Ankle Sprain Grading: How Serious Is Your Injury?

Ankle sprains are extremely common and account for up to approximately 30% of all sports injuries. If you have recently injured your ankle, you may be wondering how serious the injury is. A grading system is used to help determine the severity of a lateral ankle sprain. In this blog post, we will discuss the different grades of a lateral ankle sprain and what each one means for your recovery.

Grading system for ankle sprains

There are three different grades of a lateral ankle sprain. Grade I is the least serious, while Grade III is the most serious.

Grade I: This grade indicates a mild injury. There is usually only pain and tenderness with no swelling or bruising. You may be able to walk on your injured ankle, but it will likely be sore and typically will be recovered from your injury within a few days. It is very uncommon to see these injuries in the clinical setting in my office because typically patients will recover very well with no aggressive treatment necessary.

Grade II: This grade indicates a moderate injury. There is usually pain and tenderness with some swelling and bruising. You may have difficulty walking on your injured ankle. Grade 2 injury could also potentially indicate a partial tear to one of the ligaments on the outside of the ankle that supports the ankle. Typically, these injuries will take longer to recover from and will require some rehabilitation and activity modification/restriction for some time.

Grade III: This grade indicates a severe injury. There is usually significant pain, swelling, and bruising. You will likely be unable to walk on your injured ankle and a strict period of immobilization will be necessary. Usually, this is accomplished either with a removable cam walker or a cast. Grade 3 injury implies significant injury to the stabilizing ligaments of the outer ankle with possible complete tear and instability of the ankle. Despite the significant injury to the ligaments, it is still possible to recover fully from this injury without surgery. With that being said, there are a handful of patients that will ultimately require surgical reconstruction of the ligaments on the outside of the ankle to afford a more stable ankle and to prevent recurrent instability.

If you have suffered a Grade III ankle sprain, it is important to seek medical attention as soon as possible. These types of injuries can often lead to long-term problems if they are not properly treated.

How to grade your ankle sprain

If you think you may have sprained your ankle, it is important to seek medical attention. A foot and ankle specialist will be able to grade your injury and provide you with the proper treatment.

Treating a Grade I sprain usually involves rest, ice, compression, and elevation (RICE). You may also be advised to take over-the-counter pain medication if necessary.

Grade II and III sprains often require more aggressive treatment. In addition to RICE, you may need to wear a splint or boot and participate in physical therapy.

If you have suffered a lateral ankle sprain, it is important to follow your doctor’s instructions for treatment. With proper care, most people can fully recover from even the most serious ankle injuries.

Treatment for different grades of ankle sprain

Treatment is dictated by the severity of the injury. All injuries can be treated with rest, ice, compression, elevation, anti-inflammatory medications, and bracing. The more severe injuries may require formal immobilization like with a removable cast walker until pain and swelling have subsided. Surgery is typically not performed in acute injuries, even with high-grade III injuries because the medical and orthopedic literature has demonstrated that surgical and conservative treatment is equal. For grade II and grade III injuries, once the symptoms associated with the acute injury have subsided, physical therapy can begin usually around 1-2 weeks post-injury.

Prevention tips for ankle sprains

If you have had multiple ankle sprains there may be instability due to compromise in the integrity of the supporting ankle ligaments. Repeated sprains can lead to instability of the ankle joint and impaired balance as well. The nerve endings that offer proprioception (balance organ) terminate in some of the ligaments on the outside of the ankle. If the ligament is injured, the proprioceptive nerve endings can also be damaged which can impair your ability to have spatial awareness of where the ankle joint is in three-dimensional space. The result of this is recurrent sprains. With recurrent sprains, the process can be cyclical and worsen itself. Other injuries can occur to the ankle with instability including focal or diffuse arthritis. Focal arthritis presents as something called an osteochondral lesion of the talus.

If you have had multiple sprains in the past, and if the ankle feels unstable, it is best to wear an ankle brace during more intense activities to protect the ankle and prevent further sprains in the future. If you are struggling to get back to baseline activities whether this is activities of daily living or more intense athletics, a surgical repair could be considered.

What does surgery involve for ankle ligament reconstruction

Surgeries are performed for people that have had an unsuccessful recovery from either a single major ankle sprain or due to chronic lateral ankle instability. The procedure of choice is called a modified Brostrom repair. With this surgery, an incision is placed on the outer part of the ankle where the ligament is located. The remaining portion of the ligament is detached from the outer ankle bone called the fibula. Suture anchors are then placed into the lower part of the fibula and sutures are placed through the healthy portion of the ligament and tightened to afford stability. In most cases, the repair is further strengthened and protected with an additional, thicker suture on top of the repair. This suture technique is known as an internal brace and allows for a faster recovery which could mean getting back to baseline activities and athletics in a shorter period.

If there is an issue inside the ankle joint, typically an ankle joint arthroscopy which is also known as a scope procedure can be performed at the same time. Two small incisions are placed which allows for the introduction of a camera inside the ankle joint. The camera in the joint allows for visualization of the inner part of the joint where cartilaginous injuries can be treated or any inflamed tissue can be removed as well.

After the surgery is completed, the ankle is placed in a splint that goes from the toes to just above the knee. This splint is worn for approximately one week. At that time, you will be seen back in the clinic where the sutures are removed and you will be transitioned into a boot. The boot is worn for an additional three weeks until you are seen again in the clinic at which time we will transition you out of the boot and into a physical therapy program.

The rehabilitation process following surgery usually takes around 12 weeks before full recovery is made. However, this depends on what your pre-operative functional level was as well as any other associated injuries that were treated at the same time as your ankle sprain.

With ankle sprains, as with most injuries, the severity will determine the treatment. In most cases, an ankle sprain will heal with conservative treatment and aggressive rehabilitation. Most injuries do not require surgery. However, if you are unsure of the severity of your injury or have any questions about how to properly treat it, please consult a doctor. We wish you a speedy and complete recovery from your ankle sprain!

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