Lateral Ankle Sprain
Ankle sprains are a common injury in many high-velocity sports, can keep an athlete out of sports and tend towards being reoccurring if not diagnosed and treated correctly. Luckily, in the majority of cases, the prognosis is good, but there are some key factors to keep in mind when dealing with this type of injury.
Ever since human beings evolved to stand up, our feet and ankles have been essential to our mobility. Our foot and ankle complex is a fascinating biomechanical structure consisting of an intricate bony architecture and matrix of ligaments, joints and muscles which provide stability and strength. High demands make the foot and ankle vulnerable to injuries. Our feet are the only part of our body in contact with the surface when walking, standing, skipping, jumping and running, and without this aforementioned stability and strength all these activities are hampered. When injuries to this area occurs, rehabilitation and healing is of the utmost importance in order to return to full function.
The architecture of the foot
Before we look at the ankle sprains in particular we need to consider the foot and ankle in a bit more detail. The contradictory demands of the ankles are great – providing both stability to keep us on our feet and a wide range of mobility and strength to propel us forward in walking and running. To help us we are all equipped with a clever proprioceptive response that helps us maintain balance and alerting the brain to whether our joint position is correct. If there is a risk of losing balance, the brain responds by sending signals to appropriate muscles for correction to prevent falling over or hurting the structures in the area.
Sometimes this correction does not happen fast enough to avoid injury, and in order to minimise trauma, muscles, tendons and ligaments in our ankles are often the first ones to absorb the stress to protect our slower healing bones from damage. In the short term this can allow us a certain degree of function, but over the long term the healing process could take a long time with may pose several pitfalls.
Lateral ankle sprain
The majority of ankle sprains, almost 85%, happens with a so-called inversion injury where the sole of the foot turns inwards and the ankle moves outwards due to shifting of the body over a weight-bearing foot. This puts pressure to the outside of the ankle, leading to a stretch and/or tear of the ligaments located on the outside of the foot if the force is great enough. This is common in sports that require a lot of twisting, turning, starts and stops like football and hurling, indoor ball games and racket sports like squash and tennis. In most cases the anterior-talofibular ligament is affected, but also the calceneo-fibular and the posterior-talofibular ligament could be involved.
How it feels and what to do immediately
Symptoms of a lateral ankle sprain is pain and tenderness on the outside of the foot and ankle, inability to weight bear without pain on the effected leg and swelling and bruising around the ankle complex. If you experience this after an inversion type trauma, apply PRICE (Protect – Rest – Ice – Compress – and Elevate) and arrange with a consultation with a physiotherapist or another appropriate health care professional for assessment and start of a rehabilitation program. Avoid putting weight on the affected leg with the help of crutches until it is pain free to do so.
What to expect from a physiotherapist
When you arrive at your physiotherapist for assessment they will ask you about your previous history with ankle injuries and the mechanism of injury. Your previous history is important because evidence suggest a 70% reoccurrence rate of lateral ankle sprains in certain sports. Your mechanism of injury would also help your therapist decide the appropriate diagnosis. After sufficient information is gathered, your therapist will rule out any further damage to bones and neurovascular complex through specific tests. If a broken bone is suspected, or the severity of the ligament damage is great you might be sent for a X-ray or an MRI. Specific test is also done to determine involved ligaments, level of range of motion and degree if impairment in order to estimate severity and to prescribe rehabilitation program.
Initial rehabilitation includes early mobilisation with respect to pain and application of the PRICE principles. Once swelling has reduced sufficiently, strapping or bracing could be used to immobilise the ankle joint and let the ligament heal in a non-elongated
position. It is important to mobilise the ankle joint to prevent long term reduction in joint mobility, but avoid doing mobility in the
direction that caused the trauma in the first place (turning the sole of the foot inwards with toes pointing down). This could lead to an increase laxity preventing the ligament from restoring the original tension. Full weightbearing should only occur once it is pain free to do so. Initial rehabilitation is hence performed non- or partially weightbearing.
Once you can manage to fully weight bear pain free, rehabilitation is shifted to focus on foot and ankle function such as balance, strength and mobility. Coordination and landing/jumping strategies are also important to prevent reinjury when returning to sport. Make sure you perform this after a guided exercise program as each individual treatment plan would vary with timing and execution. Time frames also vary greatly depending on grade of severity and individual healing. Mild sprains typically heals within 2 weeks. More severe sprains can take several months to a year in some cases.
Final bits and what to look out for
Ankle sprains have the capacity to develop into Chronic Ankle Instability (CAI). This is a situation where the symptoms experienced after an ankle injury persists for more than 6 months after the injury. These symptoms are swelling, reduced strength, instability or lack of balance. For more on CAI, click here.
Chris Smetana, MISCP< Back to All Blog Items