Ankle Sprain

 What is it?

The most common type of ankle injury is a sprain to the lateral ligaments (on the outside) of the ankle.

The typical foot position in a lateral ankle sprain is combined plantarflexion and inversion of the foot (foot pointing downwards and turned inwards).  This can lead to over-stretching, tearing or possibly rupturing the lateral ligaments of the ankle.

There are 3 lateral ankle ligaments which stabilise the outside of your foot: anterior talo-fibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talo-fibular ligament (PTFL).

Usually the ATFL if affected first followed by CFL if the sprain is significant in nature.  

 

Common signs and symptoms 

  • Immediate onset of pain

  • Swelling

  • Bruising

  • Difficult to weight bear on the foot (crutches might be required).

 

What causes it?

  • Uneven surfaces

  • stepping on someone’s foot or

  • a hard/bad tackle in football

 

How can I self-manage it?

  • Implement the R.I.C.E.R. protocol

  • Heat, alcohol, running and massage should be avoided

  • Keeping the ankle moving gently (within pain limits) is also important to prevent stiffness

  • It is likely that you will also need to improve your proprioception.  An example of this is standing on one leg with your eyes closed and building up to 20 seconds (pain permitting, and next to a wall in case you lose balance) 

  • If you have followed all of the above advice without any significant improvement, please seek advice from your Physiotherapist immediately to commence your rehabilitative program

  

How physio would help

It is imperative to start ankle physiotherapy soon after an ankle sprain, within 2-3 days if possible, to decrease pain, swelling and bleeding around the injury.  

Your physiotherapist will assess the degree of laxity of the injured ligaments.  They will also examine your foot and leg for damage to other structures including bone and tendons. 

The following treatments are available: 

  • Joint mobilisation to the talocrural and subtalar joints

  • Soft tissue massage

  • Electrotherapy

  • Exercise prescription (mobility, stability, strengthening, proprioception)

  • Specific return to sport rehabilitation 

 

Taping vs. bracing

In the case of recurrent ankle sprains, taping or bracing may be recommended for use in sport as a preventative measure.  Your physiotherapist can help you make an informed decision about using a support, decide whether it is appropriate, and also discuss the pros and cons of each.

 

 

Further Management

It is important to note that swelling and bruising is not always a predictor for severity.  Also, audible crack or snap noises may not indicate bony damage.

Instead, your physiotherapist should be able to grade your ankle sprain in terms of laxity and severity.

 

A grade 3 ankle sprain will often cease to be painful soon after the initial injury.  Prior to considering surgery the affected ankle should be managed conservatively for at least 6 weeks.  If pain and instability continue, then review by an orthopaedic specialist would be advised.

 

Other indicators of severity taken into consideration will include the inability to weight bear, pain in the malleolar region, and bony tenderness.  If these are all present then an x-ray may be advised.  With any ankle sprain that is not resolving within 4-6 weeks post-injury, further investigation is warranted to exclude damage dysfunction of other structures.