Ankle Sprain: Treatment and Management
An ankle sprain is one of the most common sporting injuries. This occurs when the ankle ligaments are overstretched. Ankle sprains vary in their severity, from a mild sprain through to severe complete ligament ruptures, avulsion fractures or broken bones.
What Causes a Sprained Ankle?
An ankle sprain can occur simply by rolling your ankle. In most circumstances this will involve the foot twisting inwards (an inversion injury). This can occur when awkwardly planting your foot when running, jumping or stepping onto an irregular surface.
What are the Symptoms?
- Immediate difficulty with weight bearing and walking
- Occasionally you may hear a popping or cracking sound
- Swelling, bruising and ankle pain
- Local tenderness over the injured ligament
How is an Ankle Sprain Diagnosed?
A physiotherapist or sports physician is an expert in the assessment and diagnosis of ankle sprains. A clinical history and thorough clinical examination will determine the severity of your sprained ankle. It is important to rule out other more serious injury such as fracture/ break, dislocation, or tendon rupture. If required, you may be referred for a X-ray, CT scan or MRI to confirm or exclude specific ligament or bone injuries.
What is the treatment for an Ankle Sprain?
Initial treatment aims to minimise bleeding and swelling, promote tissue healing, prevent joint stiffness and protect against further damage using the POLICE principle (see previous blog).
It is important to avoid:
- heat/ heat rubs for the first 3 days
- running/ further damage
- vigorous soft tissue massage for the first 2 days
Correct rehabilitation is important to prevent instability/ laxity of the ankle joint. Following an acute ankle sprain, up to 1/3 will report pain and weakness 12 months after injury, and 1/3 will re-injury their ankle within 3 years. Correct post-injury rehabilitation exercises will significantly decrease this risk. Rehabilitation aims to:
- regain full range of movement and function in the ankle
- strengthen ankle and calf muscles
- restore joint proprioception (awareness of foot/ ankle/ limb placement) and balance
- correction of foot biomechanics (eg flat foot or high arch). In some instances you may require a foot orthotic (shoe insert).
- gradually introduce functional and sport-specific training. This may include taping/ bracing to protect against further injury.
It is important that rehabilitation be carefully monitored as attempting to progress too soon to the next level can delay recovery or lead to re-injury. An ankle sprain may predisposes you to a recurrent ankle sprains, foot pain, calf and leg injuries and back pain. Therefore it is important to seek professional advice. A physiotherapist can prescribe exercises that are best suited to your needs.