What is an Ankle sprain?
Ankle sprains are a common overlooked soft tissue injury, caused by rolling or twisting action of the foot, often created by a sudden unexpected movement. The tendons and ligaments around the ankle can tear or stretch beyond their normal range of motion.
There are three different types of Ankle sprains- High, Medial, and Lateral.
The most common is a Lateral ankle sprain, which presents in 85% of all cases, this is when the ankle rolls to the outside of the foot. (inversion sprain)
The medial ankle sprain is when the ankle rolls to the inside of the foot ( eversion sprain)
The third and more unusual type is a high ankle sprain or a Syndesmosis injury this is located above the ankle joint and affects the ligaments that connect the tibia to the fibula, they also take much longer to heal than lower ankle sprains.
How do you know if you have an ankle sprain?
When the ankle rolls over, a popping sound can often be heard but mainly the area swells within half an hour of the injury, accompanied by pain, stiffness, and bruising that will follow shortly after. There may be an inability to weight bear on the ankle too.
What should I do after spraining my ankle?
For homecare -use an elastic bandage for example Coban, cohesive wrap, or vet wrap, these are better than crepe bandages as they stick to themselves.
Elevate the ankle and rest without weight-bearing for as much time as possible for the first few days.
The most recent evidence is the “Peace and Love” approach to injuries, as shown in the image, suggesting no anti-inflammatories at all, this will be a surprise to most but this allows the body to heal itself and is considered to be the most effective evidence-based initial treatment.
Hospital-based care
With ankle injuries, especially if weight-bearing on the affected foot is a problem then it is wise to visit A&E for an X-ray to rule out any fractures or an ultrasound investigation to assess any soft tissue damage. Imaging is important as it may affect what treatment plan may be put in place and the expected length of recovery.
How can I help myself after an ankle sprain?
In most cases of ankle sprains, rest is a priority and if possible, it should be for a good few days.
Mobility can be a real issue for most, I am not a fan of crutches as I think they are uncomfortable, impractical and accidents can often be caused by them. I prefer air walkers in the initial acute stage. Air walkers are brilliant at both protecting the ankle but also enabling mobility, especially useful for those patients who need to go to work. There are many brands of Air walkers and they pretty much all do the same thing, it is a matter of just choosing one that suits you and your budget.
After 2 to 4 weeks in an air walker, the foot can move into a lighter supportive device like the aircast stirrup ankle support, these still give support but allow movement in the sagittal plane, encouraging walking but with the restriction of the rolling movement of the ankle.
The softer neoprene supports can be used at night in bed instead of the air walker and the final stage of support after the aircast stirrup support has been removed.
Throughout this initial acute stage, the alphabet exercises should be carried out, they can be done non-weight-bearing and they gradually get the ankle moving, which helps the swelling to be dispersed.
When the ankle becomes less painful and swelling reduces, then the supports can be gradually removed, and walking can resume with a well-supported shoe or boot. Rocker types of footwear can be useful in recovery too as they help the foot move more efficiently.
This acute stage of the recovery process can take between 2 - 12 weeks depending on the severity of the injury.
Rehabilitation will continue into months 3 to 6 by increasing the load through the ankle joint, and wobble boards especially the BOBO board is great for triplane ankle movement and strengthening. The ligaments located on the outside and inside of the ankle joint will not be particularly loaded during walking and this is why the wobble boards help in this way.
Who is more likely to get an ankle sprain?
- Taller athletes have a much greater risk of injury.
- Lateral ankle sprains are reported to be higher in females.
- Certain types of sports, especially basketball and netball that involve jumping, twisting, and swizzling have a higher incidence of injury too.
- A change or shift in training loads can put extra pressure and stress on these ligaments, priming them for a sprain.
- A history of previous ankle injuries, indicating an unstable or incompletely rehabilitated previous ankle sprain will also make them susceptible to a sprain.
- Floor surfaces can make a big difference when the foot comes to a sudden stop on a very grippy surface- the foot remains stationary but the leg and ankle continue to move over the ankle which can result in an ankle sprain.
- Injuries are increased in patients who have hypermobility in the foot and leg, this is where the ligaments have been asked to extend beyond their range of motion and consequently sprain.
Secondary injuries caused by ankle sprains
A very common and overlooked problem with an ankle sprain is that a secondary injury can often present a few weeks after the original injury. Posterior tibialis tendinitis tends to be the most common one, it is a painful injury located on the lower inside portion of the calf, and ankle and sometimes presents in the arch of the foot.
If this condition is not recognized straightaway it could easily extend the rehabilitation process, setting the athlete's progress back substantially. It's important if an ankle injury doesn't seem to be progressing as it should, then an investigation for a secondary problem is always suggested.
What can a podiatrist do for an ankle sprain?
Podiatrists are specialists in foot and leg pain. They can recognise and grade ankle sprains, set up a treatment plan for the acute stage, and chronic stage, right through to complete rehabilitation.
They may strap the ankle, use laser therapy to accelerate the healing process, or set an exercise program up for rehabilitation.
As with most ankle sprains if the rehabilitation process isn’t completed properly the chances of recurrence are high. The ankle requires the muscular structures around it to be strong as the ankle joint is the only joint in the body that operates in three planes of motion making it a complex invaluable joint for mobility.
Rehabilitation of any joint is important, but the ankle joint is crucial to enjoying a normal active life, so it's important to get the correct treatment right from start.
