Foot & Ankle
What is an Ankle Sprain?
An ankle sprain is very common and approximately 7-10% of emergency department admissions are due to ankle sprains. An Ankle sprain is when we cause trauma to the ankle ligaments on the outside, inside or back of the ankle. Females are at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults. In young children, this is the most commonly injured joint behind the knee and wrist. This kind of injury is most prevalent when playing sports such as basketball, tennis, or football or when we slip and fall though activity or even on an uneven surface. Most commonly the lateral ligaments are injured. The lateral ankle ligaments are a complex of three different ligaments including the calcaneofibular ligament (CFL), anterior talofibular ligament (ATFL), and the posterior talofibular ligament (PTFL). If you roll over your ankle and it tilts inward then it is most common to injure one or a combination of these. We can also injure the ligaments on the inside called the Deltoid ligament complex which is made up of 4 ligaments. These can be injured by rolling outward.
Ankle sprains cause trauma through stretching or the tearing of a ligament. A minor sprain may only cause a stretch or a small trauma to some of the ligament fibres while a bigger tear may result in a complete rupture. There are three kinds of ankle sprain and these are shown below.
- Grade 1 Is only a mild injury to the the ligament causing some microtears to the collagen fibres that doesn't impact the joint and there is no instability. There is mild swelling and tenderness and weight bearing is normal.
- Grade 2 Is where we have a partial tear of many collagen fibres that is significantly greater than a grade 1 injury but the ligament is still intact. There can be reduced movement, moderate swelling and tenderness and some instability. We should immobilise with a splint or brace to protect. Physiotherapy is advised with this kind of injury.
- Grade 3 Is where this is significant swelling and tenderness with instability. This is a severe injury as there is a complete rupture of the collagen fibres so the ligament is now completely torn. Crutches and immobilisation should be undertaken with a splint. It is advised that you review with a Physiotherapist and you may be also seen by an orthopaedic consultant.
What Treatments can I do? will I need Surgery?
Approximately 80% of acute ankle sprains recover fully with conservative management, while the remaining 20% develop into functional or mechanical instability that may require surgical intervention.
Home treatments may provide pain relief such as, Ice, Ankle braces and ankle supports. These can give you some protection and help reduce further trauma and pain. Rehabilitation of an ankle sprain is advised as you will have muscle weakness and the healing ligament will not be as strong as previously. Specific rehabilitation can aid in the lay down and improvement if your ligaments tensile strength thus is advised. Physiotherapy may involve manual therapy and focused rehabilitation that will improve your mobility, strength and stability allowing you to return safely to your activity or sporting interests.
If you have suffered a full rupture and/or are functional unstable (Chronic Ankle Instability) surgery may be advised to help give you the added support your ankle requires. There are many techniques for this and a Surgeon can discuss these.
What can I expect after ankle sprain?
After an ankle sprain it is important to offload the ankle to help prevent further trauma. By following the PRICE protocol you can help your recovery. This is Protection, Rest, Ice, Compression and Elevation. Using a Tubi grip for compression and Ice can help reduce pain and swelling. There are many variations for the RICE protocol however they all have the similar goal of trying to reduce further trauma, swelling and pain, It is not advisable to take Anti-inflammatory medications within the first 48 hours.
You will of course have pain at the injury site but this should reduce quickly over days-weeks depending on the severity of the injury. Most ankle sprains will resolve within 4-6 weeks. If you or your child has had an ankle sprain and are struggling to put weight on the foot it is advisable to be reviewed by your health professional to make sure there is no other injury pt trauma.
If you require, you may need crutches or an ankle brace to help give you further support. If you have failed to respond to treatment and have persistent instability then a review with an orthopeadic consultant is advised.
How do I recover?
If you have suffered an Ankle sprain the recovery will depend on the severity of your injury. You will be guided in your return to sport and activity using the PAASS framework detailed below or similar protocols.
As a Physiotherapist, we may perform manual therapy to help stiffness and also help muscle tightness and swelling. I will prescribe a bespoke exercise program for you and your Ankle injury. This will help increase your mobility, strength, and daily activity. I will advise in all areas from self-home care, walking, stairs, and how to progress your mobility, strength and exercise tolerance. This is also with the guidance of your surgeon if you have had surgery. As you progress I will instruct you on how to increase your fitness, exercise, recreational activities and return to sport if you wish.
P - Pain severity
- During Sport
- Over last 24 hours
A - Ankle Impairments
- Range of motion
- Muscle Strength, Endurance, Power
A - Athlete Perception
- Ankle confidence
- Ankle stability
- Psychological readiness
S- Sensorimotor Control
- Dynamic Postural control/balance
S- Sporting/Functional Performance
- Sports Specific activities
- Ability to complete a full training session
My objective is to help you in achieving your goals 100% of previous activities and lifestyle.