Ankle Sprain

by John Howick
© 2003

Almost everyone who is active in sports has "rolled over" on their ankle at least once. Ankle sprains commonly occur while walking, hiking or even just stepping out the front door. Perhaps because they are so common, many people think that ankle sprains are not a serious injury requiring proper care. Ankle sprains can range from a mild irritation to a very severe injury requiring surgery. I will outline what an "average" ankle sprain is, how it should be taken care of and some of the more serious complications.

The ankle joint is made up the two lower leg bones (the tibia on the inside and the fibula on the outside) and the top bone of the foot(the talus). This is a "hinge" joint designed to allow the forward and backward movement required to walk, run, jump and squat. It is stabilized on both sides with ligaments that restrict side to side movement. The strong ligaments on the inside of the ankle and the end of the fibula do a very good job of preventing our ankles from rolling inwards. Unfortunately there was a design fault at the factory and the ligaments on the outside of the ankle are not so skookum. It is quite easy to roll our ankles to the outside, especially when our foot is pointed down. The ligament that is responsible for stabilizing the ankle in this position (the anterior talofibular ligament or ATFL) is quite a puny thing and when our whole body weight is suspended by this structure it may not hold up. When this ligament has some of its fibres torn there is bleeding and inflammation and the familiar signs of an ankle sprain: swelling, bruising, heat, redness, pain, stiffness and difficulty walking.

From previous issues of this column we know that the treatment for this is PRICE.

Protect the area from further injury by immobilizing it with tape or a brace and using crutches .

Rest the ankle by using crutches or just staying off our feet... it's a great excuse to sit on the couch and watch the NHL playoffs.

Ice should be applied initially for 15 minutes every hour and then continued at least 3 times per day.

Compression should be applied with tape or a tension bandage wrap. It doesn't need to be tight but it should be worn whenever your foot is hanging down.

Elevate your foot so it is above the level of your heart. This helps the fluid drain out of the ankle and it also gives you a great view as you watch your ankle change from black to blue to yellow.

I may be a bit biased but I think everyone with an ankle sprain should consult a physiotherapist. The most common problems I see in people who don't get proper treatment are:

The ankle joint heals stiff which makes running, walking up hills or down stairs difficult and painful. It also puts stress on your knee and mid foot.

The ligaments heal stretched out and the ankle is "unstable". Clients often mention that they sprained their ankle in high school and now it rolls over all the time. THIS DOES NOT HAVE TO HAPPEN. Treated correctly, most ankle sprains recover fully.

The muscles do not regain their strength and the ankle has poor balance and coordination. This also leads to "instability".

An average, moderate ankle sprain will take a minimum of six weeks to recover. At this stage you can return to your sport if you have regained full range of motion, strength and balance. If your sport involves side to side movements or you will be on uneven ground, you will need to tape your ankle or use a brace for at least another three months to protect it from re-injury. Physiotherapy treatment includes passive joint mobilization, stretching, massage, modalities (ultrasound, electrical current), ice, taping, education and most importantly, exercises. These exercises will start out as simple range of motion movements and progress to strengthening with elastic tubing, balancing on wobble boards/trampolines, vigorous stretching and more dynamic "sport-specific" movements. When your therapist feels you have reached an appropriate level of healing they will have you run, hop, and balance to see if your ankle is functionally stable. If you pass the tests you will be instructed how to safely return to your activity.

Sometimes an ankle injury is more than a simple sprain. Occasionally, a piece of bone is pulled off with the ligament. The talus can also get chipped and the fibula or other small bones can break. Ligaments can be completely torn and may require prolonged immobilization or surgery to repair them. If your ankle shows significant swelling within minutes after the injury and you are unable to put any weight on your foot you should go to emergency. The doctor will determine the need for an x-ray and probably suggest crutches.

Just remember if you treat your ankle correctly as soon as it is injured, chances are you will recover fully and be back at your sport in no time.

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