The Truth About Sprained Ankles

The Truth About Sprained Ankles

It’s easy for someone who has never suffered from a sprained ankle to shrug off the injury and assume that it is not as serious as an ankle break. But the truth is that sprained ankles can be serious as well as painful and often need to be treated professionally in order to heal correctly.

While ankles might appear to be a very small part of the musculoskeletal system, they are pivotal to the entire system. Loaded with bones, tendons and ligaments, they are meant to hold your body weight in a stable, non-injuring way. But common ankle instability can cause the foot to roll inward or outward or to twist at an extreme enough angle that actually injures, stretches or rips the tendons and ligaments in the ankle. Since the function of these ligaments is to stabilize your joints, any tear in them, whether it’s partial or complete, causes instability and is classified as an ankle sprain.

If a person is in good physical condition then the ankles are often strong enough to keep within the proper range of motion and avoid injury. But sudden turns or abrupt moves can over-stress the tendons and ligaments on even people who are in great shape. And there are many opportunities in the real world to suffer a sprain: uneven pavements, a missed curb, a slight stumble while walking or a sudden pivot during a game of pickup basketball can cause ankle sprains.

People who do not exercise routinely (weekend athletes) are at risk for ankle sprains because their muscles are not used to being stretched regularly and can respond to a sudden movement with a ligament tear extremely quickly. Heredity can play a part in weak ankles as can being overweight. Whatever causes the problem, it’s a good idea to seek treatment for an ankle sprain.

Sprains are classified by severity:

  • Grade 1 is the mildest, involving mild damage and stretching to the ligament fibers
  • Grade 2 involves partial tears to the ligaments
  • Grade 3 involves a complete rupture of the ligament and is the most serious of the three.

Signs of a sprained ankle include sudden pain, swelling and bruising, stiffness and warmth in the area, and the inability of that side to bear weight. Because fractures and sprains often present with similar symptoms, an x-ray may be necessary to know which injury it is.

Proprioception is the word for the connection between the brain and the limb, and when an ankle is sprained, that important communicator is lost. The brain is confused and unable to send orders to the right muscles. Correcting this problem may take medical attention.

Sprained ankles can be extremely painful, and while taking anti-inflammatories and lying on the couch with leg raised and ice on the ankle is an appropriate action immediately after suffering the injury, any comfort it provides may be just a temporary way of getting some relief. When a person seeks treatment for an ankle sprain, the doctor or physical therapist can help the tendons or ligaments heal correctly and restore the communication between brain and limb. Physical therapy treatments may include strengthening exercises, supportive braces and ultrasonic treatments.

Surgery may be needed for the most serious sprains in order to repair ligaments that have been overstretched to the point that they can no longer function correctly. In these incidences, surgery involves cutting out extra ligament and reattaching the two sides in the middle to create a shorter length between the bones. Support and elasticity are restored.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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