Ankle sprain grading and treatment

What is an ankle sprain?

An ankle sprain occurs when the ligaments around the ankle are overstretched or torn due to twisting or turning motion. It is one of the most common sports injuries.

Ankle sprain grading

Ankle sprains can be classified according to the following grades.

Grade I

• Due to mild stretching of a ligament with no tears.
• Mild swelling and tenderness around the ankle.
• On examination, there is no joint instability. Patient would be able to walk with minimal pain.

Grade II

• Ligament is partially torn.
• Moderate pain, swelling, and tenderness around the ankle.
• On examination, there is mild to moderate joint instability with restricted range of motion and loss of function. It would be painful to walk or bear weight.

Grade III

• Ligament is completely torn.
• Severe pain, swelling, and tenderness around the ankle.
• On examination, there is significant joint instability with significant loss of function and range of motion. Patient may not be able to walk or bear weight.

If you suspect a Grade II or III ankle sprain, seek medical attention, as these injuries may require immobilisation, physical therapy, or surgery to completely heal.

What are the symptoms of an ankle sprain?

There are several types of symptoms if there is an ankle sprain. These symptoms may include:

• Pain at rest and during activity
• Swelling, bruising, and tenderness
• Ankle instability, or feel that the ankle is giving way

How is an ankle sprain diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Imaging Tests
   
   • X-rays: Majority of ankle sprains are caused by ligament problems, which do not show up on x-rays. Therefore, ankle injuries are not evaluated with X-rays routinely and if it is done, it is to look for fractures. In some cases, stress x-rays may be done to evaluate the severity of the sprain.
   • Magnetic Resonance Imaging (MRI): To look for an injury to the ligament.

How is an ankle sprain treated?

All ankle sprains can be treated similarly in the acute phase. Initial management is to reduce pain and swelling while maintaining a range of motion prior to gradually introducing exercises.

1. PRICE - Protection, Rest, Ice, Compression, Elevation

   PRICE is a common approach for the first two or three days.

   • Protection: The use of protective support such as an elastic bandage, splint, or cast, depending on the extent of the injury.
   • Rest: Limit weight bearing and use a crutch to assist.
   • Ice: Apply ice packs to the affected area for at least 15 to 20 minutes, every two to three hours until swelling improves.
   • Compression: Help reduce swelling by using elastic bandages.
   • Elevation: Keep the ankle above the level of the heart to reduce swelling.

2. Medication: Pain and swelling can be managed with oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs).

3. Physiotherapy: Range of motion exercises only after the acute pain and swelling have subsided.

4. Immobilisation and bracing: Depending on the grade of sprain.

   • Grade I: A few days of treatment with an elastic bandage or compression sleeve is adequate.
   • Grade II: Combination of an elastic wrap and an Aircast, a functional splint, a stand-alone brace, or a figure-eight brace.
   • Grade III: Usage of non-weightbearing cast.

When should I visit a doctor?

If you have difficulty bearing weight on the ankle or if it remains swollen or painful for more than 3 to 5 days despite PRICE, you need to be evaluated by an orthopaedic specialist to ensure that there is no fracture or to determine if your sprain is severe enough to require special care.

Book an appointment at Pantai Hospitals

A dedicated and expert team of Orthopaedics specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

Please seek immediate medical attention at the Accident and Emergency (A&E) department at your nearest Pantai Hospital in case of severe ankle pain.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.