There are 3 different kinds of ankle sprains. The severity of the ankle sprain depends on how much you turned your foot in or out. The forces put on the ligaments to turn it in or out cause the ligaments to stretch beyond their normal limits. If the force is too strong, the ligaments can tear.
The amount of force determines the grade of the sprain.
Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament. You would have minimal swelling and tenderness. It doesn't impair your activities much. Treatment would be RICE (rest, ice, compression, elevation) and usually you are fine within a week or 2.
Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (called laxity) of the ankle joint occurs. You will have moderate swelling and tenderness and won't be able to move your ankle very well. You might be moderately impaired (crutches, removable or soft cast, etc). Usually you are find within a month.
Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, major instability occurs. There is a lot of swelling and tenderness and you might be totally unable to stand on your foot at all. Treatment consists of total immobilization (walking cast) for up to 6 weeks then gradual physical therapy to strengthen the ligaments.
There is actually one worse than Grade 3 - they call these the high ankle sprains and tend not to heal as well. If the injury seems stable, then a non-weight bearing cast for 6 weeks followed by more testing for healing and stability then physical therapy. If the ankle is unstable treatment is again treated in a non-weight bearing cast for 6 weeks. If it remains unstable, then a 'syndesmotic screw' has to be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligaments heal. You are placed in a non-weight bearing cast for 3 months. If you walk on the leg/foot at all, the screw will break. At 3 months, another MRI will determine if the screws can be removed. If they can, then you go into a weight bearing cast for another 6-8 weeks then intensive physical therapy to relearn how to walk.
I had the MRI yesterday. I have an unstable grade 3 sprain high ankle sprain along with a complete rupture of most of the major ligaments in the foot and ankle which allows one to be able to stand and walk. So I will need surgery and lucky me to get screwed not once but twice (2 screws) along with suturing or repairing the ends of the ruptured ligaments together then reinforcing them with what is called a GraftJacket. At the end of the 3 months I get to go for another surgery if the MRI says I have healed I get to be unscrewed. I might be able to walk with a cane by the time of my daughter's wedding in May. If the MRI doesn't show any healing of the syndesmotic tears I will have to have my ankle fused together and that takes 6 months of non-weight bearing to heal and I will never be able to move my ankle again.
Not a happy camper right now.
