Grades of Ankle Sprains Explained

The ankle joint is supported by a group of ligaments; ligaments are fixed-length ropes or belts that hold the ankle joint in its proper position. When the foot rolls inward and the ankle moves outward, an inversion sprain occurs. This is the most common type of ankle sprain . During an inversion ankle sprain, the ligaments on the outside of the ankle are overstretched and can even tear. The traditional grading system for ankle sprains helps to determine the severity of the injury, guide treatment and establish prognosis. This system provides general guidelines; however, variations within this framework do occur.

A Grade I ankle sprain is the least severe. This is a stretching of one or more of the ligaments which results in mild pain and tenderness. Usually, the patient can bear weight and has only mild stiffness in the ankle joint. With a Grade I injury, treatment includes the classic RIICE: Rest, Ice, Immobilization, Compression and Elevation. (A soft over the counter brace or ACE bandage can suffice for immobilization.) Athletic activities can resume when symptoms have resolved and strength, as well as range of motion, have returned. With Grade I injuries, this can be as soon as a couple of weeks.

A Grade II sprain is a moderate injury and can result in partial tearing of one or two of the ankle ligaments. Patients with a Grade II sprain have significant swelling and pain. Patients can bear weight but do so with a sense of instability and a visible limp. Most moderate sprains (in the presence of a stable ankle joint) resolve with RIICE and time. The length of time will vary based on the severity of injury, as well as the health status and functional goals of the injured patient. Patients with high levels of daily activity benefit from a pneumatic walking boot as opposed to a soft brace. In addition to the treatments for Grade I injuries , patients will benefit from formal physical therapy and a longer period of bracing while recovering from a Grade II injury. These injuries take longer to recovery from, but it is typically a matter of weeks, not months.

Grade III ankle injuries involve complete ruptures of one or more of the ankle ligaments. These injuries create significant pain, swelling and bruising. Often, a golf ball sized lump of swelling will be present at the painful area. Most patients with a Grade III sprain are unable to bear weight on the injured ankle. Treatment of these injuries often begins with immobilization in a non-weightbearing cast or pneumatic boot with crutches. After a week, gradually increased weightbearing in a pneumatic boot with gentle range of motion exercises can begin. Treatment is adjusted based on symptomatic and functional tolerance. As swelling, stiffness and pain decrease, the patients are transitioned to an elastic compressive brace and formal physical therapy. With Grade III injuries, patience and a full recovery help to reduce the number of recurrent sprains and the development of chronic ankle instability .

If you have suffered a recent ankle sprain, contact Baton Rouge orthopedic ankle specialist , Dr. Patrick Hall, and request an appointment to learn more about your injury, its severity, and the recommended course of treatment.