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Ankle Injuries: Info About Sprains, Strains, and Fractures

Reviewed by
Dr. Mark Landsman

Ankle injuries are extremely common. It’s estimated that approximately 25,000 people injure their ankles every day nationwide. This injury can occur to anyone of any age, male or female.

Our ankles are very complex structures. The ankle bone and the ends of the two lower leg bones (the tibia and fibula) make up the ankle joint. Ligaments connect the bones to one another, stabilizing and supporting the ankle, while the muscles and tendons allow movement.

Common ankle injuries include:

Strains happen when a muscle or tendon is overstretched. They are less likely to happen to an ankle and more likely to happen to a back hamstring muscle. Sprains are a very common ankle injury that occurs to the ligaments.

They are more serious than strains, and are also caused by overstretching. Sometimes the ligament will tear away and take a fragment of bone with it. This is called an avulsion fracture.

According to experts, 85 percent of all ankle injuries are sprained ankles, and 45 percent of all sports-related injures are ankle-related. Injuries can also occur to your tendons and to your cartilage, which cushions your joints.

Athletes are susceptible to ankle injuries. Just ask Green Bay Packers running back Ryan Grant. He suffered an injury to his right ankle that damaged his ligaments and ended his 2010–2011 season.

Symptoms of Ankle Injuries To Be Aware Of

The symptoms of your ankle injury will depend on the type of injury you’ve sustained. For sprains and strains, symptoms may include:

  • Pain or tenderness in the area of the injury
  • Swelling of the ankle
  • Redness
  • Bruising in the injured area, which may occur immediately or several hours following the injury
  • Loss of mobility or difficulty walking

For fractured bones, symptoms may include:

  • Intense pain at the location of the break or fracture
  • Significant swelling, not necessarily localized to the site of the fracture
  • Blisters on your feet, especially over the fracture site
  • Bruising that develops almost immediately after injury
  • Change in the appearance of the ankle
  • Bone may be protruding from the skin
  • Inability to walk or difficulty walking
  • Numbness, tingling, or paralysis (this is a rare emergency)
  • Paleness or deformity

Why Does My Ankle Hurt?

Ankle injuries can occur in a number of ways. The most common injuries—ankle sprains and strains—occur when the foot twists inward, damaging the lateral ligaments located on the outside of the foot.

These are also referred to as inversion injuries, and they are more common than their opposite, pronation injuries. Pronation injuries happen with the medial ligaments on the inside of the foot are twisted outward.

Sprains are usually graded on a scale of 1 to 3, 1 being mild, 2 moderate, and 3 severe. The grade of your injury will be based on how badly the ligament is torn. X-rays are used to rule out fractures and dislocations.

Fractures are much more serious than strains and sprains, and can also happen in a variety of ways. There are several types of fractures: stress fractures, avulsion fractures, simple fractures, and comminuted fractures.

Stress fractures occur when the internal aspect of the bone is placed under a great amount of pressure over time. Avulsion fractures occur when a small piece or pieces of bone have been pulled off.

Simple fractures are a little more serious—they occur when the bone completely breaks into two pieces. Comminuted fractures are the most severe, and occur when the bone is shattered into fragments.

Fractures can be subcategorized as either displaced (broken bones are moved from their normal position), non-displaced (bones are slightly misaligned), open (a portion of the bone is protruding from the skin), or closed (the bone doesn’t break the skin’s surface).

Common causes of ankle sprains, strains, and fractures include:

  • Obesity
  • Stepping wrong on uneven ground
  • Having your foot stepped on while in motion
  • Landing incorrectly after jumping
  • Jumping in an unbalanced position

When to See Your Doctor For An Ankle Injury

If you have injured your ankle, you should seek medical attention to avoid further damaging your muscles, tendons, ligaments, nerves, or bones. Many people do not feel they need to see a doctor, especially if they are able to walk or stand on the injured ankle.

For example, if a kid were to jump off a roof and land on his or her ankle wrong, he or she might be able to get up and continue running. This is because not all symptoms appear immediately after an injury occurs.

But symptoms may develop within hours, and an injured ankle will require medical attention. If any of the following symptoms begin to develop, call your doctor immediately:

  • Increased pain
  • Increased swelling
  • Bruising
  • Blue or gray skin below the fracture site (in the foot)
  • Numbness
  • Loss of feeling below the fracture site (in the foot)

First-Aid TIP: If you are with someone who has injured their ankle, administer first-aid treatment for bleeding by covering any open wounds. Do not attempt to move the person if it can be avoided, and move them as little as possible. Transport the person to a hospital or to their doctor’s office immediately, especially if the symptoms above are visible.

