An ankle sprain is one of the most common injuries, it accounts for up to 40% of all sports injuries every year. Due to its prevalence, we sometimes overlook and underestimate the seriousness and impact it can bring on our performance. So here are some important things you need to learn about ankle sprains!
Anatomy
The ankle is a hinge joint. It is made up of the tibia, fibula, and talus of the foot. To give stability to the joint, these bones are connected with ligaments. Most ankle sprains happen on the outside (lateral) of the ankle, so the most commonly injured ligaments are:
Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)
On the inside (medial) of the ankle, we have 3 ligaments attaching to the talus, calcaneus, and fibula, they all form together as the deltoid ligament.
Types of Ankle Sprains
Inversion type: when your ankle rolls inwards, injuring the lateral ligaments
Eversion type: when your ankle rolls outwards, injuring the medial ligaments
Classification
Type I (mild): stretching and mild damage to the ligament
Type II (moderate): partial tear of the ligament
Type III (severe): complete tear of the ligament. Can also lead to a high ankle sprain--syndesmosis injury (joint between tibia and fibula). This type of sprain usually comes with complications, such as tendon disruptions and chronic instability.
Risk Factors
40% of traumatic ankle sprains happen during sporting activities. People who are overweight, have a history of previous ankle sprain, impaired balance, or joint laxity, will be more likely to sustain this injury.
Symptoms
Acute: inability to weight bear, pain, swelling, bruising, reduced range of motion
Chronic instability: recurrence of sprains, clicking, increased laxity in the ligaments, reduced balance, reduced strength in the ankle, reduced performance in sports
You should get an X-ray from A&E to rule out any fractures if:
You are unable to weight bear after the injury; AND
There is bony tenderness along the lower 6 cm of tibia/ fibula; or the base of your 5th toe (metatarsal) / the inside of the foot arch (navicular)
You should seek orthopaedic advice if:
You have painful clicking in the ankle
Your ankle sprain is recurrent despite having physiotherapy
Initial Management
The majority of ankle sprains can be managed conservatively. Grade I and II injuries can often recover in 7-15 days.
For the first 72 hours: "PEACE"- Protection, Elevation, Avoid anti-inflammatories, Compression
72 hours post-injury: "LOVE"- Load, Optimism, Vascularisation, Exercise
You can apply ice and continue with elevation to manage swelling
Weight bear as tolerated with protective footwear or an orthopedic black boot as pain allows for up to 2 weeks
Start with some range of movement exercises: drawing circles with your ankle, pointing the foot up/down; inwards, and outwards. When pain is reduced, you could try these exercises below.
Exercises
Resisted eversion: tie loop band around feet and turn injured foot outwards.
2. Y-balance: Stand on the injured leg with your knee slightly bent. Imagine a letter "Y" on the floor. Trace the letter "Y" with the unaffected leg, trying to reach as far as possible.
3. Reverse lunge to step up: Start in a lunge position with the injured leg behind. Step the injured leg onto the edge of the step with the heel lifted and drive the unaffected knee up with force.
Things To Avoid
Applying heat to injury
This would exacerbate inflammatory responses in the initial stages
Return to running/ jumping or impact activities too early without appropriate rehabilitation
This would increase the risk of re-injuring and lead to long-term instability
Stretching exercises with over-pressure in the ankle
This may further increase the laxity in the joint, creating instability
Exercising through pain
Pain is a warning sign that your body is not ready to be pushed.
You can try reducing the weight or range of movement with exercises and progress as pain allows.
Conclusion
Although ankle sprains are very common and can usually improve with conservative management, appropriate rehab is crucial to minimise the risk of ankle instability. Therefore it is important to understand what to do and what to avoid when managing these injuries.
You should always seek medical advice if you are struggling and when symptoms do not improve with appropriate rehabilitation.
References
Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World journal of orthopedics, 11(12), 534–558. https://doi.org/10.5312/wjo.v11.i12.534
Melanson, S. W., & Shuman, V. L. (2023). Acute ankle sprain. In StatPearls [Internet]. StatPearls Publishing.
Stiell, I. A. N. (1996). Ottawa ankle rules. Canadian Family Physician, 42, 478.
Zahra, W., Meacher, H., & Heaver, C. (2023). Ankle sprains: a review of mechanism, pathoanatomy and management. Orthopaedics and Trauma.
Our blogs and articles are not designed to replace medical advice. If you have an injury, we recommend seeing a qualified health professional. We offer both in-person assessments and online consultations!Â
Comments