The ankle is involved in almost all movements of the legs and has to withstand a lot of stress and pressure during activities; thus, it is a common area for sprains. Ankle sprains occur when the ligaments, which are strong fibrous tissues that connect the bones, become stretched or torn.
Sprains are classified based on how severe they are (Table 1). A Grade 1 sprain involves only mild stretching of the ligament, a Grade 2 or moderate sprain involves the partial tearing, and a Grade 3 or severe sprain indicates that the ligament is completely torn.
Table 1: Classification of ankle sprain based on the severity
| Grades | Description |
| Grade 1 | Overstretched ligament |
| Grade 2 | Partial tear of ligament |
| Grade 3 | Complete ligament tear |
Calf pain can result from various reasons, one of which is tendinitis. This is a condition wherein the tendon, which connects the muscle and bone, becomes stretched or torn resulting in sharp pain and swelling at the back of the lower leg.
In the ankle, the Achilles tendon or the tendon that connects your calf muscles to the heel bone is the most commonly injured. Tendinitis occurs as a result of overuse or repeated stress and is therefore common among athletes and highly active individuals.
Ankle sprains, especially severe ones, can occur together with other injuries such as fractures, muscle strains, tendinitis, and nerve inflammation.
If you experience pain at the back of the heel that is accompanied by swelling, weakness of the calf muscles, and difficulty putting weight on the affected foot after an ankle sprain, there is a possibility that the Achilles tendon is torn, resulting in calf pain.
Can a sprained ankle cause calf swelling?
Studies have shown that more than 10% of individuals who had an ankle sprain also had Achilles tendinitis. If you sprained your ankle and noticed that there is also pain and swelling at the back of the heel, there is a high chance that the Achilles tendon is also injured.
Calf swelling experienced together with ankle sprain suggests a more serious type of injury that may include malalignment of ligaments that connect the ankle to the foot and leg.
When should I be concerned about calf pain?
The presence of extensive swelling in the calf and ankle accompanied by pain, difficulty in moving the ankle joint, and inability to put weight on the affected leg resulting in problems with standing and walking warrant immediate medical attention.
In this case, you should go to the nearest hospital or clinic to have your leg and ankle evaluated by a physician to obtain a proper diagnosis and get appropriate treatment.
Individuals who experience on and off pain in the heel cord even before the ankle sprain occurred may already have a mild Achilles tendinitis. This can partially or completely tear once an accident occurs such as poor landing after a jump or falling or tripping, which can also result in an ankle sprain.
If you experience sudden pain in the calf, ankle, or foot without any known reason, and this is accompanied by swelling, warmth, and change in color such that the area looks redder, bluer, or whiter than the other leg, this can indicate a deep venous thrombosis or DVT. You must seek immediate medical care if this occurs.
DVT is a condition in which a blood clot forms in the vein of the leg. This is a potentially life-threatening condition as the clot can become dislodged in the leg and can travel into the lungs. If the clot reaches the lungs, it results in pulmonary embolism in which the clot impedes the blood flow and decreases the oxygen in the body.
Home Treatment
Severe ankle sprains that occur together with other injuries should be provided with immediate attention. If this is not possible, the RICE protocol can be done during the first 24 to 72 hours after the injury:
Rest: Avoid moving the ankle as well as motions that produce pain. It is best to refrain from standing on the affected leg or walking to prevent aggravating the injury.
Ice: An ice compress helps in reducing pain and swelling. It should be applied for no more than 20 minutes and a towel should be placed between the ice and the skin to prevent skin burn. Also, for it to be effective, the ice compress should be reapplied several times a day with at least 1 hour in between.
An ice compress should not be used if the injury is more than 3 days as it can disrupt the healing process. Instead, use a warm compress to increase the blood in the area to facilitate healing. This will also help reduce joint stiffness when applied before doing prescribed exercises for your ankle during the rehabilitation phase.
Compression: Compressive or elastic bandages can be used to help minimize the swelling in the affected ankle. Do not wrap too tightly so as not to hinder blood circulation.
Elevation: Elevate the ankle above the heart. Gravity will assist in draining excess fluid and limit swelling.
These home remedies can be done as first aid treatment but they are not enough to fully heal your injury. It is still best to consult your doctor or physical therapist so your condition can be diagnosed correctly.
A correct diagnosis is crucial for obtaining the right treatment, which will help you recover faster and prevent aggravation and recurrence of injury.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.