Ankle Sprains & Pains

Sprained Ankle Injury Explained

A sprained ankle is one of the most common injuries caused by participation in sports. It refers to soft tissue damage (mainly ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards) or an eversion injury (where the ankle is twisted outwards).

Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle.

The most commonly injured ligament is the Anterior Talo Fibular ligament (ATFL) which, as the name suggests, joins the fibular and talus bones together. If the force to the ankle is more severe, the Calcaneo Fibular ligament (CFL, between the Calcaneus and Fibula) is also damaged. The Posterior Talo Fibular ligament (PTFL) is very rarely damaged in comparison to the other two ligaments.

In the case of an eversion injury the damage occurs on the medial (inside) of the ankle. The ligaments on the inside of the ankle are called the Deltoid ligament and are very strong. They are so strong in fact that the bone on the inside of the ankle can be pulled off, in what is called an avulsion fracture, before the ligament is damaged.

As well as damage to the ligaments, the capsule which surrounds the ankle joint is also damaged. The damage causes bleeding within the tissues and the ankle begins to swell up and can be extremely painful.

Ankle sprains can be classified as follows:

• First degree, where only a few ligament fibres are damaged, and pain is felt but no laxity is felt upon tensing the ligaments
• Second degree sprain refers to more extensive damage to the ligament with associated swelling, increased pain and laxity
• Third degree sprain refers to a complete rupture of the ligament with swelling and a possible joint dislocation

In the more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture.

Sprained Ankle Injury Signs & Symptoms

With a first degree sprain there is pain when turning the foot in or out and also pain when the damaged area is touched. With a second degree sprain the pain is more severe, there is swelling all around the area and it is painful to walk. With a third degree sprain the pain is excruciating and walking is impossible. There is gross swelling and there may be deformity if the ankle is dislocated.

Sprained Ankle Injury Treatment

In the first 48-72 hours following the injury it is important the follow the PRICE protocol - protection, rest, ice, compression and elevation (never apply ice directly to the skin). Ice packs for a period of twenty minutes every couple of hours may help with the pain but pain-relieving medication may also be necessary.

It is important not to put too much weight on the damaged ankle, so walking should be avoided if possible. Ankle injuries can be protected using a cast and supportive taping is regularly used by athletes.

Where a fracture is suspected an x-ray should be carried out. If a fracture is found or a Grade Three sprain is diagnosed, the advice of the attending doctor should be followed. It should be borne in mind that some hairline fractures do not show up on x-ray until about 10-14 days after the injury, so if the pain persists medical attention should be sought.

In the case of a Grade Two sprain, crutches should be used to protect the injured ankle. However, it is important not to be on the crutches for longer than necessary and as soon as the pain allows the patient should begin to gently put weight through the ankle by walking.

In the early stages of the injury, ultrasound treatment can be effective in encouraging the healing process and encouraging the formation of scar tissue to repair the ligament. However, soft tissue massage can stimulate the same results and is often used more widely by physios in order to feel the progress too.

Once the patient is able walk on the ankle, more active rehabilitation can be started. Your local IPA physio is experienced with hands-on rehabilitation and giving you exercises for retraining sprained ankles, so simply phone 1300 PHYSIO to be transferred directly to their practice.

In ankles that have been repeatedly sprained there is an inherent weakness which may require surgery. This can now be done arthroscopically where a camera is inserted into the ankle and flakes of bone and excess scar tissue can be removed.

Sprained Ankle Injury Prevention

Ankle instability is characterised by ankle weakness and giving way, even though the ankle ligaments are intact and the joint is ‘mechanically' stable. It is due to an impairment of proprioception, which leads to a lack of balance and ankle joint position sense. Proprioception is the mechanism by which nerve receptors in skin, muscle, ligament and joint tissue relay information to the brain about body position sense, where this information is quickly processed and movement strategies are formulated and executed using nerve signals to muscles. This mechanism can help you ‘catch yourself' when you are about to turn your ankle.

In the unstable ankle these receptors may have been damaged directly during an ankle sprain. This impaired proprioceptive ability may, therefore, lead to a delay in protective muscle activity and the resultant loss of postural awareness and stability around a joint. This may explain why recurrent ankle sprains are so common.

The wobble board together with ankle braces are commonly used in the rehabilitation of ankle instability. Wobble boards are designed to assist the re-education of the proprioceptive system by improving sensory receptor function. Previous research has also shown that wobble board training improves single leg stance ability and balance; while other studies have suggested that patients with ankle instability who underwent wobble board training experienced significantly fewer recurrent sprains during a follow-up period than those who did not follow the training program.

Taping and bracing the ankle can also help to reduce recurrent ankle injury. Previous research has shown the injury incidence in students with taped ankles was 4.9 ankle sprains per 1000 participant games, compared with 2.6 ankle sprains per 1000 participant games in students wearing ankle braces. This compared with 32.8 ankle sprains per 1000 participant games in subjects that had no taping or bracing.