Ankle sprains are the most frequent musculoskeletal injury seen by primary care physicians. It is estimated that thousands of people around the world on a daily basis require medical care for ankle sprains of the ankle joint, which is made up of three bones held together by ligaments that provide stability by limiting side-to-side movement.
Ankle sprains are common sports injuries but can also happen during everyday activities. An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outer side of the ankle. The severity of an ankle sprain depends on whether the ligament is just stretched, partially torn, or completely torn, and on the number of ligaments involved in the injury. Ankle sprains are not the same as strains, which affect muscles rather than ligaments and an ankle fracture means broken bones.

Causes
Ankle sprains are usually caused by an unnatural twisting motion occurring in the ankle joint, most commonly when the foot is pointing downward and is forced inward awkwardly. Persons would describe this as "rolling their ankle". This stretches the ligaments on the outer side of the ankle. Sprained ankles often occur during sporting activities and can result from a fall, a sudden twist, stepping on uneven surfaces or in a hole and even wearing the wrong shoes.

Symptoms
When the ankle is sprained the soft tissues around the ankle are injured and inflamed. The symptoms may include pain or soreness, swelling, bruising or redness, difficulty walking or stiffness in the joint. The symptoms vary depending on the severity of the sprain.
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a podiatrist.
o An untreated ankle sprain may lead to chronic ankle weakness/instability and more injury.
o Sometimes it may be difficult for you to tell the difference between a sprain and an ankle fracture.
o An ankle sprain may be accompanied by other foot injury that must be treated as well.
o Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

Diagnosis
When evaluating your injury, the podiatrist will get a history of the injury and the symptoms you are experiencing. X-rays or other imaging studies such as a CT scan may be ordered to help determine the severity of the injury. A complete physical exam will be done, touching and moving the parts of the foot and ankle to determine which parts have been injured.
The initial care for a sprained ankle at home involves reducing pain and speed up healing. Persons will often report that immediately after a suspected ankle sprain they would soak their foot in hot water. This is not recommended! In fact, it increases swelling and can make the ankle worse. Always remember RICE -- rest, ice, compression and elevation. All of these are done to reduce and prevent inflammation and can be started at home even before you see the podiatrist.
Rest: For the first 24 to 48 hours after the injury your activities need to be seriously decreased or stopped all together.
Ice: For the first 48 hours after the injury, place an ice pack or frozen vegetables wrapped in a towel on the sprained ankle for 20 minutes at a time every three to four hours.
Compression: Wrap the ankle in an ace bandage from the toes to above the ankle. The wrap should be snug but not too tight so that it's uncomfortable.
Elevate: Keep your ankle elevated as high as possible by sitting in a recliner, or putting books or pillows under the ankle.
After twisting your ankle, if you have pain, swelling and difficulty walking or standing, it is time to see the podiatrist. Treatment by the podiatrist will continue the RICE treatment. The podiatrist may also apply an ankle brace or cast boot to reduce motion in the ankle joint. Crutches are also used to prevent people from walking or bearing weight on the ankle. The most common medications used to treat ankle sprains are anti-inflammatory, that reduce both pain and help control the inflammation.
When you have an ankle sprain, rehabilitation is crucial -- and it starts the moment your treatment begins. Early therapy helps to promote healing and increase your range of motion. This may include doing prescribed exercises or even seeing a physical therapist, who will help with flexibility and strengthening exercises. A follow-up visit is usually scheduled one to two weeks after the initial treatment to monitor healing progress.
Most ankle sprains heal without complications or difficulty, leaving the person able to walk and play their sport without pain or swelling. The healing time depends upon the severity of the ankle sprain and if there was any other accompanying injury. If people do not get treatment and rehabilitation after an ankle sprain, chronic ankle instability results which makes the ankle weak, "gives way" at times and increases the risk of more injuries in the future. Very seldom surgery may be needed to repair torn ligaments around the ankle.
Ankle sprains can be prevented by wearing proper shoes for the activity you are engaged in. Always wear stable shoes that give your ankle support -- like high-top basketball shoes. High heels or platform shoes are not the best choice if you want to prevent an ankle sprain. For athletes, balanced training may keep the ankles strong and flexible. They may also consider having a weak ankle taped or wear an ankle brace for extra support during the game.

oFor more information on ankle sprains visit www.apma.org or www.footphysicians.com. To see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates, Albury Lane, telephone 394-5820.

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