A strained or sprained ankle occurs when you overstretch or ‘roll’ your ankle causing damage to the ligaments that support and stabilise the foot and ankle bones. Ankle sprains vary in their severity – a minor tear to the ligament(s) is classified as a Grade 1, moderate tear (up to 50%) is Grade 2 and a complete rupture of the ligament is a Grade 3 tear. In extreme cases an avulsion fracture (small non-displaced fracture) or displaced fracture can occur.
Injuries occur when your ankle is overstretched medially (inwards) or laterally (outwards) under a load that is too significant for the ligaments and supporting musculature to bear, hence causing them to tear. For example, landing unbalanced from a jump, awkwardly planting your foot when running, stepping onto an unstable surface or an outside force acting on the ankle (such as a push or bump from another person).
What are the symptoms of a sprained ankle?
The mechanism of injury (how it happened) is a key factor in whether you have sprained your ankle. When rolled, you may feel or hear a popping or cracking sound followed by ankle pain, swelling and bruising. Lateral or medial ligament sprains are tender to touch over the injured ligament. You may have trouble standing on your foot or walking, depending on the severity of your ankle sprain. In these cases, crutches, support strapping or bracing may provide comfort to help you mobilise. In more extreme cases, a person may experience sharp pain deep in the ankle joint, an inability to weight-bear/walk for 4 steps, throbbing and significant swelling – these are signs that may be associated with a fracture.
Which ligaments can be injured?
Your ankle joint is known as the talocrural joint, and is comprised up of three bones. Your tibia (shin bone), fibula (outer lower leg bone), and your talus (deep ankle bone at the top of the foot). Beneath your talocrural joint lies the subtalar joint, which is the articulation between the talus and the calcaneus (heel bone). Ligaments attach bone-to-bone and their primary role is to passively limit the motion and stabilise the joint.
Outside of the ankle are the lateral ligaments, which are the most frequently injured in an ankle sprain. These include the:
- Anterior Talofibular Ligament (ATFL)
- Calcaneofibular Ligament (CFL)
- Posterior Talofibular Ligament (PTFL)
The main medial (inside of the ankle) ligament is the much stronger deltoid ligament complex. High ankle sprains involve the inferior Tibiofibular Ligament and Syndesmosis. These are more disabling ankle injuries. Unfortunately, misdiagnosis is common.
How is a Sprained Ankle Diagnosed?
Your physiotherapist is highly skilled in the assessment and diagnosis of an ankle sprain. Your physiotherapist will listen to your injury history and perform a clinical examination involving range of motion, special ligament integrity tests, palpation examination and gait analysis to determine the severity of your sprained ankle. If necessary you may be referred for further diagnostic testing such as an x-ray, or MRI. These tests may assist in confirming or excluding specific ligament or bone injuries but are often not necessary in determining the diagnosis.
Ankle Sprain Treatment
PHASE I
Reduce Swelling and Pain Management
Your physiotherapist will likely implement a range of treatments in order to reduce your symptoms and swelling. This can include:
- Manual therapy techniques such as massage or trigger point therapy and of the lower leg musculature. Gentle ankle joint mobilisations and supportive taping or bracing.
- Restoring ankle dorsiflexion (or bend) as soon as possible is a very important first step.
- Advice specific to ankle sprains which may include education on the use of crutches, avoiding unstable surfaces, relative Rest, Ice, Compression and Elevation (RICE) to manage swelling.
- A home exercise program will be implemented by your physio most likely focussing improving ankle range of motion (ROM) and maintaining strength.
PHASE II
Restoring Normal Movement and Strength
- Once your pain is well controlled you will gradually begin a supervised exercise program focussing on strength of the muscles supporting your foot and ankle. This can be in the form of clinical pilates and/or a gym based program.
- As the ROM and strength of your ankle improves, your physio will progress your home exercise and supervised exercise programs into more functional positions/postures.
- Depending on your chosen work, sport or activities of daily living, your physio will aim to restore your function to safely allow you to return to your desired activities in line with your specific treatment goals.
PHASE III
Restoring Full Function, Balance and Proprioception & Preventing a Recurrence
- The last stage of your rehabilitation aims at returning you to your desired activities and preventing a recurrence. Most ankle sprains recur as a result of poor or incomplete rehabilitation in the first instance. An ankle sprain is a significant injury – a fact that should not be underappreciated.
- The fine-tuning of your balance and ankle awareness (proprioception) is a key component to full rehabilitation. Addressing any deficits in these areas is important in the prevention of a recurrence. Your physio will guide you through self-management techniques to reduce and manage any future symptom increases.
If you have hurt your ankle and would like to have a FREE assessment by a Physiotherapist or Exercise Physiologist, book in to Back in Motion Aspendale Gardens here.