Ankle Sprain

ANKLE SPRAIN
INTRODUCTION:-

A sprained ankle is a very common type of ankle injury. A sprain is stretching and or tearing of ligaments (you sprain a ligament and strain a muscle).

MECHANISM OF INJURY:-

The most common is an inversion sprain (or lateral ligament sprain) where the ankle turns under so the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.

A medial ligament sprain is rare but can occur particularly with a fracture. This happens when the ankle rolls the other way, so the sole of the foot faces outwards, damaging the ligaments on the inside of the ankle.

The most common damage sustained in a sprained ankle is to the anterior talo-fibula ligament shown towards the front of the image opposite. This ligament, as the name suggests, connects the talus (ankle bone) with the fibula (smaller of the two bones in the lower leg). If the sprain is severe there might also be damage to the calcaneo-fibula ligament (connects the heel bone to the fibula) which is further back towards the heel. This ligament only becomes injured in more severe injuries due to its increased strength and laxity whilst the toes are pointed (a common position for injuries).

In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. Complete ruptures of the anterior talo-fibular, calcaneo-fibular and posterior talo-fibular ligaments results in dislocation of the ankle joint and is often associated with a fracture.

 CAUSES

A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology

A sprained ankle is classified into three categories depending on severity:

First degree ankle sprain:
  • Some stretching or perhaps minor tearing of the lateral ankle ligaments
  • Little or no joint instability
  • Mild pain
  • There may be mild swelling around the bone on the outside of the ankleSome joint stiffness or difficulty walking or running

Second degree ankle sprain:

  • Moderate tearing of the ligament fibres
  • Some instability of the joint
  • Moderate to severe pain and difficulty walking
  • Swelling and stiffness in the ankle joint

Third degree Ankle Sprain:

  • Total rupture of a ligament
  • Gross instability of the joint
  • Severe pain initially followed later by no pain
  • Severe swelling

Physiotherapy diagnosis

Active movements

The patient moves the foot from plantar flexion to dorsi flexion.Looking for reduction in normal range of movement and any pain in performing these movements.Then repeat moving from eversion to inversion

Passive movements

The therapist moves the ankle and foot from plantar flexion to dorsi flexion and then inversion to eversion looking again at range of movement, comparing one foot with the other and and painful movements.The athlete remains relaxed and does not resist or actively move the foot or ankle. Any pain at the extreme range of inversion may indicate ligament damage as it is the ligament that is being stressed.The anterior drawer test is a special test which assesses the integrity of the ankle ligaments, particularly the anterior talo fibula ligament and the calcaneo fibula ligament

Resisted movements

The therapist gently resists the athlete as they try to move the ankle from inversion to eversion Pain when performing this test may be an indication of tendon damage or inflammation (possibly peroneal tendons) as it is the tendons connecting muscle to bone that are stressed when performing this test.

Functional tests

These can only be performed if pain allows. A badly injured ankle will not be capable of performing these tests. The lunge test involves the athlete leaning forwards over one knee keeping the heel of the front foot in contact with the ground. It measures dorsi flexion in comparison to the uninjured ankle. Other tests include one leg standing balance (eyes closed) test and hopping tests.

 Note - hopping on a recently injured ankle is definitely to be avoided but this test may be of benefit much later in the rehabilitation process.

 Palpation (touching and feeling).

Finally the therapist will touch or feel certain points of the ankle to identify any specific painful areas.

The following are usual points to palpate: distal fibula (bottom of the fibula bone), lateral malleolus (bony bit on the outside of the ankle -peroneal tendon dislocation, lateral ligaments (most likely to be painful), talus (bone at the top of the ankle which the tibia or shin bone sits on), peroneal tendon, base of 5th metatarsal (where the peroneus brevis attaches to) and medial ankle ligaments.

If the sprain is severe and the athlete has trouble weight bearing an X-Ray may be beneficial in identifying possible fractures.

However, an experienced sports medicine professional should be capable of palpating to identify if the pain is worse on the bone (lateral or medial malleolus) or on the ligament itself.

The therapist will then record any significant signs or symptoms and test results for future reference and as a record of what was found

Physioline’s Recommended Ankle sprain treatment

Treatment of a sprained ankle can be separated into immediate first aid and longer term rehabilitation and strengthening.

Immediate First Aid for Ankle Sprains:

Aim to reduce the swelling by RICE.  (Rest, Ice, Compression, Elevation) as soon as possible.

R is for rest. It is important to rest the injury to reduce pain and prevent further damage. If you need crutches then use them! This accelerates rehabilitation.

I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow.

C is for compression – This reduces bleeding and helps reduce swelling.

E is for Elevation – Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury.

In addition to immediate first aid the athlete can do the following:

Visit Physioline for further treatment and rehabilitation

Physioline management

-Protect the injured ankle by taping or an ankle support. Tape can also be used during the rehabilitation phase to protect the joint and give proprioceptive feedback to the ankle without risking further injury. When partial weight bearing an ankle support or taping method can protect the lateral ligaments (allowing them to rest) while ensuring forwards and backwards motion is allowed keeping the rest of the joint healthy.

-Swelling reduction by compression devices or taping techniques

Electrotherapy to reduce pain and inflammation and promote healing

-Cross friction massage to promote healing and reduce scar tissue development

-Prescribe a full ankle rehabilitation programme to strengthen the joint and help prevent future ankle sprain