Ankle Injury Complications To Know About

If you sustain an injury to your ankle and leave it untreated by a podiatrist or doctor, you could be increasing your risk for future complications. Not only can these complications affect your ankle and foot, they can also lead to problems with your knees, hips, neck, and back.

Over time you can even develop leg deformities, which can cause intense pain. Other complications that can arise include:

  • Traumatic arthritis
  • Inflammation
  • Chronic pain and swelling
  • Stiffness in joints
  • Severe pain
  • Imbalance within other joints
  • Failure to heal properly
  • Shock from blood loss
  • Obstruction of nearby arteries
  • Travel of fat cells from the injury site to the lungs or brain

Most of these complications arise from damage to the cartilage sustained during the ankle injury. The cartilage prevents bones from rubbing together when you are in motion. When it is damaged, it breaks down and weakens, wearing away layer by layer over time.

As each layer wears away from the ankle joint, the space within the joint becomes narrower. This is what causes the imbalance in the joint.

How Are Ankle Injuries Diagnosed?

It’s important that you see a foot doctor as soon as possible after you injure your ankle. There are many types of sprains, strains, and fractures, and waiting can make the problem worse. Your doctor will ask questions about your medical history and activities and give you a physical exam to determine the severity of the injury. He or she will also order an x-ray to check for breaks, fractures, or dislocations. A proper diagnosis can usually be made with an imaging test.

How Can My Ankle Injury Be Treated?

How your ankle injury is treated will depend heavily on the type and severity of the injury. It’s important to know that ankle injuries usually heal very slowly, typically over a period of two or three months.

Strains and sprains usually require the RICE method: Rest, Ice, Compression, and Elevation.

You may be given crutches to help you stay off your foot, or your doctor may put a brace or cast on your ankle. Ice should be applied for twenty minutes at a time. Compression involves wrapping the ankle with an elastic bandage for support, and elevation helps to minimize bruising and swelling.

The ankle should be elevated above the heart as much as possible during the first forty-eight hours. Over-the-counter medications such as ibuprofen are also used to reduce swelling and pain.

Most ankle sprains and strains take six to eight weeks to heal properly. If the injury is severe, recovery could take up to twelve weeks, and physical therapy may be required. Physical therapy or rehabilitation typically begins once the pain and swelling improve.

On rare occasions, surgical procedures are used to repair ligaments. This is usually done if the person is experiencing significant pain, swelling, or recurrent sprains.

Treatment for fractures usually includes setting the fracture or fitting the bones back together. For open or displaced wounds, antibiotics are prescribed to prevent infections. Generally the patient is immobilized with a cast and given crutches to enable them to stay off the foot while standing upright.

In most cases, healing takes eight to twelve weeks. If you’ve shattered your ankle bone, your doctor may have to use screws, metal plates, pins, or staples to stabilize the pieces.

As mentioned earlier, once the pain and swelling improve your doctor will want you to begin using your ankle as much as possible.

He or she will recommend physical therapy to avoid stiffness in the ankle joint, edema (excess fluid in the tissues), and loss of muscle mass. Your doctor will have specific instructions for you to follow once treatment has been administered.

How Can Ankle Injuries Be Prevented?

There are several things you can do to prevent ankle injuries, even if you play high-impact sports or participate in events that put you at greater risk. Here are some prevention tips to keep your ankles injury-free:

  • Maintain physical fitness
  • Maintain a healthy weight and diet
  • Wear proper footwear and other protective gear for your sport or activity
  • Stretch your muscles before and after exercising
  • Strengthen weak muscles through exercise
  • Accident-proof your home and office
  • Increase your intake of vitamins A, D, and C, and Zinc supplements to promote bone health
  • Follow your doctor’s instructions

Questions to Ask Your Doctor

Here are some questions you may want to ask your doctor about an ankle injury:

  • Will I be able to resume the activity that caused this injury?
  • Do you have special orthotics to help me prevent this injury from recurring once it’s healed?
  • Should I lose weight?
  • How long should I wait to contact you if the healing process doesn’t seem to be moving forward? Are there additional symptoms I should watch for that might indicate the healing process has stopped?

This page was last updated on October 29th, 2015

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