, diclofenac) are effective for pain and inflammation but should only be used for a short duration (3 to 5 days), respecting any contraindications. Topical NSAIDs (gel) constitute a good local alternative.

Immobilization and Rehabilitation

A semi-rigid brace or a stabilizing ankle support, worn for 3 to 6 weeks depending on the grade, is now preferred over a plaster cast. Physiotherapy is essential: it aims to restore mobility, muscle strength, and especially proprioception, which prevents recurrences. Severe sprains (grade III) may justify ligament surgery, especially in athletes.

Prevention of Recurrence

The risk of recurrence after a sprain is high. To limit it:

• Complete proprioceptive rehabilitation (Freeman board, balance exercises).

• Muscle strengthening of the peroneal muscles and triceps surae.

• Suitable footwear adapted to the activity, in good condition.

• Warm-up before sports, stretching after effort.

• Strapping or ankle support when resuming a risky activity.

• Avoid uneven terrain and high heels if there is a history of injury.

Possible Complications

The most common complication is chronic ankle instability, leading to recurrent sprains and early osteoarthritis. Other complications can occur: algodystrophy (complex regional pain syndrome), unnoticed osteochondral lesion of the talus, residual laxity, chronic pain, functional impairment, and cessation of sports activities.

When to Contact a Doctor for a Sprain

Every sprain deserves a medical evaluation, especially if it is painful. Here is what you should do:

• As a first resort: contact your primary care physician, who will assess the need for an X-ray and prescribe the appropriate treatment.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of warning signs (deformity, skin tear, loss of sensation, total inability to bear weight), call 144 immediately or go to the emergency room.

Conclusion: Treat Well to Prevent Recurrence

An ankle sprain is a common injury that, when properly cared for, usually heals without complications. It is characterized by pain, swelling, bruising, and functional impairment, which can lead to complications like chronic instability, early osteoarthritis, or recurrent sprains if rehabilitation is neglected. The RICE protocol, proper immobilization, and proprioceptive rehabilitation are the three pillars of treatment.

If in doubt, consult your primary care physician first. If they are not available, Docadom provides an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.