Sprains are one of the most common types of ankle injuries, which usually involve extreme twisting of the foot and damage to the ligaments around the ankle. Ankle sprains usually occur accidentally when descending stairs or walking on uneven surfaces, and are also common in sports. Injuries are usually categorized as mild, moderate, or severe. In mild injuries the ligaments are often not torn, while in severe injuries the ligaments are often completely torn. Severe ankle sprains can also cause an ankle fracture, so taking x-rays to rule out a fracture is essential. Treatment for severe ankle sprains includes the use of both braces and casts. Any ankle sprain that does not resolve within a few days should be seen by a foot and ankle surgeon for further examination. Are ankle sprains common? According to data published by the National Institute of Arthritis, Musculoskeletal, and Dermatologic Diseases (NIAMSD), ankle sprains occur in the United States at an average rate of one sprain per minute, and 850,000 ankle sprains per year nationwide. What do I need to do if I have a sprained ankle? The guidelines for self-treatment of an ankle sprain are R.I.C.E: R=Rest (Rest, Brake); I=Ice; C=Compression (Compression bandage); E=Elevation (Elevation of the injured foot). These treatments should be implemented as soon as possible after the injury. Mild ankle sprains take a few days to resolve, while severe ankle sprains take 6-8 weeks to heal. If your ankle sprain does not resolve or even worsens within 1-2 days, you need to see a foot and ankle surgeon. What if my ankle sprain doesn’t heal? Some patients with ankle sprains continue to have pain and swelling up to 2 months after the injury. These patients need to be examined further to see if there is some hidden injury that was not initially diagnosed, such as a cartilage injury. Physical therapy is often used for those with chronic injuries. The goal of rehabilitation is to restore balance (stability), mobility (flexibility) and soft tissue shape (aesthetics) of the ankle joint i.e. elimination of swelling. What factors can affect rehabilitation after an ankle sprain? In order to find out the reason why you have not been able to recover from an ankle sprain, some necessary tests have to be done. There are many possible causes of ankle sprains: (1) instability of the ankle joint due to unrepaired ligaments; (2) the possibility of an undiagnosed fracture, which can be either extra-articular (e.g., distal fibula) or intra-articular (fracture of the articular cartilage or articular surfaces); (3) injury to the talonavicular joint; and (4) stiffness of the joint due to adhesion of tissues in the ankle joint. All of these factors can lead to prolonged ankle sprains, and for these prolonged ankle sprains, a comprehensive workup, including MRI, CT, and ankle stress radiographs, may be needed to correctly diagnose the problem. Do I need surgery for an ankle sprain? If you have sprained your ankle for the first time, it is usually mostly cured by conservative treatment and rarely requires surgery. Conservative treatment includes anti-inflammatory medications, ankle braces, physical therapy, rest and time (it takes time for any injury to repair). For patients with multiple repeated sprains of the ankle joint, the ankle joint is weak and the brace is of little use. In this case surgery is needed to rebuild or tighten the damaged ligament. Minimally invasive arthroscopic surgery can be used to treat intra-articular exfoliation of bone fragments or ankle stiffness that occurs after ankle sprains. Repeated habitual ankle sprains may progress over a number of years to permanent cartilage surface damage to the ankle (traumatic arthritis), at which stage the injury requires surgical intervention, and ankle fusion or ankle replacement may be the best treatment for this stage of ankle sprain. Normal Ankle Traumatic Arthritis Ankle Replacement and Ankle Fusion How can I prevent an ankle sprain? The key to preventing ankle sprains is to prepare well for the sport, perfect your technique, increase your safety awareness and concentration during the game as well as strengthening your ankle in general. Once an ankle sprain occurs during a game, you should withdraw from the game and enter an ambulance station for treatment. Try to walk on a flat surface when you are walking. Strengthen the muscle strength training around the ankle joint.