Ankle Sprains

ANKLE SPRAINS 

An ankle sprain is an injury to the ligaments of the ankle. The lateral or outside ligaments are most commonly injured. Symptoms Twisting the ankle stretches or tears the ligaments. This usually occurs with an inversion injury, which means the foot rolls inward. Swelling occurs shortly after the injury and bruising may become visible 3 to 5 days later. 

Anatomy 

Ligaments hold joints in proper position and connect one bone to another. The two most commonly injured ankle ligaments are the anterior talofibular ligament (ATFL) which connects the talus to the fibula and the calcaneal fibular ligament (CFL) which connects the fibula to the calcaneus. ATFL and CFL sprains must be differentiated from a high ankle sprain which has longer recovery time. High ankle sprains involve the ligaments connecting the tibia and fibula above the ankle joint. 

Diagnosis 

Physical examination will show tenderness and swelling at the injured ligaments. Ankle anterior drawer test may be performed to evaluate the integrity of the ligament. This involves a shuck maneuver to feel if the joint is loose indicating that the ligament is torn. X-rays may be used to rule out fractures. An MRI is not necessary to diagnose a sprain and is reserved for when the ankle is not healing properly or another injury is suspected. 

Treatment 

Surgery is not required in the majority of ankle sprains. The grade of the sprain will classify the injury severity and recovery time. Sprains are classified into Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe) injuries. Those that can bear weight after the injury are likely to return quickly to normal activity. Those who cannot walk may need to be immobilized. 

Follow the R.I.C.E. guidelines: 

• Rest your ankle by not walking on it until you do it comfortably (this may require a boot brace or lace-up brace) 
• Ice to control acute swelling in the first 48 hours and afterward as needed. Use a thin piece of cloth between the ice bag and skin and don't ice more than 20 minutes at a time to avoid frostbite. 
• Compressive bandages help to immobilize and support your injury. 
• Elevate your ankle in the first 48 hours. The swelling usually improves within a few days. 

Returning to sports and exercise with a properly sized ankle brace may prevent re-injury. An ASO speed lacer brace can be ordered online: 

• ASO Speed Lacer Medium – https://amzn.to/476Iul1

• ASO Speed Lacer Small – https://amzn.to/4cJ1Dug

• ASO Speed Lacer Large –  https://amzn.to/3ABHmJK

Recovery

There are 3 phases of recovery: 

• Phase 1 includes rest, brace or boot protection, and swelling reduction. 
• Phase 2 includes restoration of motion and strength 
• Phase 3 includes a gradual return to straight-ahead activity and maintenance exercises, followed late by sport-specific exercises (e.g., sprinting and cutting).

Once you can stand on your ankle, you may start ankle stabilization exercises to improve flexibility, balance, and coordination. Later, you may walk, jog, and run figure-eights with your ankle taped or in a brace. Some degree of ankle ligament soreness may persist for 3 to 6 months from the injury. Rehabilitation lessens the chance of re-injury, chronic pain, or instability.

When is surgery needed?

The vast majority of ankle sprains improve with physical therapy and temporary bracing. Chronic pain and instability that does not respond to non-operative treatment will usually respond well to surgery.