Common Conditions

Ankle Sprain

Types, Symptoms and Treatments

Understanding Ankle Sprain

Ankle sprain, also known as a "turned ankle / twisted ankle," is one of the most common sports injuries. It occurs when the ankle joint is forced to move beyond its normal range of motion, leading to the tearing or stretching of the ligaments. The most common type is a lateral ankle sprain, followed by medial ankle sprains and high ankle sprains.

Symptoms of Ankle Sprain

The most prominent symptom is pain around the ankle area, which can hinder your ability to walk or play sports. An audible pop might indicate a more severe injury to the ligament. The following symptoms would start within 1-2 hours following the injury:

Swelling: usually around the bony landmark of the ankle. Extensive swelling up the leg or down to the foot indicates more severe injury to the ankle;
Bruising: usually occurring around the ankle and down to the foot and another sign for a more severe injury;
Restricted ankle movement: twisting (inverting or everting) would usually be the most painful movement to perform after ankle sprains;
Limp: the patient would need to limp when walking due to pain when weight-bearing and restricted ankle range of motion.

Types of Ankle Sprains

Lateral ankle sprain

The most common type, caused by the foot landing in an inverted position, which can tear or rupture the ligaments on the outer side of the ankle. This might tear or rupture the ligaments on the lateral (outside) side of the ankle, including the ATFL (anterior talofibular ligament), CFL (calcaneofibular ligament) and PTFL (posterior talofibular ligament). Grades of ligament tears are classified as follows:

- Grade 1: ligament was strained with no laxity, projected to recover in 1-2 weeks;
- Grade 2: ligament was partially torn with laxity, projected to recover in 3-4 weeks approximately;
- Grade 3: ligament was fully ruptured. The recovery is estimated for over 6 weeks depending on the need for orthopaedic intervention and the involvement of other injured structures.

Medial ankle sprain

Less common than lateral ankle sprains, occurring when the foot lands in an everted position, injuring the ligaments on the inner side of the ankle. The grading system would be like lateral ankle sprains as above.

High ankle sprain

Also known as a syndesmosis injury, it is described when the ligaments (AITFL & PITFL, anterior and posterior inferior tibiofibular ligaments respectively) in the high ankle are damaged when the foot is everted and dorsiflexed (toes pointing up). Apart from the high ankle ligaments, the syndesmosis, which is a thick fibrous tissue connecting the fibula and tibia, is torn and stretched out. The stability of the ankle would be significantly compromised at this point so the recovery would take longer.

Acute Stage Treatment

Professional Treatments

The acute stage treatment of ankle sprain may include:

Electrical Modalities: ultrasound therapy, interferential therapy, and high energy inductive therapy are commonly used modalities for swelling control and pain relief;
Dry Needling: acupuncture around the injured sites could help with pain relief and swelling control;
Manual Therapy: soft tissue therapy can be performed on muscles surrounding the ankle, such as the soleus, gastrocnemius, and plantar foot muscles for promote overall mobility;
Gait Aid Prescription: depending on the severity of the injury, the patient might require crutches to aid walking in the first few days to offload the injured ankle. For high ankle sprains or the more serious ankle sprains, a camboot might also be fitted to immobilize the ankle for protection;
Exercise Therapy: early mobility is highly important for swelling control. Light mobility exercises performed on pilates reformer or with a soft resistance band could reduce joint stiffness and aid recovery.

LATER STAGE REHABILITATION

As the acute symptoms subside, the focus shifts to improving mobility, strength, proprioception, and functional performance:

Proprioception Training

It is highly imperative that the individual needs to sense the position of the ankle and properly reposition if required. Dynamic balances are given on unstable surfaces such as foam or wobble board to enhance the proprioception of the ankle.

Specific Strengthening

For those with recurrent ankle sprains or chronic ankle instability, there might be predisposing muscle weakness that have contributed to the current injury. For long-term ankle health and performance, the underlying weakness needs to be identified and addressed prior to return to sports.

Taping or Bracing

Depending on the functional needs, taping skills might be taught to individuals who need short-term immobilisation during sports for protection. Ankle braces could also be fitted for similar purposes.

Frequently Asked Questions

Do I need an X-ray for ankle sprain?

According to the Ottawa Ankle Rules, X-ray is recommended if any of the following symptoms are present to rule out fractures or other bony injuries:

Inability to immediately bear weight and walk 4 steps
Tenderness to touch around any of the 4 key bony landmarks around the ankle

How can I prevent recurrence of ankle sprain?

You can prevent future ankle sprains through proprioception training, specific strengthening: addressing any underlying muscle weaknesses and using ankle supports during activities.

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