An ankle sprain or ‘rolled ankle’ refers to an over-stretching or tearing of ligament fibres- the strong bands of connective tissue which attach bone to bone.
Ankle sprains, in particular lateral ankle sprains are one of the most common sporting injuries that we see.
In this article Osteopath Dr Abbey Davidson discusses the anatomy of the ankle bones and ligaments, how ankle sprains usually occur, share some tips on how to avoid ankle sprains, how you can treat a mild ankle sprain yourself, and what an Osteopath or Physiotherapist will do if you’ve really injured yourself!
Ankle anatomy – the bones
The ankle joint is made up of 3 joints- the talocrural joint, the subtalar joint and the inferior (or distal) tibiofibular joint:
- The talocrural joint is created by the tibia and fibular (the lower leg bones) and the talus of the foot.
- The subtalar joint is created by the talus and calcaneus.
- The tibiofibular joint is created at the distal end of the leg, between the tibia and fibula.
Ankle anatomy – the ligaments
While sprains can occur to the ligaments that cross any of these joints, by far the most commonly sprained ligaments at the ankle are the lateral ligament group (on the outside of the ankle) that cross from the fibula to the calcaneus and talus.
There a three different groups of ligaments in the ankle. There are the lateral ligaments, the medial ligaments (Deltoid Ligaments) and the tibiofibular ligaments (High ankle ligaments or syndesmosis). Individually each of these groups can be sprained. Once a ligament has been torn or sprained the elasticity and resilience of the structure is usually reduced.
The most common sprain is an inversion-type sprain with damages the lateral ligament complex on the ankle. Lateral ligaments sprains make up 85% of sprains, compared to high ankle sprains which make up 1% of sprains. Ankle sprains are really common among sports populations and the incidence is even higher in indoor sports. It has been reported that ankle sprains account for 25% if time lost in athletics.
Causes of Ankle sprains:
Ankle sprains commonly occur with a recent injury and awkward twisting of the ankle. Sports falls, running on uneven surfaces, someone stepping on your foot/ankle while moving and stepping awkwardly off a kerb are common culprits.
Each ligament group has a separate mechanism which leads to an over-stretching or spraining. The lateral group in injured with pointed foot turning inwards. The Deltoid group is injured with the sole of the foot turning outwards. High ankle sprains are caused with an outward spinning of the leg in a dorsiflexed .
Ankle sprains are graded into three different categories or severities. There are three grades one being the least severe with minimal degree of tearing, swelling, bruising and instability. Three being the most severe with a complete tear and accompanying swelling, bruising and instability.
Signs and Symptoms of an Ankle sprain:
After an ankle sprain an individual can present with some or all of the following:
- Recent incident of ankle twisting
- Pain
- Inability to weight bear
- Bruising
- Swelling
- Feeling of instability
If there is any deformity or suspicion of fracture in the ankle it is best an individual gets assessed as soon as possible by a health professional.
What you can do to help yourself:
After an ankle sprain you should implement RICE, weight bear as soon as possible, perform gentle ankle range of motion exercises and/or brace or strap the injured ankle.
Rest, Ice, Compress and Elevate (RICE). After an acute injury like an ankle sprain there can be a considerable amount of swelling and inflammation. By resting you are providing an opportunity for torn ligament fibres to repair and avoid any further stretching of already damaged ligaments. Icing, compression and elevation all aim to decrease the inflammation and pooling of fluids around the ankle area. Ensure with icing there is no direct contact with the skin and application is for 10-20mins hourly for the first 48 hours after injury.
Weight bear as soon as possible, unless otherwise advised by a health professional. Within pain limits an individual with a sprain ankle should be attempting to weight bear 1-2 days after injury. Immobilisation after this time frame can permanently impact the range of motion available at the ankle joint.
Gentle ankle range of motion exercises should be performed. Aim to perform pointing and flexing the toes and then bringing the sole of the foot inwards and outwards. Begin these within 1-2 days after the injury and perform within pain limits. This will aid in the maintenance of ankle range of motion and the movement of excess swelling away from the ankle area.
Bracing and strapping of the ankle joint can assist in an individual returning to weight bear, improving the feeling of stability and assist in the return to sporting activity. An instructional video on how to tape a lateral ankle sprain (most common) is linked below.
How to prevent Ankle Sprains:
Once you have sprained an ankle you at more likely to sprain that ankle again. This is due to a lack of ankle mobility and/or stability from the initial injury. Performing some simple exercises to improve mobility and stability through the ankle can help prevent future sprains. The video below with Physiotherapist Ryan Dorahy demonstrates some of these exercises:
What your health professional will do:
A health professional will establish if you truly have sprained your ankle by ruling out other conditions. Following a diagnosis a treatment and management plan can be formulated.
A physiotherapist or osteopath will spend a period of time asking you questions about your recent ankle injury. After this they will assess your ability to weight bear, move your ankle in all ranges and use orthopaedic tests to assess the stability of the ligaments in your ankle. They will also take the opportunity to screen your body. The hip, knee, ankle and foot mechanics will be assessed to establish what other regions require treatment and if they potentially contributed to the initial injury. Your physiotherapist or osteopath will then spend time explaining their findings and how in combination you and your practitioner will manage your condition.
Hands on techniques will focus on maintaining and improving your ankles range of motion, reducing the level of welling and returning you to weight bearing as soon as possible. As your pain symptoms reduce your osteopath or physiotherapist will prescribe you exercises to assist with the return of range of motion, strength and balance. It is important that you follow your partitioners advice as they are aiming not only to repair your current sprain but prevent another occurring in the future.
Prognosis:
The time it takes to heal from a sprain is heavily dependent on the grade of the initial injury. Grade 1 sprains are anticipated to recover in 1-3 weeks; Grade 2 within 3-12 weeks and Grade 3 within 6-12 months.
It is quite common that after an initial ankle sprain other’s can occur. Each time your re-injure an ankle the likelihood of incurring another sprain increases again. Some who experience recurrent sprains may encounter balance issues which is a good indication for further rehabilitation or further osteopathic/physiotherapy management.
After a higher grade sprain or recurrent sprains, the ankle joint can become unstable. This may involve more intensive rehabilitation with a physiotherapist or osteopath. In rare cases where instability and recurrent severe ankle sprains are present surgery can be performed. High ankle sprains generally always require surgery.
Often individuals who experience recurrent sprains will continue to brace or strap the ankle during sporting activity as a preventative measure.
