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Ankle Sprains & Fractures
While ankle sprains and fractures are common and can result from a twist or fall, differentiating between the two injuries is crucial for optimal treatment and recovery in the weight-bearing ankle joint.
What are Ankle Sprains and Fractures?
Ankle sprains and fractures are types of overuse injuries.
Ankle and foot stress fractures occur as tiny cracks in your bones that develop when your muscles become overtired (fatigued) and can no longer absorb the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones, creating a small crack or fracture.
Stress fractures can also occur with normal usage if osteoporosis or some other disease weakens your bones and leaves them vulnerable, referred to as “insufficiency fractures” because there isn’t enough bone to withstand the stress of daily use.
Ankle sprains, on the other hand, occur when a ligament protecting the ankle joint is forced to stretch beyond its normal range. A severe sprain causes actual tearing of the elastic fibers. Approximately 25,000 people experience a sprained ankle each day.
What are the symptoms of ankle sprains and stress fractures?
- Pain that develops gradually, increases with weight-bearing activity and diminishes with rest
- Swelling on the top of the foot or the outside ankle
- Tenderness to touch at the site of the fracture or torn ligament
- Possible bruising
What causes Ankle Sprains and Fractures?
- Overuse: Suddenly increasing activity levels can put stress on bones.
- Improper equipment: Worn-out or poorly fitting shoes can alter how forces are absorbed by your feet.
- Surface changes: Shifting from one running surface to another (grass to clay, indoor to outdoor) can increase stress.
- Training errors: Poor technique or training plans can overload certain bones.
- Foot abnormalities: Flat feet or bunions can change how weight is distributed on the foot.
- Weak bones: Osteoporosis or hormonal issues can make bones more susceptible to fracture.
Treating Ankle Sprains
Most ankle sprains need only a period of protection to heal. The healing process takes about four weeks to six weeks. Even a complete ligament tear can heal without surgical repair if immobilized appropriately. Even if an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion.
Conservative Measures:
- Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control pain and inflammation.
- R.I.C.E (rest, ice, compression, and elevation): Ice can be used for 20 to 30 minutes, three or four times daily. Compression dressings, bandages, or ace wraps immobilize and support the injured ankle. Elevate your ankle above your heart level for 48 hours.
- Immobilize or splint the ankle: A short leg cast or a cast brace may be used for two weeks to three weeks.
Surgical Treatment Options:
Surgery for ankle sprains is rare and is reserved for injuries that fail to respond to nonsurgical treatment and for persistent instability after months of rehabilitation and nonsurgical treatment.
- Arthroscopy: A surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage or part of the ligament caught in the joint.
- Reconstruction: A surgeon repairs the torn ligament with stitches or sutures or uses other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.
Treating Ankle Fractures
Conservative Measures:
- Reduce your activity level: Staying off your feet as much as possible gives your injury time to heal. Athletes should switch to a sport that puts less stress on the foot and leg. Swimming and bicycle riding are good alternative activities.
- Wear protective footwear: Your doctor may recommend wearing a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe for two to four weeks.
Advanced Treatment:
- Wearing a cast or using crutches: Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal, perhaps as long as six to eight weeks. Your doctor may apply a cast to your foot or recommend that you use crutches until the bone heals.
- Orthopedic surgery: In some cases, you may need surgery so that the orthopedic surgeon can insert a screw in the bone to ensure proper healing.
Rehabilitation
Rehabilitation is used to help to decrease pain and swelling and to prevent chronic ankle problems. Ultrasound and electrical stimulation may also be used as needed to help with pain and swelling. At first, rehabilitation exercises may involve an active range of motion or controlled movements of the ankle joint without resistance. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Lower extremity exercises and endurance activities are added as tolerated.
Proprioception training is very important, as poor proprioception is a major cause of repeat sprain and an unstable ankle joint. Once pain-free, other exercises, such as agility drills, may be added. The goal is to increase strength and range of motion as balance improves over time.
Ankle injury recovery phases
All ankle sprains recover through three phases:
- Phase 1 includes resting, protecting the ankle, and reducing the swelling (one week).
- Phase 2 includes restoring range of motion, strength, and flexibility (one week to two weeks).
- Phase 3 includes gradually returning to activities that do not require turning or twisting the ankle and doing maintenance exercises. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities), such as tennis, basketball, or football (weeks to months).
Why choose
Synergy Health Partners?
