What is it?
A "sprained ankle" is one of the most common injuries a sports medicine physician encounters. It is also one of the most poorly understood by lay persons and health care providers (including physicians), and is often under treated. A severe ankle sprain, although treated properly, can still result in chronic instability of the ankle. Fortunately, most are not severe and with quick and proper treatment these injuries heal well.
Three essential ligaments cross the lateral (outside) surface of the ankle joint and are the most commonly injured with ankle sprains.
- Anterior Talofibular Ligament (ATFL)
- Posterior Talofibular ligament (PTFL)
- Calcaneo Fibular Ligament (CFL)
Much more uncommonly, however, on the medial (inside) surface of the ankle joint, the deltoid ligament is injured.
Mechanisms of Injury
The injury is usually the result to the ankle turning in, commonly referred to as "going over the ankle." In squash this can occur with sudden pivoting or cutting movements. More often the ATFL and CFL are involved.
Classification of Ankle Sprains
- First Degree: Most common and often neglected. The ligaments are stretched, not torn. There may be minimal to mild swelling and no instability. This patient usually treats him/herself and simply puts up with a sore ankle for a week or so.
- Second Degree: Ankle ligaments are partially torn and bleeding into the surrounding soft tissue occurs resulting in ecchymosed (bruising and discoloration). Swelling and pain may be very minimal initially and gradually worsen over the next few days peaking within a week. This degree of tear requires varying degrees of immobilization and usually 3-6 weeks before the person van resume activities.
- Third Degree: Most severe and ominous. Represents complete disruption of at least the ATFL and CFL and sometimes the PTFL. The ankle is unstable. X-rays are normal. Healing requires 8 to 10 weeks.