You must have experienced ankle sprains before – an awkward footplant, followed by a sickening pain as your ankle twists inward and the agony of any further movement.
Following the injury, rapid bruising and swelling confirm your injury, but the severity will vary. Tenderness over the horizontal anterior talofibular ligament (see illustration) indicates less damage than if the major calcaneofibular ligament is torn. There is always the possibility that a sprain may involve other bones and ligaments, too.
If you only have local tenderness over the ligaments, a case can be made for not x-raying the ankle. Any suspicion of a fracture as indicated by bone pain makes an x-ray mandatory – otherwise you can justifiably sue your doctor! Oddly enough, a simple sprain may cause you much more swelling and bruising than a fracture!
What else could it be?
As the injury can span anything from a simple sprain to major bone disruption, chronic injuries may require MRI scanning or arthroscopy to eliminate damage to the peroneal tendon and nerve which run around the outside of the joint.
If you do not apply RICE immediately, you deserve long-term pain! Tubigrip folded over on itself provides reasonable compression for minor sprains, but if weight-bearing is particularly tender, you may need to wear an ankle stirrup brace. You’ll inevitably experience a loss of fine balance, which you can restore by doing wobble-board exercises or bouncing a ball while standing on the injured foot. You should start this as rapidly as possible after 48 hours.
If your ligament is completely ruptured (if it is, you probably won’t be able to bear weight or fully point your toes), there is a risk of chronic instability. A plaster cast encourages muscle wasting and joint stiffness, but a careful programme of ultrasound and massage will usually provide a cure. Your problems will need reassessment if they continue beyond six weeks, which may culminate in surgery to reunite severed ligaments and prevent the ankle persistently giving way.
Can you run through it?
Six hours to six months, depending on the severity of the sprain and how intensively you treat and rehabilitate it. A minor sprain may simply make you hobble for a few minutes before it eases completely, but a severe tear that makes weight-bearing painful could stop you completely for two or three weeks.