Synergy Health Partners is Michigan’s sole integrated musculoskeletal care provider. We offer a comprehensive suite of services, including orthopedic urgent care, in-office treatments, ambulatory surgery centers, virtual consultations, and an in-house pharmacy. Our coordinated approach ensures seamless, personalized care for your musculoskeletal well-being.
Find a Doctor
Synergy Health Partners brings together doctors with specialized expertise in musculoskeletal care. Our physicians are affiliated with Michigan’s top hospitals and stay up-to-date on the latest technologies and treatments, both surgical and non-invasive, to provide patients with advanced, proven medical care.
Frequently Asked Questions
How are ankle sprains diagnosed?
With a foot or ankle injury, your doctor may order X-rays to make sure you don’t have a broken bone. Ankle stress fractures and sprains have similar symptoms.
If there is no broken bone, the doctor may be able to tell you the grade of your ankle sprain based on the amount of swelling, pain, and bruising.
The physical exam may be painful. The doctor may need to move your ankle in various ways to see which ligament has been hurt or torn.
If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. If this occurs, the injury may also cause damage to the ankle joint surface. An MRI (magnetic resonance imaging) scan can detect a very severe injury to the ligaments, injury to the joint surface, a small bone chip, or other problems.
How are ankle fractures diagnosed?
If you suspect a stress fracture in your foot or ankle, stop the activity and rest the foot. Ignoring the pain can have serious consequences, and the bone may break completely. Apply an ice pack and elevate the foot above the level of your heart. Try not to put weight on the foot until after seeing a doctor.
Stress fractures are difficult to see on X-rays until they’ve actually started to heal. Your doctor may recommend a bone scan, which is more sensitive than an X-ray and can detect stress fractures early.
Most stress fractures occur in the weight-bearing bones of the foot and lower leg. The most commonly affected site is the second or third of the long bones (metatarsals) between the toes and the midfoot. Stress fractures also can occur in the heel, the outer bone of the lower leg (fibula), and the navicular, a bone on the top of the midfoot.
What are ankle sprain grades?
The amount of force determines the grade of the sprain. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3. (See Table 1.)
- Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament.
- Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
- Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.
How can I prevent ankle sprains?
The best way to prevent ankle sprains is to maintain good strength, muscle balance, and flexibility.
- Warm up before doing exercises and vigorous activities
- Pay attention to walking, running, or working surfaces
- Wear good shoes
- Pay attention to your body’s warning signs to slow down when you feel pain or fatigue
How can I prevent stress fractures?
Because stress fractures that don’t heal properly can develop into complete breaks of the bone and can become a chronic problem, it’s better to prevent them in the first place. Here’s what you can do:
- Maintain a healthy diet. Eat calcium-rich foods to help build bone strength.
- Use the proper equipment for your sport. Don’t wear old or worn running shoes.
- Alternate activities. For example, you can alternate jogging with swimming or cycling.
- Slowly increase any new sports activity. Gradually increasing time, speed, and distance means a 10 percent increase per week is fine.
- If pain or swelling returns, stop the activity. Rest for a few days. If pain continues, see an orthopedist.
Is my ankle sprain acute or chronic?
If you have sprained your ankle in the past, you may continue to sprain it if the ligaments do not have time to completely heal. If the sprain happens frequently and the pain continues for more than four weeks to six weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces, cutting actions, and sports that require rolling or twisting of the foot, such as trail running, basketball, tennis, football, and soccer.
Possible complications of ankle sprains and treatment include abnormal proprioception. There may be imbalance and muscle weakness that causes a re-injury. If this happens over and over again, a chronic situation may persist with instability, a sense of the ankle giving way (gross laxity), and chronic pain. This can also happen if you return to work, sports, or other activities without letting the ankle heal and become rehabilitated.
Who’s at risk for stress fractures?
- Athletes who participate in high-impact sports such as track and field, basketball, gymnastics, ballet, or tennis
- Adolescents whose bones have not yet fully hardened
- Women, particularly female athletes, who have abnormal or absent menstrual cycles that can result in decreasing bone mass
- Military recruits who suddenly must shift from a sedentary civilian life to a more active training regime
Dealing with an ankle sprain or fracture? Discover relief.
An undiagnosed ankle sprain or fracture can lead to long-term problems. If your ankle pain persists, reach out to us for proper diagnosis and treatment. We’ll guide you on your journey to pain relief.