Ankle sprains and injury of the ligaments on the outside of the ankle is the most common injury found in people doing sport or general exercise. Ankle sprains are also very common in the general population. Ligament sprains on the inside aspect of the ankle do occur, but they are less common. Sprains such as these have the highest re-injury rate in the leg and are most likely due to poor or no rehabilitation and/or returning to sport too soon. The correct assessment and treatment is, therefore, very important to limit re-injury of the ligament.
A look at ankle ligament sprains.
There are three outer ankle ligaments. When we sprain our ankle, we can either hurt one or more of these ligaments. There are three grades of injury that are based on the severity of the injury:
| Grade | Type of Injury | What it looks and feels like |
| 1 | Stretching of one of the ligaments causing small tears. | Mild swelling and maybe slight bruising. Pain with putting full weight on the foot. |
| 2 | Moderate injury of possibly more than one of the ligaments. | Swelling, bruising and tenderness over the ankle. |
| 3 | Total tear of one of the ligaments and partial tears of the other two ligaments. | Swelling and more significant bruising over the foot and heel. |
Assessment of ankle sprains
When assessing a ligament injury of the ankle, your physio will assess the following:
- How the injury occurred and what position the foot was in when it was injured.
- Whether there is a history of ankle sprains.
- The person’s ability to put weight on the leg.
- Swelling, bruising and the level of pain.
- Ligament tear tests.
- Joint movement at the ankle.
- Muscle strength of the foot and leg.
- Balance on a stable and unstable surface.
- How the person walks.
- The ankle’s position sense (does your brain know where your ankle is?)
Once the assessment has been completed, treatment will depend on what is found. This may include:
- joint mobilisation,
- loosening of the muscles,
- strengthening of the leg and foot muscles,
- improving balance and
- improving position sense at the ankle.
Treatment
If you have a Grade 2 sprain, you may need to use crutches for a day or two. Bracing or strapping can also be used for a few days.
If you have a Grade 3 sprain, you will need to wear an ankle brace and also use crutches for about one week. Even if you are on crutches, physiotherapy should be started as soon as possible to prevent the ankle joint from getting stiff, to help control swelling and pain and to prevent the muscles from weakening. If the joint is stiff and the muscles around the ankle are weak, rehabilitation will take longer.
Below are some basic ankle rehab exercises that may be included in your rehabilitation programme given to you by your physio:
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| Balancing on the injured leg with your eyes open and with your eyes closed. |
Slow and controlled heel raises.
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Balancing on an uneven surface on the injured leg. Picture courtesy of http://www.kneesurgeryacl.com |
This article was submitted by Wendy Snyders Associate Manager at the Tygervalley Practice Speak to her about rehabilitation for ankle strains, or else fill in our handy appointment form to send a message.
References:
- Al-Mohrej and Al-Kenani (2016). Acute ankle sprain: conservative or surgical approach. Foot and ankle 1: 34 – 44
- McGovern and Martin (2016). Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine 7: 33–42
- Delahunt et al (2018). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. British Journal of Sports Medicine.
- Some images courtesy of https://www.physio-pedia.com