What is an ankle sprain?
An ankle sprain refers to stretching or tearing of the ligaments of the ankle. The most common ankle sprain occurs on the outer part of the ankle.
Anatomy
There are multiple ligaments in the ankle. The two most commonly injured are:
1. The ATFL or anterior talofibular ligament, which connects the talus to the fibula on the outside of the ankle.
2.The CFL or calcaneal fibular ligament, which connects the fibula to the calcaneus below.
Grades of Ankle Sprains
Grade 1 Sprain (Mild)
· Slight stretching and microscopic tearing of the ligament fibers
· Mild tenderness and swelling around the ankle
Grade 2 Sprain (Moderate)
· Partial tearing of the ligament
· Moderate tenderness and swelling around the ankle
· There is an abnormal looseness of the ankle joint when the ankle is moved in a certain direction
Grade 3 Sprain (Severe)
· Complete tear of the ligament
· Significant tenderness and swelling around the ankle
· Substantial ankle instability when the ankle is pushed or pulled in a certain direction
What are the symptoms an ankle sprain?
- Pain on the inner or outer part of the ankle joint
- Swelling
- Bruising
- Loss of range of movement
- Limping gait
- Tenderness over inner or outer part of ankle joint
How is an ankle sprain diagnosed?
Ankle sprains can be diagnosed thorough history taking and physical examination. The location of pain on the ankle with tenderness and swelling in a patient who rolled their ankle is very suggestive.
It should be noted to not simply regard any injury as an ankle sprain because other injuries can occur as well. For example, the peroneal tendons can be torn or bruised. There can also be bone fractures around the ankle including the fifth metatarsal or the tip of the fibula. In very severe cases, an MRI may be warranted to rule out other problems in the ankle such as damage to the cartilage. An MRI typically is not necessary to diagnose a sprain.
Before an MRI is suggested, the physiotherapist can use the Ottawa ankle rules to screen for an foot fractures.
What are the treatment options?
Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilised appropriately.
We recommend our three-phase ankle sprain rehabilitation programme - from mild to severe:
· Phase 1 (0 - 6 weeks) includes light and gentle progressive loading, resting, protecting the ankle and reducing the swelling.
· Phase 2 (6 - 12 weeks) includes restoring range of motion, strength and flexibility.
· Phase 3 (12 - 24 weeks) includes balance exercises and the gradual return to activities that require turning or twisting the ankle. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities)—such as badminton, basketball, or football.
How long is the recovery?
Recovery may take just 2 weeks for minor sprains, or up to 6 to 12 weeks for more severe sprains. However, this is different for each individual and it can be influenced by sleep, nutrition, physiotherapy, physical activity, and other health related issues.
Frequently Asked Questions
What is a high ankle sprain and is that different from a regular ankle sprain?
A high ankle sprain refers to tearing of the ligaments that connect the tibia to the fibula (this connection is also called the syndesmosis). This injury is more severe and in most cases is more complicated than regular ankle sprains.
Do ankle sprains ever need to be repaired acutely?
Ankle sprains will heal by itself through conservative management. Surgery is rarely needed. The vast majority simply need to be treated with some rest, heat or ice, gentle ankle exercises followed by physiotherapy and in some cases temporary bracing.
I have sprained my ankle many times. Should I be concerned?
Yes. The more you sprain an ankle, the higher chance for it to reoccur. For example, turning the ankle can lead to damage to the cartilage inside the ankle joint and your balance may be compromised or your ligament may not have healed well from the previous sprain.
Is it necessary to do treatment after an ankle sprain?
Yes and No. It is difficult to answer this question since some of us do recover without treatment. The best advice is to see a physiotherapist to rule out any serious injury and then seek their expert opinion.
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Image credit: https://www.impactphysicaltherapy.com/understanding-ankle-sprains/
