Most ankle sprains will happen to the outside (lateral) ankle. The
position of the ankle at the time of injury can help to pinpoint which
ligament may have been injured
The ankle contains 3 joints the, talocrural (ankle)
joint, inferior tibiafibular joint and the subtalar joint. The
talocrural joint is a hinge joint allowing the movements dorsiflexion
(bringing the foot towards the shin) and plantarflexion (pointing the
foot). The joint is the least stable in plantarflexion and is why most
ankle sprains occur in this position. The ligaments of the lateral
(outside ankle) are shown in the picture above. The ligaments on the
medial ankle (inside) are strong and require a great force to be
injured, the lateral ligaments are considered to be weaker than the
medial offering less stability to the joint on that side. This is why
inversion (foot rolling inwards) injuries are far more common than
eversion (rolling outwards). The mechanism of injury is an important
clue to diagnosis after ankle sprain.
Data collected from emergency departments in the United Kingdom suggest
there are over 300 000 ankle sprains a year 42 000 of those severe.
If the ankle is sprained and is
inadequately rehabilitated it can lead to prolonged symptoms, decreased
sporting performance and high risk of recurrence. Most people when they
get an ankle sprain don't receive rehabilitation, maybe this is due to
lack of education and not enough information out there on what to do for
your ankle sprain.
Symptoms
The onset of pain is very important. A history of
being able to weight immediately after the injury with subsequent
increase in pain and swelling as the you continue sport or walking about
suggests mild to moderate ankle sprain rather than a severe ankle
sprain which is usually associated with a fracture.
The location of the pain, swelling and bruising gives
an indication as to the ligaments injured. The most common site is the
anterolateral aspect (front just to the outside) involving the anterior
talofibular ligament. The degree of swelling and bruising is a good
indication of the severity of injury but not always. the degree of
disability is also a good indication of severity.
The initial management should be the P.R.I.C.E
regime. For a treatment used by most professional athletes watch the
video above for immediate care of your ankle sprain. You may need
restricted weight bearing after the injury but if not severe then after
24 hours you should start to put weight through the joint as soon as
possible and gain a good heel-to-toe strike gait pattern. Loading of the
joint helps the functional healing of the injury and stops the injury
from becoming stiff later on.
Ideally you should see a injury specialist for your
ankle sprain however minor especially if it has happened more than once.
An injury specialist should always ask if you have had a previous ankle
sprain and whether this was properly rehabilitated.
Lateral ligament sprains
These injuries happen most commonly in activities requiring a quick
change of direction especially if these are on uneven surfaces.
Basketball, netball and football players have a higher risk of the
injuries and many professional teams will have an injury prevention
program in their training. The usual mechanism is inversion and
plantarflexion (foot rolls inwards in a pointed position). The anterior
talofibular ligament (ATFL) gets injured first before the
calcaneofibular ligament (CFL), mainly due to the plantarflexed position
where the ATFL is more taut and the CFL is relaxed. The ATFL is also a
weaker ligament only been able to tolerate half the strain of the CFL
before tearing. A complete tear of all 3 ligaments would lead to a
possible dislocation of the joint and fracture. This however is very
infrequent. Isolated CFL and posterior talofibular ligament (PTFL) are
also rare, a PTFL is usually associated with a fracture because the
injury happens when the foot is dorsiflexed (foot pulled up towards the
shin) the joints bone structure itself is very stable in this position
which is why a fracture is usually associated. So the number of
ligaments injured can also give an indication of the severity.
Severe ankle sprains where you cannot weight bear should always be
checked out at A&E just to check for any associated fractures as
this will affect the healing time and type of rehabilitation in the
early phases.
Treatment
Initial management should be P.R.I.C.E
If unable to weightbear gradually increase as soon as possible as this will
enhance healing and rehabilitation.
Reduction of pain and swelling can be done by using NSAIDS (non
steroidal anti inflammatories like ibuprofen) A weeks course should be
taken but always check with your doctor first. There's not much research
backing up the use of NSAIDS in helping to decrease inflammation.
Inflammation is a vital part of the healing process NSAIDS work to help
get rid of this. If you don't want to take them then just use the ice
treatment. Do not take paracetomol in the first 48 hours as they can
delay the healing process but maybe helpful later if the ankle is still
painful but again always check with the doctor. Ankle pumps should also
be used to help regain movement and help pump out swelling.
Regaining full range of motion (ROM) is the main aim of early
rehabilitation. If crutches are needed starting partial weightbearing is
vital and helps protect the joint, if less severe then taping can be
used to gain a full walking gait pattern quickly. As soon as pain allows
doing active range of motion exercises plantar flexion, dorsiflexion,
stationary cycling and walking in water will help the joint recovery.
Inversion and eversion can be brought in gradually and later on
plantarflexion and turning the foot inwards and outwards (mechanism of
injury).
Muscle conditioning includes active strengthening exercises including all
movements when pain allows. They should progress from isometrics to full
range. The resistance should increase slowly and a useful method is
using rubber exercise bands. Strengthening ankle eversion with the ankle
fully plantarflexed is particularly important in the later stages to
help prevent future sprains. Weight bearing exercises (shuttle runs) and
balance (wobble board) exercises are encouraged as soon as pain allows
again to help prevent recurrence. The very last stage of rehabilitation
needs to cover functional exercises related to the activities required.
Taping and bracing may help speed up weight bearing exercises as it
helps to support the joint but eventually the joint needs to learn to
work alone.
Fo rthe more severe ankle sprains rehabilitaion is still advised even if
surgery is going to be needed. The stronger you can get the surrounding
structures the quicker your return after surgery.
Videos coming soon
"Simple ankle taping for inversion ankle sprain" "Early stages of
rehabilitation for an ankle sprain" and "Advanced exercises for an ankle
sprain"
Still to come soon on this page, information
about other ankle injuries.
