Twisted ankle

• What causes a twisted ankle?
• What should you do after twisting an ankle?
• Risk factors
• Symptoms
• Diagnosis
• Treatment
• Prevention
• FAQ

Overview: what causes a twisted ankle?

A twisted ankle is usually caused by landing awkwardly on the foot, whether during sports or in your free time. Turning or rolling the ankle can often result in injury to the joint. The twisting movement can result in bruises, sprains, a torn ligament or even fractures.
 

Immediate measures: What should you do after twisting an ankle?

mmediately after twisting your ankle, it is important to take the right steps. The RICE rule includes four immediate measures to relieve pain and reduce swelling: 

•  Rest:
• Immediately after twisting your ankle, you must refrain from putting any weight on the foot.
• Ice:
  Cool the affected area as soon as possible. Ice should not be placed directly on the skin because of the risk of frostbite. A bag of ice water wrapped in fabric is ideal. Cold water or cold wet towels are a good alternative.
• Compression:
  After sufficient cooling, a thick elasticated bandage must be wrapped around the foot, starting at the toes and going all the way up to cover the ankle. Then continue cooling from outside the bandage.
• Elevate:
  Consistent elevation of the foot prevents additional swelling.

Risk factors

One careless move, and that’s it: twisting an ankle is far from uncommon. As a matter of fact, some people are more susceptible to twisting their ankle than others. As a general rule, if you have twisted your ankle in the past, you will often have an increased risk of doing it again, especially if the corresponding muscles and stability have not been adequately strengthened.

Sports

Contrary to popular belief, it is certainly not only ‘clumsy’ people who often twist their ankles. Even fit athletes, whose joint stability is put to the test again and again by high speed, jumps and unpredictable movements, may suffer these injuries frequently.

Twisted ankles are particularly common in sports involving quick changes of direction and jumps.

Twisted ankles are especially prevalent in the following sports:

• Football
• Basketball
• Volleyball
• Tennis
• Trail running
• Hiking on uneven terrain

Older age

Older people, in particular, often twist an ankle when walking on uneven ground. This is because balance, muscle strength and reaction speed tend to decrease with increasing age, making falls and twisted ankles much more likely.

Accidents can be prevented by regular exercises to improve balance, strength and mobility, as well as by wearing suitable, supportive shoes. Remaining aware and attentive when walking on uneven paths and removing trip hazards in everyday life can also reduce the risk of injury.

Unsuitable footwear

Shoes with insufficient grip, unsupportive soles or very high heels increase the risk of a twisted ankle. Suitable and comfortable footwear that gives stability to the foot is ideal for preventing this. The right footwear is also good for your health in a number of ways, because shoes that force your feet into an unnatural position can lead to tension, fatigue or back pain over time. Choosing suitable shoes is therefore particularly important.

People with certain foot shapes or deformities

People with high-arched feet, pronounced foot misalignment or limited mobility are often also more prone to twisting their ankles. These differences can affect the load and stability of the foot, making a twisted ankle more likely.

Hypermobility

People with hypermobility, i.e. above-average mobility of one or more joints, may be more prone to twisting their ankles. Their joints often have less of the passive stability usually provided by ligaments and connective tissue. This means that sudden movements can more easily tip the foot into an unfavourable position.

In addition, some hypermobile people experience reduced proprioception (perception of joint position), which means that the body reacts more slowly to a twisting ankle. The work of stabilising the ankle therefore has to be done primarily by the muscles. If they are not sufficiently strengthened or are fatigued, the risk of sprains and repeated twisted ankles increases. Targeted strength, balance and stabilisation training can help to better protect the joints of hypermobile patients.

While flexibility is an important training goal for many people, for those affected by hypermobility the focus is often on stabilisation of the joints. Exercises should therefore be aimed at strengthening the muscles in a targeted manner, improving joint control and building up secure resilience to cope with everyday life and sporting activities.

We particularly recommend training under the guidance of physiotherapists who specialise in hypermobility. They are familiar with the particular challenges of hypermobile patients and know what kinds of exertion are appropriate for them and which should be avoided. On this basis, they can create an individually adapted training programme that specifically improves stability, strength and body control.

Weak or loose ligaments (ligament laxity)

Ligaments serve as important passive stabilisers as they limit extreme movements. People with weak or loose ligaments are correspondingly more susceptible to twisting their ankles. If the ligaments are too flexible, the foot can bend more easily inwards or outwards when treading on uneven ground or when turning quickly.

Ligaments contain many receptors that send important signals via the stretch, tension and position of a joint to the central nervous system, where they are processed. If the patient has pronounced looseness or a ligament injury, this signal perception process can be impaired. Ligament laxity puts more strain on the muscles and tendons. This can also increase the risk of ankle injury.

