When You Hurt Your Ankle: Understanding Sprains Versus Strains
The pain in your ankle makes it clear that you’ve hurt it. But understanding if it’s a sprain or a strain – and what to do next – makes a big difference.
Sprains and strains are common injuries and commonly mixed up. Strains – which include a T – happen to tendons. Sprains affect ligaments and both types of injuries vary in severity.
“These injuries happen when we stretch – or break – a ligament or tendon,” said podiatrist Ryan Prusa, DPM, Avera Medical Group Specialty Care Brookings. “They can happen in an accident, during sports or even just stepping off a curb.”
Sprains and strains can occur anywhere in our bodies where ligaments and tendons are doing their work.
Understanding an Ankle Sprain
When you roll your ankle and your foot turns to its outside surface, it’s called a lateral or inversion ankle sprain. It puts pressure on the ligaments on the “outside” of your ankle that hold your ankle in its normal position.
“Ankle sprains are common injuries,” said fellowship-trained podiatrist Ruth Moen, DPM, Avera Orthopedics Sioux Falls. “In fact, the ankle joint is the most commonly sprained joint in the body.”
Moen said toes and the middle of the foot can also be sprained.
Sprains are identified as three grades:
- Grade 1: Ligament is stretched and sore.
- Grade 2: Ligament is partially torn and painful.
- Grade 3: Ligament is completely torn and movement is extremely painful.
“A grade 3 sprain is not too far from a fracture as far as severity of the injury,” Prusa said. “With a fracture, you won’t be able to bear any weight. A ruptured ligament is nearly as painful.”
The pain response and weight-bearing ability of the individual can vary greatly. People too often tough it out when they face sprains. Others might assume they broke their ankle but in reality, it’s just a sprain.
In addition to pain, you might see swelling or bruising with a sprain.
In short: if you have pain walking, go see a provider. Treatment begins conservatively if a provider sees it in time.
“If you had an ankle sprain in the past, you’re at greater risk of experiencing another one,” Moen said.
Age can also play a role in how sprains occur. Ignoring a sprain can lead to more sprains – and more severe ones, due to ligament damage.
Strains Affect Muscles and Tendons
Tendons, such as the Achilles tendon that connects our calf muscle to the bones in our heel, can be strained and lead to pain. Unlike a sprain, there’s usually no bruising around the area.
“Strains can be sore, or they can be complete tears that require a more aggressive treatment plan,” Moen said.
Like sprains, strains can get worse if not treated.
As with a strain, seek medication attention if you have pain with movement, lack of mobility and inability to bear weight on your foot or ankle.
“Sometimes people think if they can move their toes or point them, that shows them if it is a fracture, sprain or strain,” Moen said. “But that’s a misconception. You can have a severe injury and still move or point your toes.”
Prevention and Treatment of Strains and Sprains
Good overall health – with plenty of activity – is the best way to prevent sprains and strains. Shoes with more support also help; keeping active and exercising is the best way to keep joints strong and flexible.
If you feel you have a minor ankle injury, you can try treating at home with RICE:
- R: Rest
- I: Ice
- C: Compression
- E: Elevation
“The RICE approach works great for mild strains and for grade 1 sprains,” Prusa said. “Use ice 15 minutes on, 15 minutes off, reduce activity as much as possible and use a bandage to reduce swelling.”
Elevate a sprained ankle helps keep swelling down, too. Rest might not mean “lie in bed” – especially for younger people.
Treatment Beyond RICE
Treatment beyond RICE for more serious sprains and strains can include rehab and physical therapy, braces and walking boots. If these don’t relieve pain, surgical approaches might be considered to repair a tear.
Most procedures are minimally invasive and treat inflammation and can remove tissue. Ligament repairs are typically open procedures – they are more serious injuries.
Depending on the severity, sprains can take a month to several months to heal completely.
“A small population of patients fail to get better, even with appropriate conservative therapy,” said Moen. “In these cases, we can consider arthroscopic evaluation of the ankle joint to repair or remove damaged tissue.”
