Both ankle pain and ankle tendinitis can be caused by injuries (such as sprains and strains from sports) or diseases and conditions (such as rheumatoid arthritis or gout). Acute ankle sprains are initially treated with ice, rest, and limiting walking and weight-bearing on the injured ankle. The leg can be elevated to reduce swelling, and crutches are often recommended to avoid further trauma to the injured ligaments. Anti-inflammatory medications can be given to reduce local inflammation. Ice packs help decrease further swelling of the area and can reduce pain. Patients with severe injuries are placed in immobilization casts. Surgical repair of grade III injuries is considered, especially for those patients contemplating future athletic participation. Physical therapy programs are part of the rehabilitation process, incorporating strengthening exercises of the lower leg muscles. Broken ankles (fractures) can accompany ankle sprains or occur without sprains. Fractures are repaired with casting to immobilize the bone for healing. Depending on the severity, fractures can require orthopedic casting or surgical procedures including pinning, and open repair of the fractured bone.