The ankles support the entire weight of the body and are particularly susceptible to injury. Each year, an estimated 2 million patients are treated for ankle sprains and strains, and ankle fractures are one of the most common injuries treated by orthopedists. Causes Anyone, from the most well-conditioned athlete to the most sedentary person, can incur an ankle injury. Usually, the cause is accidental (e.g., stepping into a pothole, slipping while getting out of the car). People who are overweight and those who wear high-heeled shoes are at higher risk for ankle injuries.

Ankle injuries usually involve a sudden, unexpected, loss of balance that results in a sharp twist of the ankle. A strain occurs when a muscle or tendon overstretches. A sprain is more serious and occurs when strong connective tissue that connects one bone to another (ligaments) become overstretched. In some cases, a ligament tears and may pull a fragment of bone with it. When a piece of bone is pulled away, it is known as an avulsion fracture.

Sprains & Strains

Most ankle sprains and strains are inversion injuries in which the foot twists inward, damaging the lateral ligaments on the outside of the foot. Pronation injuries to the medial ligaments on the inside of the foot, which are caused by twisting the foot outward, are less common.

Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe), depending on the degree of tearing to the ligaments. In most cases, x-rays are performed to rule out a fracture or dislocation.

ligament sprain is a tear to the ligament fibers. A rating system notes the severity of the tear and how much damage the ligaments have sustained.

	Grade I sprain - results in little to no structural damage to the ligament itself. The integrity of the ligaments is preserved and recovery occurs in days.
	Grade II sprain - indicates there has been some structural damage to the ligaments. They may have been stretched, but not fully torn. This will likely result is some permanent laxity, or slack, in the injured ligaments.
	Grade III sprain - usually categorized as a complete rupture of one or more ligaments.

A number of years ago surgical reconstruction would have been recommended for a grade II or grade III ligament tear in the ankle. However, medical wisdom has since prevailed. By comparing surgical cases with those left alone, it has become evident that non-surgical cases have done as well as or better than their surgical counterparts with regard to pain and function. Consequently, most people who suffer even grade III ankle sprains do not require surgery. Only individuals who sprain recurrently, often without much provocation, are viable candidates for reconstruction.

The mechanism of injury is often the most important clue in determining whether a lateral ankle ligament has been injured. Again, high speed/high force trauma is an essential component in order to injure these ligaments. They simply do not break down the way tendons do (repetitive microtraumatic insults). So, an individual crossing the finish line of a marathon may have pain in their ankle, but they do not have a ligament injury unless they stepped in a hole or on a rock and rolled their ankle some where along the way.