The most common type of ankle injury is a sprain to the lateral ligaments (on the outside) of the ankle. Ligaments are fibrous tissue attaching the lower leg bone (fibula) to the foot.
There are 3 lateral ankle ligaments which stabilize 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. Rarely the PTFL is damage as it is a very tough ligament.
Signs & Symptoms
When ‘rolling’ or spraining your ankle it would be likely that you have an immediate onset of pain, swelling and possibly bruising. Some people may find it difficult to weight bear on the foot at this time and crutches might be required.
What Causes It?
Uneven surfaces, stepping on someone’s foot or receiving a tackle in football are all cited as common mechanisms of injury for lateral ankle sprains. The typical foot position in a lateral ankle sprain is combined plantarflexion and inversion of the foot. This position usually occurs due to excessive rolling on the outer edge of you foot, normally with the foot pointing downwards and turned inwards. This can lead to over-stretching, tearing or possibly rupturing the lateral ligaments of the ankle.
Sprains to the medial (inside) ankle are uncommon but can occur if the foot is rolled outwards.
How to Self Manage
Like all acute injuries, rest, ice, compression and elevation should be administered for the first 48-72 hours. Heat, alcohol, running and massage should be avoided.
Keeping the ankle moving gently is also important to prevent stiffness. An exercise you can do, once pain permits, is to try drawing the letters of the alphabet with your foot.
It is likely that you will also need to improve your proprioception. When you roll your ankle, your ability to know what your foot is doing without looking at it can become impaired. To improve stability and prevent re-injury your rehabilitation needs to include proprioceptive exercises. An example of this is standing on one leg with your eyes closed and building up to 20 seconds. Again pain permitting, and next to a wall in case you lose balance.
If you have followed all of the above advice, please seek advice from your Physiotherapist immediately to commence your rehabilitative program.
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.
Grade 1 ankle sprain: No abnormal laxity of the ligament
Grade 2 ankle sprain: Some laxity but firm end feel
Grade 3 ankle sprain: Significant laxity with no end feel
A grade 3 ankle sprain will often cease to be painful soon after the initial injury. Prior to considering surgery they are managed conservatively for at least 6 weeks. If pain and instability continue, then review by an othopaedic specialist would be advised.
Other indicators of severity taken into consideration will include 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 or dysfunction of other structures.
How Physio Helps
It is imperative to start ankle physiotherapy soon after an ankle sprain, within the next 2 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.
Manual treatment may include joint mobilization to the talocrural and subtalar joints, massage, electrotherapy, and extensive exercise prescription to ensure you regain your movement and return to sport and daily activities as soon as possible.
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.