The ankle is an incredibly complex joint system consisting of 26 bones in the foot and the two bones of the lower leg. The complexity of this joint system, makes the ankle commonly injured. Ankle sprains can occur at any age and from a variety of movements. These sprains can range from mild to severe, depending on the amount of damage the ligament has undergone. To better understand how ankle sprains occur, it is important to know the makeup of the ankle.
Stability of the ankle is created through the actions of the muscles, the orientation of the bones in the foot/ankle, and ligaments surrounding the ankle/foot. The major ligaments of the lateral ankle consist of the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneal fibular ligament. The major ligament of the medial ankle is the deltoid ligament, which is made up of three distinct structures, the anterior and posterior tibiotalar ligaments, and the tibiocalcaneal ligament. The most common ligament that is sprained is the anterior talofibular ligament.
Common Symptoms Of Lateral Ankle Sprains:
- Sharp pain at the time of injury
- A “popping” sound is not unusual at time of injury
- Swelling and bruising is often noted but this depends on the severity of the sprain
- Pain and tenderness to the touch over the involved ligament
- May have limited ability to bear weight onto ankle/foot
- May demonstrate increased laxity of ligament
Common Causes Of Lateral Ankle Sprains:
- The most common form of a lateral ankle sprain is a downward and inward movement of the ankle/foot, known as an inversion ankle sprain
- Stepping onto an opponent's foot during sport
- Stepping into a hole or off the edge of a curb
How Can Physical Therapy Help Lateral Ankle Sprains?
Interventions are going to be specific to where you are in the recovery process and the extent of the injury. Progression of movements is quality based. As you demonstrate greater competency and capacity to do the movements, your physical therapist will progressively make the moves more challenging.
- Acute Sprains (1-7 days)
- Encourage weight bearing as soon as possible with functional bracing as needed. Functional braces include things such as an air cast or lace up brace that can provide some support but allow for movement to occur at the foot/ankle
- Compression with an ace bandage or compression sleeve
- Active ankle movements by writing the alphabet with your toes to help with swelling
- Manual therapy to address swelling and pain
- Contrast bath ice/cold and warm water
- Subacute Sprains
- Manual therapy to mobilize stiffness in the joint and surrounding tissues
- Balance/proprioception based movements
- Strengthening for specific weakness of the ankle/foot complex as noted during examination
- Progressive return to activities with graded exposure and limited to no bracing if able
- Specific exercises to hips, core, and lower extremities as indicated based upon examination findings
Grading System For Ligament Sprains
During your initial evaluation with a physical therapist, they will determine the grade of your injury from Grade I to Grade III depending on the severity of the sprain.
- Grade I:
- Relatively no loss of function
- Negative special test findings during examination
- Minimal to no bruising
- No point tenderness
- Minimal to no structural damage to ligaments
- Grade II:
- Some loss of function
- May demonstrate increased laxity during special tests but with a good/firm end feel
- Bruising and swelling
- Point tenderness
- Noted structural damage to ligaments but the ligament is intact
- Grade III:
- Significant to complete loss of function
- Significant laxity with empty end feel
- Bruising and swelling
- Point tenderness
- Likely complete disruption of the ligament
Every individual and every ankle sprain is very unique. The treatment suggestions listed above include several options to try and see how they may improve your situation. In addition, a thorough evaluation by a physical therapist can help identify specific features about your condition and how to best manage them. Understanding as much as possible about your current condition is a very important aspect of the recovery process and will empower you to take the necessary steps to get back to your normal activities with as little discomfort as possible.