A sprained ankle occurs when your ankle ligaments are overstretched, usually by your ankle being turned, twisted or rotated past its capabilities. Ankle sprains vary in their severity, from mild “rolled ankle” sprains through to severe complete ligament ruptures, avulsion fractures or broken foot bones.
The structures and ligaments that are often injured are:
– The Anterior Talofibular ligament (ATFL) – Lateral ankle
– Calcaneofibular ligament (CFL) – Lateral ankle
– Anterior Inferior Tibiofibular ligaments and Syndesmosis – High ankle
– Deltoid ligaments – Medial ankle
– Lateral Malleolus – Lateral ankle
– Medial Malleolus – Medial ankle
– Fibula fractures – High and Medial ankle
Ankle Sprain Treatment
The treatment of an injured ankle consists of manual therapy to help reduce swelling and protective muscle tightness, strengthening exercises to improve range of motion and function and advice on how to best return to work or sport following full rehabilitation.
In the early stages, ankle injury physiotherapy consists of more hands-on techniques aimed at restoring your full ankle movement again. This is coupled with taping the injured foot to better support it and gentle exercises such as moving your foot in small circles and walking as tolerated.
Once the swelling has decreased and the movement has returned, we can progress to a full exercise program to help strengthen the muscles of the foot, ankle and calf. The calf and the surrounding stabilising muscles are important to work on as they play a large role in how successfully you return back to sport or work, and how big the risk is of re-injury down the track. Our goal during this phase of rehabilitation is to build enough strength to comfortably perform single leg calf raises on both sides. This is done so that we can then progress to running, jumping and hopping movements which further challenge the integrity of the ankle.
As many ankle injuries are sustained during running, jumping and hopping, these are exercises we incorporate into the end stage rehabilitation. These work to improve the power, endurance, balance and proprioception of the ankle, to decrease the risk of rolling it again and sustaining another injury.
Balance and proprioception exercises are aimed and improving the stability of your ankle. These are exercises which can be performed on unstable surfaces such as foam pads or wobble boards, or just combined with other tasks to take away your concentration. For example, balancing on one foot may seem like an effective exercise, but in a controlled environment is it usually quite easy to perform. Our balance can be challenged by changing the environment to mimic that of which we will return to, so for an athlete, we can mimic their sport by throwing them a ball whilst they balance on one foot or get them to jump from one foot to another and stick the landing.
Lateral Ankle Sprains
Ankle sprains are a very common injury during exercise and sports. Ankle sprains occur when the ligaments on the outside of your foot are stretched past their capacity – which happens when the ankle rolls inwards. It is possible for this to happen to the ligaments on the inside of the ankle too, however this is a lot harder to achieve and therefore a rarer incident.
Symptoms can vary however most will experience some level of bruising, swelling and soreness over the area which may leave some unable to full weight-bear in the first few days after injury.
There are many factors that can lead to rolling your ankle:
– Uneven surfaces
– Unsupportive footwear
– Poor balance and proprioception
– Weakness of foot, ankle and calf muscles
– Unpredictability of sport (Getting tackled or stepping on another person’s foot)
– Previous history of foot and ankle injuries
High Ankle Sprains
A high ankle sprain is an injury to the upper ligaments of your ankle, located above the ankle itself. These ligaments are responsible for holding the two lower leg bones (the fibula and the tibia) together for stabilisation during activities like running, jumping and twisting. Due to the position and purpose of these ligaments, they are injured by excessive rotation or twisting of the ankle. In a sporting situation, this can occur when a person plants their foot and rotates their body, or when they are tackled, pinning their foot and getting their body twisted over the top of it.
Due to the nature and severity of this type of injury, the rehabilitation process and time frames are normally a lot longer than a lateral ankle sprain, and may require a moon boot or even surgery in extreme cases.
In comparison with the typical symptoms you would experience with a lateral ankle sprain, high ankle sprains will present with pain and swelling above the ankle joint and between the two lower leg bones rather than the outside of your foot. These injuries are usually much harder to put weight through and walk on, requiring crutches or a moon boot as assistance in the first week or two. As the pain can be quite significant, these types of foot and ankle injuries are often referred for imaging as well to rule out any breaks or fractures within the fibula or tibia.
Medial Ankle Sprains
Medial ankle sprains occur to the inside of the ankle, when the deltoid ligaments are injured. These ligaments are less commonly affected as they are stronger than the lateral ligaments and because it is much more difficult to “roll” your ankle outwards than inwards. The main method of injuring these ligaments are through trauma which often results in a fracture of the ankle or fibula as well.
Symptoms are similar as those described above like pain, bruising and swelling however the location is on the inside of the ankle. Medial or deltoid ankle sprains are another severe type of ankle sprain, which is usually accompanied by loss of movement and difficulty weight-bearing. Due to this and the common association with fibula fractures, it is again recommended that imaging take place when medial ankle sprains are suspected.