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What is an ankle sprain?
Ankle sprain is a sprain to the ankle. The ligaments that stabilize the joint are overloaded. The upper ankle joint (OSG) is most frequently affected. Twisting or spraining the upper ankle joint is one of the most common musculoskeletal injuries and is considered the most common sports injury, accounting for around 40 percent of all injuries1.
Risk factors and causes: What causes an ankle sprain?
Most ankle sprains occur when running or during abrupt changes of direction, such as in soccer, basketball or tennis. People with pre-existing instability in the ankle joint - usually due to previous injuries or illnesses - also have an increased risk of spraining their ankle. Ligaments that are already overloaded and weak foot and leg muscles can contribute to an ankle sprain. Other risk factors:
- Carelessness in everyday life, for example when climbing stairs, tripping or wearing the wrong shoes.
- Unfavorable emergence after a jump.
- Restricted coordination or impaired balance.
Symptoms of a sprained ankle
Typical symptoms usually occur immediately after twisting an ankle: Sudden pain, swelling, bruising and restricted movement - sometimes walking is hardly possible or no longer possible at all. In the case of supination trauma, these signs often occur on the outside of the foot. The rapidly occurring swelling is caused by tissue irritation and bleeding. After some time, a bruise or discoloration may become visible. Other symptoms:
- Pressure pain at the injured area, especially over the affected ligaments.
- Insecurity when walking: Many of those affected are initially barely able to put any weight on the foot, if at all.
- Feeling of instability or "twisting" of the foot when walking.
Can ankle sprains be prevented?
Prevention is possible if you know the risk factors and take targeted countermeasures: through training, awareness and the right footwear. Regular exercises to strengthen the foot and leg muscles as well as balance exercises (for example on wobble boards) improve the stability of the ankle and reduce the risk of twisting an ankle. Before certain activities, active athletes should warm up with stretching and coordination exercises to prepare their muscles and joints for the strain. Other preventive measures:
- If instability is already known: Wear medical aids such as orthoses or supports.
- Take care on slippery, uneven or sandy surfaces.
How is ankle sprain diagnosed?
The symptoms vary depending on the severity of the ligament injury (strain, partial tear or complete tear). A medical examination is necessary to rule out fractures and make an accurate diagnosis: If an ankle sprain is suspected, the affected ankle joint is first examined thoroughly.
This usually reveals swelling from the outer ankle to the heel to the midfoot. If a ligament is torn, there is often a bruise (hematoma) in this area. The area around the outer ankle is sensitive to pressure and painful.
Certain hand movements can also be used to check whether the ankle joint is unstable - for example, whether the hindfoot can be moved too far forward. This can be an indication of a tear in the anterior outer ligament (talofibular anterior ligament).
An X-ray examination of the ankle joint can be carried out for further clarification. In this way, fractures or bony injuries - for example to the fibula or metatarsal bone - can be detected or ruled out. If the stability of the joint is unclear, additional X-rays can be taken using special holding techniques.
Only in special cases is an additional magnetic resonance imaging (MRI) scan carried out to assess whether the joint surfaces or other structures of the ankle joint are also damaged.
Ankle sprain is often a supination trauma
If a sprain is caused by twisting the foot outwards, it is a supination trauma. 85 percent of all sprains occur as supination trauma1:
- Torn or stretched collateral ligament: the anterior collateral ligament (ATFL) is particularly frequently affected.
- Capsular strain or tear: the joint capsule is overstressed by twisting the ankle.
- Bony injuries: for example, avulsion fracture of the lateral malleolus or ankle fracture.
- Cartilage damage in the talus: joint surfaces can also be injured by the pressure when twisting the ankle.
- Injury to the syndesmosis: the connection between the tibia and fibula can be affected by severe trauma.
Treatment options: Therapy after supination trauma and ankle distortion
The treatment of an ankle sprain depends on how badly the ligaments are injured. In most cases, the injury can be treated conservatively, i.e. without surgery.
The PECH method is a proven immediate measure for acute ankle sprains:
- P = Pause: Stop exercising immediately.
- E = Ice (cooling): Cool the affected area with ice or a cold compress.
- C= Compression (pressure): Elastic compression bandage to reduce swelling.
- H= Elevation: If possible, elevate the injured leg above heart level.
Further measures are:
- Compression bandage or orthosis to stabilize the joint.
- Pain-adapted weight-bearing: You can put as much weight on the foot as the pain allows.
If the pain is severe, crutches can help temporarily. If one or more ligaments are completely torn (rupture), conservative treatment is usually also used - supplemented by targeted physiotherapy to restore mobility and stability and prevent chronic instability.
Surgery is only necessary in certain cases, for example in the event of multiple dislocations of the ankle joint, additional fractures or if all three outer ligaments are torn.
Exercises after supination trauma
Adapted training helps to improve the performance of your ankle joint and reduce the risk of re-sprains. Benefit from exercises that are suitable for the rehabilitation phase after minor and serious injuries.
Products from medi for ankle sprains
The stabilizing orthoses medi ankle RTS and Levamed stabili-tri can be used in the event of a sprain. The medi Rehab one medical compression stocking was specially developed to reduce swelling after injuries or operations on the lower extremities and counteract the formation of oedema.
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The human body
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Medical compression stocking for the treatment of postoperative and posttraumatic oedemas
Source:
1Lichte et al. Current diagnosis and treatment of ankle sprains in Germany. Unfallchirurgie 2024;127:449– 456.
