Ankle Sprain

Ankle Sprain

An ankle sprain occurs whenever one or more of the ligaments of the ankle are partially or completely torn. Ankle sprains are commonly classified by first degree (mild) in which there is microscopic tearing of the ligament without joint laxity, second degree (moderate) in which there is tearing of some ligament fibers with moderate laxity, and third degree (severe) in which there is a complete rupture with profound laxity. Other classification could be a single, double, or triple ligament rupture.

 

Etiology

85% of ankle sprains that occur are inversion-type, lateral ligament injuries. In other words, most ankle sprains occur to the ligaments on the outside part of the ankle. The most common ankle ligament to be sprained is the anterior talofibular ligament (ATFL) due to its location. Ankle sprains occur highest in the sports population than any other population and is the second most likely body part to be injured.
 

 

Lateral ankle sprains usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to overstretch and tear. Less commonly, an eversion ankle sprain occurs when forceful eversion movement at the ankle injures the strong deltoid ligament. “High” ankle sprain occurs with external rotation and dorsiflexion.

Risk Factors

Intrinsic

  • Previous ankle sprains compromising the strength and integrity of the stabilizers and interrupt sensory nerve fibers

  • Sex

  • Height

  • Weight

  • Limb dominance

  • Postural sway and foot anatomy
     

Extrinsic

  • Taping/bracing

  • Shoe type

  • Competition duration

  • Intensity of activity

  • Clinical Presentation

  • Inversion injury or forceful eversion injury to the ankle. May have previous history of ankle injuries or instability

  • Only able to partially weight-bear on the affected side (put weight onto injured ankle)

  • Cold foot or paraesthesia (burning, pricking sensation) could mean compromise of peroneal nerve

  • Tenderness, swelling, and/or bruising on either side of ankle

  • No bony tenderness, deformity, or crepitus present

  • Passive movement into inversion or plantar flexion (point toes toward floor) and inversion should replicate symptoms for a lateral (outside of ankle) ligament sprain. Passive eversion should replicate symptoms for a medial (inside of ankle) ligament sprain.

  • Special Tests to verify sprain: Anterior Draw, Tamar Tilt, Posterior Draw, or Squeeze Test (depending on structures involved)

Medical Management

Mild

  • Natural (non-operative) full recovery within 14 days

  • Taping and follow up to evaluate healing progression

  • First time, mild sprains can resolve quickly with minimal intervention from therapy

  • “PRICE” should be incorporated 3-5 times a day

  • Protection- tape, casting, bracing, etc

  • Rest- rest from any aggravating activities

  • Ice- 10-15 min with elevation to control swelling

  • Compression- compression bandage to control swelling

  • Elevation- above the level of the heart ideally, or not in a position in which it is under the rest of the body
     

Moderate

  • Still treated non-operatively

  • Can be split up into three phases: max protection/inflammatory phase (0-3 days), mod protection/proliferation phase (4-10 days), and min protection/remodeling phase (11-21 days)
     

Max/inflammatory phase:

  1. Still incorporates “PRICE”

  2. Active movements with toes and ankle within pain free limits

  3. Manual therapy in the acute phase to improve dorsiflexion (pull toes up/stretch calves)
     

Mod/proliferate phase:

  1. Gradual increase in activity and weight bearing

  2. Practice foot and ankle functions (range of motion, active stability, motor coordination)

  3. Tape/brace
     

Min/remodeling phase:

  1. Education about preventive measure (tape/brace, proper shoes during sport activities, types of sports, etc)

  2. Practice foot and ankle functions (balance, muscle strength, motion and mobility)

  3. Work on dynamic stability

  4. Irregular surfaces training

  5. Late remodeling phase continues to progress the load-bearing capacity and complexity of exercises until the patient’s restored


Severe (tear)

  • Treated surgically or with immobilization and supervised physical therapy

  • Immobilization and protection last longer than mild or moderate sprains, and then physical therapy protocol follows similar to that of a moderate ankle sprain

At Home Exercise Videos