Ankle Sprain

Ankle sprains are a common type of musculoskeletal injury that result from a partial or total tear or stretching of the ligaments supporting the ankle. They mostly affect people who are active or involved in sports, and they appear when the ankle moves outside of its normal range of motion.

Ligaments help in joint stabilization by limiting excessive motion. The ligaments get strained beyond their typical range of motion, which results in a sprained ankle. Injuries to the ankle’s outer ligaments are common in cases of sprained ankles.

The severity of the injury affects how to treat a sprained ankle. You might be able to manage with self-care and over-the-counter painkillers, but to determine the best course of action and determine the severity of your ankle sprain, a medical evaluation might be necessary.

The mechanism of injury:

A sudden shift in the body’s center of mass over the landing or weight-bearing foot is typically the cause of lateral ankle sprains. When the foot twists inside and the ankle rolls outward, the lateral ligament stretches and tears.

Regaining the strength and mobility of a torn or overextended ligament is unusual. There have been cases reported by experts wherein the healing process of injured ligaments is hampered by an early return to play.

Lateral aspect

• Plantarflexion and inversion are the mechanism of injury.
• Ligaments: anterior talofibular joint,
• Calcaneo-fibular ligament
• Talofibular ligament in back

Medial aspect

• Damage mechanism: eversion
• Ligaments: ligament of the posterior tibiotalar
• Ligament Tibio calcaneal
• Ligament tibio navicular
• Anterior tibiotalar ligament

High aspect

• Injury mechanisms include dorsiflexion and external rotation.
• Anterior-inferior tibiofibular ligament
• Posterior-inferior tibiofibular ligament
• Transverse tibiofibular ligament

Ankle sprain classification:

There are various grading plans for ankle sprains, each with specific advantages and disadvantages. Therapists use a number of systems that take into account the patient’s circumstances and educational background to ensure effective continuity of care.

Since the ankle joint is covered by multiple ligaments, it may not always be easy to apply a grading system designed to describe the status of a single ligament, unless it is certain that only one ligament is injured. Ankle sprains are graded using a different system based on the quantity of injured ligaments. It is difficult to identify the exact number of torn ligaments, though, unless there is significant proof from radiographic imaging or surgery.

A grading system that focuses on a single ligament can be used to classify ankle sprains;

• Grade I (Limited stretching, no tearing): slight fiber damage or overstretching
• Grade II (partial tear): A ligament partial tear
• Grade III, also known as full tear or rupture, refers to a total ligament rupture.

Causes:

When your ankle is forced to move from its natural position, one or more of the ligaments may stretch, partially tear, or rupture entirely, resulting in a sprain.

These wounds result in bruises or edema. You might experience pain or discomfort when you put weight on the injured area. The sprain may result in damage to tendons, cartilage, and blood vessels.

This type of injury can be caused by sports-related activities, uneven ground, or even the incorrect type of footwear.

A sprain can occur from one or more ligaments stretching, partially rupturing, or rupturing entirely when your ankle is forced out of its natural position.

It could be the result of the following;

• Spinning Ankle Motion
• Awkwardly landing on your foot while jumping.
• Exercise or strolling on an uneven surface
• Someone else’s foot or landing on your ankle while you’re playing sports.

Symptoms:

Depending on how severe the injury is, there are different signs and symptoms of a sprained ankle.

They might consist of;

• Pain, particularly when you put weight on the affected foot
• Sensitivity when the ankle is touched
• Your ankle’s range of motion may be restricted by a sprain.
• Acute ankle instability
• At the moment of injury, a popping sound or sensation

Medical Examination:

Physical Assessment

In addition to carefully examining your foot and ankle, your doctor will ask you questions regarding the injury in order to diagnose your ankle sprain. This physical examination may be painful because of the swelling and inflammation, and it frequently entails;

• Observation: When examining the injured ankle, your physician will make an assessment with the unaffected ankle. Usually, the ankle bruises and swells over the injured ligaments after a sprain.

• Palpation: The region immediately over the injured ligaments is typically the only one that is tender. Your doctor will use gentle force to identify the injured ligaments in your ankle.

• Range of motion testing: A swollen or stiff ankle may be difficult to move, so the doctor may try a few different ankle movements.

Based on the degree of swelling, pain, bruising, and stability, your doctor might be able to determine the severity of your ankle sprain. You might require more testing to rule out a fracture if you have trouble bearing weight or if you have pain in the ankle and foot bones.

Imaging Examinations

Ankle sprains are mostly diagnosed clinically based on the patient’s history, physical examination results, and symptoms. Sometimes, to rule out a fracture or other damage to the surrounding tendons and cartilage, imaging tests are obtained, such as X-rays and magnetic resonance imaging (MRI).

