Soft Tissue Injury: Ankle Sprain

  • Reference Number: HEY-234/2016
  • Departments: Emergency Department, Physiotherapy

Introduction

This leaflet has been produced to give you general information about your injury. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it, you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is an ankle sprain?

A sprained ankle occurs when a ligament is forced into an abnormal position, causing it to overstretch. Ligaments are strong bands of tissue that connect one bone to another and help hold joints together.

The most common type of ankle sprain is when the sole of your foot turns inwards, overstretching the ligaments on the outside of your ankle and squeezing those on the inside.

What are the symptoms?

  • Mild ache or a sudden pain.
  • Swelling and bruising.
  • Inability to move the ankle normally.
  • Difficulty putting weight on to the foot.

What if I need pain relief?

To manage your pain, we advise that you regularly take simple pain relief which can be bought over the counter. If you have allergies or conditions which prevent the use of pain-relieving or anti-inflammatory medication, please seek advice from your General Practitioner (GP) or a pharmacist.

What should I do in the first 72 hours after the injury?

The most important initial treatment is aimed at controlling the pain and swelling by following the principles of RICE:

R – Rest

Complete rest is not advisable but it is important that you prevent putting the ankle under strain in the early stages of healing. The movements below should be done 10 times, within your limits of pain, 3 to 4 times per day:

1. In sitting, lift your foot a few centimetres off the floor and pull your toes and ankle up towards you.

To assist this movement, place a scarf around your foot and pull the end of the scarf with your hands.

Rest - Step 1A
Now point your toes away as far as possible without causing pain. Rest - Step 1B
2. Still whilst sitting, gently turn your ankle inwards then outwards.

Ensure the movement comes from your ankle and not the knee.

Rest - Step 2
3. Moving only from your ankle joint, make a circle with your foot.

I – Ice

Ice will help reduce the pain in your ankle and so should be applied for 10 to 15 minutes before performing the exercises above. This will in turn help to reduce the swelling.

There are many different ways in which ice can be applied, however crushed ice is thought to be the most effective. Whichever method you choose it is important that you wrap the ice in a damp towel to prevent it from ‘burning’ the skin.

Please Note:

Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.
Do not apply the ice to an open wound.
Do not apply an ice pack to an area that has poor circulation.
During ice application, check the skin every five minutes and discontinue its use if:

  • the area becomes white, blue or blotchy.
  • the area becomes excessively painful, numb or tingles.

C – Compression

If you have been given a tubigrip to wear, it is important this is removed if you develop any signs of poor circulation. Signs of poor circulation can include pins and needles or numbness. In addition it should be removed when you go to bed at night.

E – Elevation

The ankle should be elevated above the level of the heart as much as possible as this will reduce and prevent swelling.
Elevation Carrying out the movements of the ankle described above, while the leg is elevated, may help to reduce any swelling further.

What not to do

Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided.

Walking and exercise

It has been shown that your ligaments will heal quicker if you walk normally on the ankle as soon as possible after the injury. Normal walking means that you strike your heel to the floor first, then rock forward onto your foot and lastly push off from your toes. Not all patients will require crutches to achieve this normal walking pattern, but this will be assessed on an individual basis.

If you follow the basic advice, healing of the ligament normally takes around six weeks. However, everyone recovers from injuries at different rates and it is dependant on the severity of the injury and the presence of any other medical problems.

Once your pain begins to settle it is important to add into your regime the following exercises. These exercises will help you to regain full function, flexibility and strength. These will also reduce the risk of the injury reoccurring.

1. Stand facing a wall and step backwards with your injured leg.
 Walking and exercise - Step 1 Keep this leg straight with your toes pointing forward and the heel on the floor.

Now bend your other knee until you feel a stretch in the calf of your injured leg. Hold this for 30 seconds and repeat three times per day.

2. From the position above, move your injured leg forward, but keep it slightly behind your other leg.
 Walking and exercise - Step 2 Ensure that your toes point forward and bend both knees, keeping the heel of your injured leg on the floor.

You should feel a stretch in the calf of your injured leg. Hold for 30 seconds and repeat three times per day.

3. Stand holding on to a chair, spread your weight equally over both feet and push up onto your toes as high as possible.
 Walking and exercise - Step 3 Hold for 5 seconds and slowly lower. Repeat 10 times, twice per day.

Once this becomes easier you can increase the number of repetitions, or progress to repeating this stood on the injured leg on its own.

4. Stand on your injured leg and balance for as long as possible. To begin with you may need to hold on to something solid to prevent you falling over.
 Walking and exercise - Step 4 As you improve try doing functional activities such as washing the dishes or cleaning your teeth while you are standing on the one leg.

Try to hold your balance for up to 30 seconds.

Once you can do this comfortably try closing your eyes while you continue to balance on your injured leg.

When can I return to normal activities?

If you participate in an active hobby then it is advisable that you do not return to this until you have full strength, full range of movement and you can walk briskly without experiencing pain and swelling.

If you play a sport you can practice sports specific activities, like dribbling or jumping. Build up these exercises gradually, in order to help regain strength and flexibility, before returning to full training sessions and competition.

When to seek further help

You will normally be offered a referral onto physiotherapy following this type of injury, unless your symptoms are minimal on your initial appointment. Your physiotherapy could be at one of various locations in the Hull and East Riding area.

If 10 days following your injury you are unable to weight bear and the ankle remains painful and swollen, despite following the advice above, please contact your physiotherapist.

If at this stage you have not started your physiotherapy treatment please contact the Emergency Care Physiotherapy Team on telephone number (01482) 674880. If there is no answer, please leave a message by clearly stating that you were seen in the Emergency Care Department and leave your full name, address, telephone number and brief description of the problem. A member of the team will get back to you as soon as possible.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

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