Diagnosing an ankle sprain correctly is essential for determining the appropriate treatment and ensuring a full recovery. The first step in diagnosing an ankle sprain usually involves a physical examination by a healthcare professional, such as a doctor, physiotherapist, or orthopaedic specialist. During the exam, we will assess:

Swelling and Bruising: They will look for any visible swelling, bruising, or signs of trauma around the ankle.

Pain Points: We will palpate different areas of the ankle to determine where the pain is most concentrated, helping to identify which ligaments may be affected.

Range of Motion: Range of movement in your ankle to check for stiffness or limitations in motion, which helps determine the severity of the injury.

Stability: Through special tests we will test the ankle’s stability by applying gentle pressure to see if the joint feels unstable or if it “gives way.”

In some cases, doctors use a set of guidelines known as the Ottawa Ankle Rules to help decide whether further imaging is necessary. These rules are used to assess whether an ankle injury is likely to involve a fracture, and they focus on:

• Pain near the malleolus (the bony protrusions on either side of the ankle).
• Inability to bear weight immediately after the injury and during the exam.
• Tenderness over specific areas such as the base of the fibula, fifth metatarsal (foot bone) or the navicular bone (near the arch of the foot).
• If you meet any of these criteria, further investigation may be required to rule out a fracture.

When diagnosing an ankle sprain, imaging tests play a key role in assessing the severity of the injury and ruling out other underlying issues, such as fractures or ligament tears.

X-rays

X-rays are typically the first step in diagnosing an ankle injury. They provide a clear view of the bones, allowing doctors to rule out fractures or bone-related issues. However, standard X-rays are limited to showing only bone damage and can’t detect soft tissue injuries, such as ligament sprains or tears.

In cases of suspected syndesmotic injuries (also known as high ankle sprains), a specialised type of X-ray may be required. Standing X-rays or stress views are used to assess the space between the tibia and fibula (the bones of the lower leg). In syndesmotic injuries, the ligaments that connect these bones—specifically the anterior inferior tibiofibular ligament (AITFL)—can be stretched or torn, leading to abnormal widening between the bones.

MRI (Magnetic Resonance Imaging)

When ligament or tendon damage is suspected, an MRI is often the next step. Unlike X-rays, MRIs provide detailed images of soft tissues, including ligaments, tendons, muscles, and cartilage. This makes MRIs especially useful for diagnosing more severe sprains, tears, or damage to the ankle’s ligaments. MRIs are invaluable for detecting moderate to severe sprains, ligament tears, or other structural injuries, such as damage to the deltoid ligament in medial sprains or the lateral ligaments in inversion sprains.

CT Scan (Computed Tomography)

In rare cases, a CT scan may be necessary to obtain more detailed images of the bones and soft tissues, particularly if the injury is complex. This scan is useful when fractures or joint damage are suspected but not clearly visible on X-rays. For example, CT scans can help doctors assess fractures that are not easily visible in traditional X-ray images, or they may be used to evaluate intra-articular fractures (fractures within the joint) in complex sprains.

Ankle sprains can vary in severity, and the treatment plan should be tailored to the extent of the injury. From mild sprains to more severe ligament tears, the goal of treatment is to reduce pain, prevent further injury, and restore function as quickly and safely as possible. Here’s a breakdown of the different treatment options:

For most mild to moderate ankle sprains, the R.I.C.E. protocol is the first line of treatment and should be followed immediately after the injury to reduce swelling and promote healing.

Rest: Avoid putting weight on the injured ankle and limit activity to prevent further strain on the ligaments.

Ice: Apply ice to the injured area for 15-20 minutes every 2-3 hours during the first 48 hours. This helps reduce swelling and numb the pain.

Compression: Use an elastic bandage or ankle wrap to apply gentle pressure, helping to control swelling. Be careful not to wrap it too tightly, as this could affect circulation.

Elevation: Elevate the ankle above the level of your heart whenever possible to reduce swelling and improve circulation.

In addition to the R.I.C.E. protocol, one of the most effective ways to treat an ankle sprain, particularly in moderate to severe cases, is by using an air boot or walking boot as soon as possible. An air boot helps stabilize the joint and keeps the ankle in a controlled, rigid position. This is crucial for a number of reasons:

Stabilising the Joint: The air boot limits the range of motion in the ankle, preventing the joint from moving in ways that could worsen the injury or delay healing. This protection is especially beneficial during the first critical days when the soft tissues (ligaments and tendons) are at their most vulnerable. It helps prevent further stretching or tearing of the ligaments, reducing the risk of long-term instability.

Soft Tissue Healing: By stabilizing the ankle joint in a more rigid position, the air boot creates an environment where the soft tissues—such as the ligaments and tendons—can heal more effectively. Soft tissue healing occurs most efficiently when the injured area is held in a neutral, immobilized position, which minimizes stress on the healing fibers.

Reducing Pain and Swelling: An air boot can also help control swelling by providing gentle compression. This is particularly important during the early stages of recovery, as it prevents excessive fluid buildup that can slow down rehabilitation. Additionally, the boot helps reduce pain by limiting movement and providing a cushion that absorbs some of the pressure from walking or standing.

Early Mobilisation: One of the significant advantages of an air boot is that it allows for early mobilisation of the injured ankle. Unlike a cast, which completely immobilizes the ankle, an air boot can be worn during weight-bearing activities as healing progresses. This encourages gentle movement without compromising the healing process.

Ankle sprains are a common injury, but with the right knowledge and treatment, recovery doesn’t have to be long or complicated. Whether you experience a mild twist or a more severe sprain, taking quick action with R.I.C.E., seeking professional diagnosis when necessary, and following through with a rehabilitation plan are all essential steps for a full recovery.