• X-ray: An X-ray causes radiation to pass through your ankle. This test can confirm the presence of bone fractures.

• CT scan: More precise information about the bones of the joint can be obtained through CT scanning. By combining X-rays taken from various angles, CT scans can produce three-dimensional or cross-sectional images.

• MRI : MRI stands for magnetic resonance imaging. With magnetic resonance imaging, or MRI, a strong magnetic field and radio waves are used to produce incredibly detailed three-dimensional or cross-sectional images of the soft internal ankle structures, such as ligaments.

• Ultrasound : Sound waves are used by an ultrasound to produce images in real-time. In different foot positions, these images could help your physician in evaluating the health of a tendon or ligament.

Treatment:

The goals of treatment are to lessen pain and swelling, promote ligament healing, and restore ankle function. You may be referred to an orthopedic surgeon or a physician with expertise in physical therapy and rehabilitation if your injuries are severe.

Home treatment:

• Rest : Stay away of uncomfortable activities.

• Ice : For ten to fifteen minutes, apply an ice pack. Repeat this once every two to three hours.If you have diabetes, vascular issues, or decreased feeling, consult your doctor before using ice.

• Compression: Wrap the ankle in an elastic bandage and squeeze it until the swelling goes down. Avoid wrapping too tightly as this might restrict blood flow.

• Elevation: To reduce swelling, especially at night, raise your ankle above your heart. Gravity drains excess fluid, minimizing swelling.

Medications

• Sprained ankle pain can usually be effectively treated with prescription analgesics like ibuprofen (Advil, Motrin IB, etc.), naproxen sodium (Aleve, etc.), or acetaminophen (Tylenol, etc.).

Physiotherapy:

Your doctor will have you start an exercise regimen aimed at improving the strength, flexibility, range of motion, and stability of your ankle as soon as the pain and swelling have fully subsided. Your doctor or physiotherapist will go over the proper form and exercise routine with you.

Especially for athletes, therapeutic exercise is crucial in the treatment of ankle sprains. Remember that the treatment plan varies according to the extent of the injury and whether the sprain is acute (lasting less than four weeks) or chronic (lasting more than four weeks).

Physiotherapy intends to reduce pain and swelling while strengthening the ankle joint. It usually takes a patient five to fourteen days to recover. In cases of chronic ankle sprains, physiotherapy attempts to reduce pain and edema and restore functional movement and stability. Recovery for a patient typically takes three to twelve weeks, or more.

Exercises for ankle sprain:

Most patients can begin ankle rehabilitation activities three days after the accident if the injury is not too severe. But no schedule has been defined. Pay attention to your body’s signals and follow any advice given by a doctor.

Ankle pump

• To start, find a comfortable spot on the ground to sit.
• From the side of your ankle, take a step with your toes.
• Hold this pose for a few seconds.
• Bring your toes up to the ankle.
• Hold this pose for a few seconds.
• Then return to your neutral position.
• Then relax.
• Perform the exercise five to ten times.

Towel curl

• As you sit, place a small towel on the ground in front of you.
• Maintain a neutral foot contact with the ground.
• Grasp the towel by its middle and use your toes to curl up with it.
• Then return to your neutral position.
• Then relax.
• Perform the exercise five to ten times.

The ankle alphabet

• First, take a seat in the chair.
• Raising your foot a few inches, begin writing the alphabet in the air with your big toe, starting with the capital letters.
• Make use of lengthy, downward-pointing sentences.
• Proceed to writing lowercase characters after you have completed writing the alphabet.
• Then return to your neutral position.
• Then relax.
• Perform the exercise five to ten times.

Towel stretch

• You can perform this easy stretch while sitting on the floor or in bed.
• Sit on the floor or your bed with your legs out in front of you.
• Place a rolled-up towel behind each heel of your feet and grasp its ends.
• Gently draw the towel toward you while maintaining a straight knee.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.
• Perform the exercise five to ten times.

One leg balance

• Grab a sturdy chair or countertop for support.
• Keep your back to the chair or tabletop and keep it within reach.
• Bend the knee to a comfortable position and raise one foot off the ground.
• A patient’s comfort level and ability will determine whether the non-standing leg is kept straight, slightly elevated, or bent.
• Your primary objective should be to keep your balance while using your core muscles.
• Don’t droop or tilt in one direction.
• As your strength increases, progressively lengthen the initial short moment of balance.
• If necessary, you can use the chair or countertop for support, but as you become more stable, try reducing how much you rely on it.
• Then return to your neutral position.
• Then relax.
• Perform the exercise five to ten times.

Surgery:

Surgery may be required in certain cases if the injury does not heal or if the ankle does not stabilize after extensive physiotherapy as well as rehabilitation exercises.

