An ankle sprain is where one or more of the ligaments of the ankle are partially or completely torn.
Inversion ankle sprains are the most common, making up 85% of all ankle sprains. The most commonly torn ankle ligament is the anterior talofibular ligament (ATFL) which is on the lateral aspect of the ankle. Additional ligaments on the lateral aspect of the ankle include the calcaneo-fibular ligament (CFL) and the posterior talofibular ligament (PTFL).
Signs and symptoms of a sprained ankle include:
- Pain, especially when you bear weight on the affected foot
- Swelling and, sometimes, bruising
- Restricted range of motion
Grade I – Mild – Little swelling & tenderness with little impact on function
Grade II – Moderate – Moderate swelling, pain and impact on function. Reduced proprioception, ROM and instability
Grade III – Severe – Complete rupture, large swelling, tenderness, Loss of function and marked instability
When the patient needs to see a doctor:
- cannot step on the foot or bear weight at all.
- cannot move the foot / knee.
Prognosis:
The prognosis for isolated and adequately treated ankle sprains is excellent. With good rehabilitation program 85% of the people recover within the first 6 months.
Some of the people will experience recurrent ankle sprains. If recurrent ankle sprains are treated early and appropriate rehabilitation is initiated, the prognosis is excellent with conservative treatment.
The goals of rehabilitation program:
- Full active and passive range of motion.
- Good muscle strength.
- Good muscle control and balance during all activities.
- Movement with no pain.
Rehabilitation phase 1 (first 72 hours):
- Protection – protect the affected area from further injury by using a support or, in the case of an ankle injury, wearing shoes that enclose and support the feet, such as lace-ups.
- Rest – Avoid sport related activity for the first 48 to 72 hours after the injury.
- Ice – for the first 72 hours after the injury; apply ice wrapped in a damp towel to the injured area for 10 to 15 minutes every two to three hours during the day.
- Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or an elasticated tubular bandage. It should be wrapped snugly around the affected area, but not so tightly that it restricts blood flow. Remove the bandage before you go to sleep.
- Elevation – keep the injured area raised and supported on a pillow to help reduce swelling. If your leg is injured, avoid long periods of time where your leg isn’t raised.
Rehabilitation phase 2:
- Massage: Gentle massage in the elevated position has been shown to assist in the reduce swelling.
- Range of Motion (ROM) exercises- with and without weight.
- Flexibility exercises: CALF stretch.
- Pain relief techniques: TENS, US, Tape.
- Partial or full Weight Bearing exercise: depense on the severity and pain level.
- Use ankle brace only if the patient feels he is not controlling the ankle while walking.
- Ice in the end of treatment – 10 min.
Rehabilitation phase 3:
- Keep with Range of Motion (ROM) exercises- with and without weight.
- Strengthening exercise for the ankle stabilisers- evertors specifically.
- Full Weight Bearing exercise: Functional exercise according to the patients complains.
- Pain relief techniques: TENS, Ultrasound, Tape.
- Ice in the end of treatment – 10 min.
Rehabilitation phase 4:
- Keep with Range of Motion (ROM) exercises- with and without weight.
- Strengthening exercise for the ankle stabilizers- evertors specifically.
- Full Weight Bearing exercise: Functional exercise according to the patients complains.
- Start with balance exercise according to the patient’s level.
- Pain relief techniques: TENS, US, Tape.
- Ice in the end of treatment – 10 min.
Rehabilitation phase 5:
- Sport specific activities
- Balance exercise
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References:
1. Whitman, et al. Predicting short term response to thrust and non-thrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Phys Ther, 2009; 39(3):188-200.
2. Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28:112–116
3. Van der Wees PJ, Lenssen AF, Feijts YAEJ, Bloo H, van Moorsel SR, Ouderland R, et al. KNGF-Guideline for Physical Therapy in patients with acute ankle sprain. Dutch J Phys Ther. 2006; 116
4. Van der Wees PJ, Lenssen AF, Hendriks EJM, Stomp DJ, Dekker J, de Brie RA. Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: a systematic review. Aust J Physiother. 2006; 52:27-37
