Sprained Ankle

Ankle sprains divide into two groups: complicated and uncomplicated. Uncomplicated ankle sprains are treated without surgery. They include injuries not associated with fractures. Complicated ankle sprains usually require surgical management.




Ankle trauma is evaluated with a careful history (situation and mechanism of injury, previous injury to the joint, etc.) and a careful physical examination (for example, inspection, palpation, weight-bearing status).  Tests including Xray and diagnostic ultrasound.    With pain lasting more than six weeks, computed tomographic (CT) scanning or magnetic resonance imaging (MRI) should be considered to rule out greater injury.


Initial Management


Because increased swelling is directly associated with loss of range of motion in the ankle joint, the initial goals are to prevent swelling and maintain range of motion.    Early management includes RICE (rest, ice, compression and elevation). Cryotherapy should be used immediately after the injury.  Heat should not be applied to an acutely injured ankle joint because it encourages swelling and inflammation through hyperemia.   Compression Below Knee casting may be utilized to prevent long term chronic instability to the ankle.  Minimum immobilization for 10 days may allow for greater structural ankle joint integrity.


The injured extremity should be elevated 15 to 25 cm (6 to 10 in) above the level of the heart to facilitate venous and lymphatic drainage until the swelling has begun to resolve.  In some patients, the use of crutches may be considered.


Functional Rehabilitation


The importance of proper rehabilitation after an ankle sprain cannot be overemphasized, especially when the debilitating consequences of decreased range of motion, persistent pain and swelling, and chronic joint instability are considered. After initial acute treatment, a rehabilitation regimen is pivotal in speeding return to activity and preventing chronic instability.  The four components of rehabilitation are range-of-motion rehabilitation, progressive muscle-strengthening exercises, proprioceptive training and activity-specific training.   Ankle joint stability is a prerequisite to the institution of functional rehabilitation.


Ankle sprains should not be taken lightly, to prevent chronic instability and discomfort.