Mark loves playing basketball. Although he is not tallest member of the team he is known for his ability to jump and shoot. Early in the season during a game he went up for a shoot and came down off balance with another player and landed awkwardly. Immediately he knew he had injured his ankle. With determination and grit he limped to the bench. His ankle began to swell almost immediately. His athletic trainer suspected an ankle sprain and treated him appropriately with compression, ice and elevation.

The next day he was evaluated in the youth sport medicine clinic at Rocky Mountain Hospital for Children. After x-rays confirmed that no fracture had occurred, he was fitted with a brace and physical therapy was started.

What is an ankle sprain?

An ankle sprain is an injury to the ligaments that stabilize the ankle. Ligaments are soft tissue structures that connect bone to bone while tendons connect muscle to bone. Ligaments in an ankle sprain are most commonly injured on the outside (lateral side) of the ankle. Because there are several important ligaments on the lateral and medial side of the ankle, the severity (grade) of the ankle sprain corresponds to the number of ligaments that are damaged.  

Are ankle sprains common?

Ankle sprains are very common in teenagers and adults, but are less common in younger children who will more frequently break or fracture the bone. In the younger age group, the ligaments are relatively stronger than the growth plates at the ankle. Once a person has sprained an ankle, it is easier to sprain it again. Recurrent ankle sprains can be decreased with dedication to an easy rehab program aimed at strengthening muscles and ligaments of the ankle.

What causes an ankle sprain?

Ankle sprains are usually caused by “rolling an ankle”, or inverting it, causing the sole of the foot to turn upwards.

What are the symptoms of an ankle sprain?

Ankle sprains produce a varying amount of pain, swelling and bruising over the joint, usually on the outer side (lateral side) of the ankle. Often these symptoms mimic an ankle fracture yielding so much pain that it seems impossible to bear weight.

How does an ankle sprain get diagnosed?

A sprained ankle is diagnosed by careful history of the injury combined with a thorough physical exam. Sometimes X-rays are done to rule out a fracture in the bone of the ankle. X-rays cannot demonstrate the ligaments but can show soft tissue swelling typical of a sprain versus a fracture. It is very uncommon to require an MRI to diagnose a sprained ankle.

How is an ankle sprain treated?

The initial treatment plan for a sprained ankle is PRICE: Protection, Rest, Ice, Compression and Elevation. The details of the protection depend on the severity of the injury. A splint or brace can be used for most sprains. Sometimes a cast is used if there is severe instability or there is a question of a patient’s compliance and ability to limit activity. Crutches are prescribed when a patient is too uncomfortable to walk on the injured side. The rehab portion of recovery includes exercises to regain the normal range of motion, strength and balance in that ankle. Since recurrent ankle sprains are a common problem it is very important that the patient remain dedicated to the rehab program. Failure to do the exercises will make it more likely to re-injure the ligaments yielding a chronic “bad ankle”.  If ligament damage is severe, then surgical repair is possible, but thankfully is very uncommon in kids and teenagers

What is the long-term outlook for my child after an ankle sprain?

Most patients with ankle sprains heal very well and return to their full activity without any long-term problems. Some patients choose to wear sport protective supports after the injury has healed especially in those activities where ankle injuries are common.

Even though Mark’s ankle injury was severe, he was able to return to his team midway through the season. He participated enthusiastically in his rehab program and encouraged his fellow players to wear ankle protection for practices and games to avoid injuries that might sideline a player. His team had a successful season without any additional injuries.