Ankle Sprains

Ankle Sprains

Ankle sprains are one of the most common sports medicine injuries.  

The ankle is stabilized by 3 ligaments on the outside; the anterior talofibular, calcaneal fibular and posterior talofibular ligaments (see figure-1 st panel, and by a fan-like ligament in to inside-the deltoid ligaments.

Inversion injuries, turning the ankle inward, strain the outer ligaments, while eversion injuries will sprain the inner deltoid ligament.   Sprains are classified by degree of severity.

1 st degree sprains involve stretching of the ligaments but not tears.

  There is minimal swelling and instability.   Usually the patient may resume sports within a few weeks.  This is most common in ankle injury.

2 nd degree injuries involve tearing of ligaments with more swelling and bruising.

This may take several weeks to return to sports.

3 rd degree injuries involve severe tears of the ligament (yet surgery is rarely required).

Because the ligaments are torn it may take 8-12 weeks to heal.

Laxity and instability can result of this injury.

Many injuries with incomplete tears fall between 2 nd and 3 rd degree tears.

Treatment of Ankle Sprains

The first thing to do is accurately diagnose an ankle sprain and not miss other serious fractures that require other treatment.

Any injury that is very painful or unable to walk on should be suspected as a fracture and be seen by a doctor.

The severity of the injury should dictate the treatment.

Even a severe ankle sprain should be kept splinted and on crutches (even if no fracture is seen on the x-ray) since this treatment will also help them heal.

Approach to Rehabilitation

Stage 1- Inflammation (3days)

It is important to rest and splint the ankle. PRICES or Protection, Rest, Ice, Compression, Elevation and Support, will help decrease the pain and swelling associated with the acute injury.  

An anti-inflammatory drug may be used as well.

That will treat both the inflammation and the pain.

Stage 2-Early mobilization and strengthening (up to 1 week)

This involves walking on injury (assisted with crutches for partial support if needed).

Taping or a brace will also give support.

Early exercises to maintain range of motion are important.

Stage 3-Rehabilitation

This involves improving ankle strength, flexibility, and balance.

Physiotherapy or athletic therapy are important (this may begin on the 2 nd week).

Stage 4- Late Rehabilitation

It is important to ensure that the ankle is adequately strong enough to allow return to sport.

Some advocate over-rehabilitation, which refers to, the continuing of stretching and exercise programs at home to ensure that this same injury ill not reoccur.

Often making the athlete stronger than they were before the injury.

Forms of Treatment

Crutches- should be used whenever the injury is very painful to walk on.

Gradually crutches may be used less as the injury heals, by allowing more weight to rest on the foot.

Athletic Taping- supportive athletic tape is applied to the ankle to give support.

The tape must be applied by an experienced therapist and not left on overnight as it can interfere with circulation.

Ankle Braces- commercial over-the-counter braces give similar support to taping but may be easily applied by the patient and are reusable.  

They may also be used continually to prevent future ankle injuries.

Ankle braces such as air cast or equivalent are useful in limiting the injured ankle motion to an up and down plane (dorsiflexion/plantar flexion) but preventing any rolling over.  

This allows a quicker return to normal activities without re-injuring the injured ankle.

Medications

As mentioned earlier, anti-inflammatories are used at the onset to control inflammation and pain.

They are also of benefit later during rehabilitation.

Analgesics such as Tylenol (acetaminophen) give pain control but not anti-inflammation.

Glucosamine is an herbal agent that although slower in onset, has anti-inflammatory effects.

Corticosteroid injections are sometimes used in chronic injuries that still have significant pain and swelling but are not used for fresh injuries.

Therapy

Athletic therapy and physiotherapy are both specialties that assess and guide sports injuries through a program that is appropriate for each individual and injury.

They may use modalities such as therapeutic ultrasound and heat (among others) with an exercise program to restore pain free function.

A therapist will assess the degree of injury and stage of healing.   He/She will guide the patient through a program appropriate for them.

It is important not to do too little or too much. It is important to remember that each injury is different and may take it’s own amount of time to heal.

References:

1.   Textbook of Sports Medicine; Read

2.   Sports Medicine Secrets

Figure 1 Deltoid ligament of ankle

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Figure 2 Anterior talofibular ligament

Our clinic…

The Skylark Medical Clinic specializes in Sports Medicine and Travel Medicine.

Our clinic is affiliated with the Winnipeg Clinic, and is an active member of the American College of Sports Medicine, Divers Alert Network, International Society of Travel Medicine, and the Wilderness Medical Society.

Information current as of January 2006.

Copy write Skylark Medical Clinic 2003.

Information may be copied for educational purposes.