Chances are at one time or another, you've sprained your ankle.  If you've made it through your life so far without one, then consider yourself lucky.  However, whether you've experienced one or not, it's an injury everyone should have an understanding of.  You never know when your next step may be a wrong one.

What is a sprain anyway?

When you sprain your ankle, you actually are injuring the ligaments that hold the ankle joint together, stretching them further than they normally would, or in some cases tearing the ligaments. 

Anatomy of the Ankle

The ankle joint or the mortise joint is formed by three bones: the talus (the dome of the ankle), the tibia and the fibula (the bones that make up the lower half of the leg). The joint is held together by three strong ligaments on the outside of the ankle: the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament; and one very strong ligament on the inside of the ankle: the deltoid ligament.

How exactly can you injure the ligaments?

Spraining your ankle can occur when the foot rolls inward or outward, resulting in damage to the ligaments on the respective sides.  This is commonly known as "twisting" your ankle.  It's easy to do this while stepping off a curb or walking on an uneven surface, especially if you are wearing high-heeled shoes. Twisting your ankle in this fashion typically rolls your foot inward, causing damage to ligaments on the outside of the ankle. The anterior talofibular ligament is the most commonly sprained ligament in the ankle and probably the most commonly sprained ligament in the body.  It is possible to "twist" your ankle inward, injuring the deltoid ligament, but it is less common.  Also, the deltoid ligament rarely tears; more often it remains intact but will break away from the tibia, along with a bone fragment still attached to the ligament.  

Severity of a Sprain

Ankle sprains are categorized into 3 grades, depending on the severity.

• Grade I:  Some stretching and possibility of slight tearing.  Little or no instability of the joint.  Mild pain, swelling, and stiffness. 
• Grade II:  Some tearing of the ligaments and moderate instability of the ankle joint. Moderate to severe pain, swelling and joint stiffness.
• Grade III:  total rupture of ligament(s) and severe instability of the joint.  Severe pain and swelling, causing extreme joint stiffness.
  
  Grade III sprain will probably require immobilization for 1-3 weeks. and surgical repair or reconstruction may be necessary.

Immediate Ankle Sprain Management

The best immediate treatment is RICE. You need to limit internal bleeding and swelling and if the sprain is severe, splint the ankle. You may need crutches to relieve stress and pain during ambulation.

RICE: 

• Rest your ankle immediately.  This can minimize swelling and help you walk sooner.
• Ice your ankle until swelling subsides.  Ice constricts blood vessels and helps reduce swelling.  Fill a plastic bag with ice or use a bag of frozen vegetables.  Ice for 15-20 minutes, 3-5 times per day.
• Compress the ankle between icings with an elastic bandage (you can find them at your local pharmacy). This helps reduce the swelling and bruising.
• Elevate the ankle so it is above the level of your heart.  Use pillows while sleeping or watching television. 

What should you do if you sprain your ankle

• See your doctor.  It can be difficult to differentiate between a sprain and a  fracture.  For example, if the ankle is very swollen, it may be just a bad sprain, however, very little inflammation can actually indicate a fracture.  An x-ray should be taken to determine this.   
• Physical Therapy.  The doctor will most likely give you a prescription for physical therapy to rehabilitate your ankle to get you back on your feet as soon as possible. 

What can you do to help prevent future injuries?

• Maintain good range of motion, strength, and balance.  The exercises listed at the end of the article will help maintain all 3 of these. 
• Wear an ankle brace.  If you play sports or participate in other recreational activities, it will help stabilize and support the joint.

Unfortunately, once you have a sprained your ankle, you are more susceptible to sprain the ankle again and again, especially if it is left untreated.