When there is instability in the ankle syndesmosis due to high ankle sprains, surgery might also be necessary. In cases where a severe ankle sprain follows by other injuries, like a ruptured tendon or injury to the ankle cartilage, surgery may be advised.

Surgery types:

Surgical alternatives consist of;

• Artheroscopy

Your doctor will examine your ankle joint during an arthroscopy using an arthroscope, a tiny camera. To extract any loose bone or cartilage pieces or portions of the ligament that might be caught in the joint, tiny instruments are utilized.

• Rebuilding or repairing

Your doctor might be able to use sutures or stitches to fix the torn ligament. In some cases, the injured ligament may be rebuilt via tissue grafting from other tendons and/or ligaments in the foot and ankle region.

Recovery:

• Immobilization

Following surgery, there is usually a period of immobility. To safeguard the ligaments, a protective boot or cast is put on. It is important that you follow to your doctor’s instructions regarding the duration of use of the protective device, as premature movement or bearing weight may rip the repaired or reconstructed ligament.

• Rehab

Regaining strength and range of motion after surgery is necessary to enable you to resume your pre-injury function. Your expected recovery time will be based on the severity of your injury and the type of surgery you had. Rehab can take several weeks or months.

Risk factors:

A sprained ankle may happen due to a number of factors, such as

• Uneven surfaces

Ankle sprains are more common when running or walking on slippery surfaces or in unfavorable field conditions.

• Involvement in sports

Ankle sprains are a common sports injury, especially in activities like basketball, tennis, football, soccer, and marathon running that require for leaping, cutting, rolling, or twisting of the foot.

• Unsuitable physical state

When playing sports, the risk of spraining your ankles increases if your ankles are weak or flexible.

• Incorrect footwear

Ankle injuries are more common in people wearing high-heeled shoes or shoes that don’t fit well or aren’t suitable for an activity.

Prevention:

You can avoid sprained ankles and repeated sprains by using the following advice;

• Wear footwear that fits properly and is proper for the activity.
• Reduce your use of high-heeled footwear.
• Refrain from playing sports or dealing in other unprepared activities.
• When you work out or play sports, warm up.
• Exercise caution when jogging, walking, or working on uneven surfaces.
• Apply an ankle support brace or tape to a weak or previously injured ankle.
• Keep up a healthy level of muscular flexibility and strength.

Summary:

People of all ages and activity levels frequently suffer from ankle sprains, which are actually the main cause of missed athletic participation.

Usually sprains heal in 4-6 weeks, during which rest, edema control, and subsequent strength and mobility restoration are essential. Repeated sprains or insufficient healing may result in complications such as arthritis, persistent instability, and tendon issues, though these are rare. Consistent stretching, strengthening exercises, balance training, and wearing supportive shoes reduce the risk of sprains significantly.

FAQ:

References:

• Mayo Clinic, “Symptoms and Causes of Sprained Ankle,” August 11, 2022. Mayo Clinic. https://www.mayoclinic.org/conditions-diseases/sprained-ankle/causes-symptoms/syc-20353225

• 2024b, August 19, Dhameliya, N. The cause, symptoms, treatment, and exercise of an ankle sprain. Exercise and Physical Therapy Treatment. ankle sprain at physical-therapy.us

• Ankle Sprained | Ortho Info | AAOS (n.d.-b). Ankle sprains can be caused by a variety of diseases and conditions.

• Sprained Ankle. (2019c, March 8). The website Healthline provides information on ankle sprains.

• Image 1, On June 11, 2020b, Form, P. Ankle strains. How to manage ankle sprains can be found on Physio Form’s website.

• Image 2, Ankle strains in the following locations: Irving, Coppell, Carrollton, and Grapevine. August 5, 2021. Ankle sprains can be treated by NTFA. https://www.ntfoot.com/services/

• Image 5, Phase One Rehabilitation of the Ankle. January 8, 2013b. The ankle and shore foot. Phase I of the recovery of the ankle can be found at https://shorefootandankle.com/ankle-rehabilitation/

• Image 7, Yahoo belongs to the Yahoo brand family. (n.d.–b). https://www.yahoo.com/lifestyle/10-minute-equipment-free-home-184132938.html?guccounter=1&guce_referrer_sig=AQAAAKPSEO-CNtDxdtv44kugYVhocMjfIJ_pEeEXMZdT1tu2mnB6fTiOmfFcNQ-YcebptowLWb6NGIu42B-ZjVbd4K1UM7Z3o2B4xqMJYP6ELgAbF5ckCFRZ-Gpga24dtJ9jx0Tm93m2W1e7eCJI8pb4IYeOTejpllKfLScp0xmdIJNN.