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Ankle Sprains

by: - September 16, 2016
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Dr Lucia Corriette

Dr Lucia Corriette

By Dr Lucia Corriette
Physiotherapist

Background
A sprain is an injury to or tear of a ligament, which is a strong band of tissue that holds bones together. An ankle sprain (twisted ankle, rolled ankle) is one of the most common ligament injuries. It usually occurs as a result of walking over an uneven surface or “rolling” the ankle. It can also be the result of a fall or athletic activity. This type of sprain is typically an inversion sprain and results in damage to the ligaments on the lateral side or outer side of the ankle joint.

Ankle ligaments

Ankle ligaments

Ankle ligaments

Ankle ligaments

Inversion sprain

Inversion sprain

Signs and Symptoms

The signs and symptoms of an ankle sprain include:
• Pain
• Swelling
• Difficulty moving the ankle
• Inability to bear weight on the affected leg
• Instability of the ankle (in severe sprains)

air-stirrup

How to Manage a Mild (Grade 1) Ankle Sprain

Most mild ankle sprains (Grade 1 sprains) get better on their own, over time. In such cases it is recommended that you:
• Rest the ankle. Avoid putting weight on the ankle. If the pain is severe, you may need crutches until it goes away.
• Ice the ankle to reduce pain and swelling. Apply an ice pack for 10-12 minutes every two to three hours for two days, or until the swelling is improved. After that, ice it once a day until you have no other symptoms.
• Compress the ankle. Use an elastic bandage to keep down swelling.
• Elevate the ankle on a pillow when you’re sitting or lying down. Be sure to support the knee.

How to Manage a Moderate (Grade 2) or Severe (Grade 3) Ankle Sprain – Conservative or Non-surgical Treatment
Usually, pain and swelling associated with ankle sprains lasts 2-3 days. In cases of moderate ankle sprains it may be necessary to stay off the ankle. Crutches would then be prescribed. Anti-inflammatory pain killers may also be needed, in which case they would be prescribed by the attending physician. The doctor may also order tests such as x-rays to rule out broken bones; an ultrasound to examine the ligaments; or magnetic resonance imaging (MRI) to assess very severe injuries. However, ankle sprains can be diagnosed without these tests.

In the early phase of recovery, it will be necessary to provide support for the ankle and protect it from sudden movements. If there is a Grade 2 or moderate sprain, a removable brace such as a cast-boot or air stirrup-type brace can be used. Grade 3 sprains (severe sprains) may require a short leg cast for 2 to 3 weeks.

Air stirrup-type ankle brace

How to Manage a Severe (Grade 3) Ankle Sprain – Surgical Treatment
In most cases, severe ankle sprains heal without surgery but will need to be immobilized in a brace or cast. Surgery for ankle sprains in not common and is done when conservative or non-surgical treatments such as physiotherapy do not produce a good outcome. Surgery may also be done for those patients who have an unstable ankle. Surgical options include arthroscopy, in which a small camera is used to look into the ankle joint. In this procedure, loose fragments of bone or cartilage, or parts of the ligament that may be in the joint are removed. Surgical reconstruction is done when the torn ligament is repaired with stitches or sutures. In some cases, a tissue graft obtained from other ligaments and/or tendons found in the foot and around the ankle may be used to rebuild the damaged ligament.
Following surgery, the ankle is placed in a cast and crutches are used to avoid weight bearing on the affected leg. Rehabilitation/physiotherapy will begin after the crutches are removed and may take weeks to months depending on the severity of the injury and the nature of the surgery performed.

Physiotherapy
Rehabilitation exercises are used to prevent stiffness, increase ankle strength, and prevent chronic ankle problems. During Physical Therapy:

• Early movement is encouraged. To prevent stiffness, your doctor or physiotherapist will provide you with exercises that involve range-of-motion or controlled movements of the ankle without resistance.
• When able to bear weight without increased pain or swelling, exercises to strengthen the muscles and tendons in the front and back of your leg and foot will be added to your treatment plan. Aquatic therapy or water-based exercises may be used if land-based strengthening exercises are too painful. Exercises with resistance are added as tolerated.
• Poor balance often leads to repeat sprains and ankle instability. Balance exercises are a big part of physiotherapy treatment.

wobble-board
• Manual therapy is also a part of physiotherapy management of ankle sprains.
• When there is no pain, other exercises may be added, such as agility drills. Running in a figure-8 pattern is an example of this. The purpose of this exercise is to improve strength and range of motion as balance improves over time.

Take Away
It is very important to manage ankle sprains correctly the first time around. Not doing so can lead to a chronic sprain, which is pain that continues for 4-6 weeks and is felt very often or when doing strenuous activities. Early treatment is the key to good recovery. Patients tend to have good results with proper treatment.

References
1. Petersen W, Rembitzki IV, Koppenburg AG, et al. Treatment of acute ankle ligament injuries: a systematic review. Archives of Orthopaedic and Trauma Surgery. 2013;133(8):1129-1141. doi:10.1007/s00402-013-1742-5.
2. Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of Chiropractic Medicine. 2011;10(3):204-219. doi:10.1016/j.jcm.2011.02.001.
3. McGovern RP, Martin RL. Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine. 2016;7:33-42. doi:10.2147/OAJSM.S72334.
4. Derrer, DT. Ankle sprain. http://www.webmd.com/pain-management/ankle-sprains
5. Haddad, SL. Sprained ankle. http://orthoinfo.aaos.org/topic.cfm?topic=A00150
6. Mosby’s Medical Dictionary (9th ed.). http://medical-dictionary.thefreedictionary.com/ankle+joint
7. Avoid ankle sprains this autumn. http://nelife.com.au/avoid-ankle-sprains-this-autumn/