Some people naturally have a little more ligament laxity without experiencing any discomfort. The decisive factor is whether the joint can cope with exertion in a controlled way and without pain. The following may indicate loose ligaments:

• Frequent twisted ankles (e.g. even on only slightly uneven ground)
• The feeling that a joint is ‘unstable’ or ‘wobbly’
• Recurring sprains despite normal exertion
• Unusually high mobility in several joints

Weak muscle and joint stability

People with weak leg, foot or core muscles also tend to be prone to twisting their ankles. Weak muscles can make the body less able to compensate for an awkward movement of the joint. This places more stress on the joints, which increases the risk of injuries such as sprains or ligament injuries to the foot.

Poor proprioception

Proprioception refers to the ability of the body to perceive its own position in space. In some people, this self-perception is impaired. Since they may not be able to perceive the position of their feet and joints very well, they are particularly at risk of twisting an ankle.

Their limited perception means that they react more slowly to changes such as uneven ground or a false step, and that the body cannot compensate for the movement in time. The result is an increased risk of twisting and injuries to the foot and ankle joints.

Symptoms: when should you see a doctor after twisting your ankle?

In many cases, the twisted ankle heals on its own, provided that the affected part of the body is rested for a few days. However, if you have the following symptoms, you should consult your family doctor:

• That area of the body is severely swollen or there is a bruise.
• The affected person feels a cracking or tearing.
• The ankle joint is unstable after the injury.
• Severe pain at rest or when putting weight on the foot.

Diagnosis

The first step in diagnosis of a twisted ankle is taking the patient’s medical history. The attending doctor asks how the injury occurred, how the ankle was twisted and whether similar injuries have occurred in the past. In addition, the intensity and type of pain are discussed.

The second step is to examine the affected foot and ankle more closely for any swelling, bruising or deformities. The doctor will then systematically touch different areas of the ankle (palpation) to assess pressure sensitivity, temperature and swelling. The extent to which mobility is restricted is determined by the movement of the joint.

Imaging techniques such as X-ray, ultrasound or magnetic resonance tomography (MRI) can be used for a more precise assessment. An X-ray image can be used to rule out fractures, for example. Ultrasound is suitable for showing soft tissue injuries and fluid build-up. An MRI can accurately depict ligament tears, cartilage damage or damage to surrounding structures, as it allows detailed imaging of soft tissue. In some cases, other diagnostic procedures, such as arthroscopy, are also used. This method makes it possible to view the joint directly from the inside.

Treatment: how is a twisted ankle treated? 

If you follow the RICE rule after twisting your ankle and take appropriate immediate pain-relieving measures, you can not only reduce your symptoms, but also have a positive effect on the healing process. After first aid, your attending doctor will support this process with further treatments.

Do you have a twisted ligament, or even a torn ligament? The type of treatment and duration of healing depends greatly on the severity of your injury. After an in-depth examination, your doctor will decide which treatment is best for you.

Pain and inflammation relief

Anti-inflammatory painkillers can be used to relieve pain and swelling after twisting an ankle.

Splints and braces

Braces prevent incorrect movements and stabilise injured joints. Splints can protect injured structures, enabling a safe healing phase.

Braces are tried-and-tested orthopaedic aids that are subject to a constant process of technological change. A brace makes it possible to guide certain movements and make them safe, while limiting those that could put strain on the joint. As a result, you retain some of your mobility. A splint, on the other hand, restricts the affected part of the body as completely as possible.

How long a splint or brace is worn depends on the severity of the injury. In the case of minor sprains, a few weeks are often enough; in the case of more severe injuries, a longer period of immobilisation may be necessary.

Physiotherapy for stability and flexibility

Physiotherapy plays an important role in healing and rebuilding stability. Targeted exercises strengthen the muscles, improve the mobility of the foot and help prevent the ankle from twisting again. If the injury affects the external ligaments, it is particularly important to restore the stability of the joint in order to be able to safely put weight on the foot again and to avoid chronic instability.

Surgery – in exceptional cases

Surgery is only necessary in rare cases, such as a torn ligament, a fracture or a permanently unstable joint. Most injuries are treated conservatively.

If the symptoms persist over a longer period of time, they should be re-examined by a doctor.

Prevention: how can you stop yourself from twisting an ankle?

Twisted ankles cannot always be avoided, but the risk of them resulting in an injury again can be reduced in a targeted manner.

Anyone who does sport on a regular basis should warm up appropriately before exercising and wear suitable shoes in order to avoid twisted ankles or pulled or torn ligaments (sprains).

Supports, splints or tapes can provide additional support when exercising after twisting your ankle or if the ankle joint is unstable. They stabilise the ankle joint and can reduce the risk of twisting it again, but do not replace targeted strengthening and balance exercises, which are particularly important for long-term stability.

Targeted muscle training for stabilisation is and will remain one of the most important preventive measures. Ligaments can’t be strengthened, but the muscles around the ankle can. After all, the muscles provide stabilisation, which can counteract sudden ankle twisting. Preventive proprioceptive stabilisation exercises can be of particular help to make the ankle resilient enough (again) for everyday life and sport.

Something particularly important is prevention by undertaking muscle strengthening exercises. These stabilise the ankle joint in cases of ligament laxity. Patience is required, first and foremost, in order for the ankle to become more resilient: progress does not occur within a few days, but through consistent training over several weeks to months.

FAQ