Ankle Sprain

An ankle sprain is a very common injury in both sportspeople and the general public alike. As already discussed in the anatomy of the foot and ankle there are lots of ligaments that provide support for the ankle joint, with the strongest being the deltoid ligaments that reside on the inside of the ankle.

A typical ankle sprain occurs in weight bearing when the ankle joint rolls outwards and the inside of the foot (or sole) rolls inwards, known as an ‘inversion injury’. This forced movement puts the ligaments on the outside of the ankle under immense load which can lead one or more to tear.

A less common injury is then the ankle rolls inwards and the sole of the foot rolls outwards, known as an eversion injury. Injury to the ligaments on the inside of the ankle are less common as they blend together to form the strong deltoid ligament complex.

People who suffer an ankle sprain will be able to recall an incident where their foot rolled inwards / outwards and they may report a ‘popping’ noise as a result. People may also report:

• A history of ankle instability / ankle injuries
  
• Ability to partially weight bear on the affected side
  
• Possible pins and needles into the foot
  
• Tenderness, swelling and / or bruising

With an ankle injury it is essential to rule out anything more serious, such as an anke fracture and this can be ruled out quickly. It is a highly sensitive and specific test and if negative, it is highly likely you do not have an ankle fracture. It is also important to rule out a syndesmosis injury, also known as a ‘high ankle sprain’.

After taking down the history of the injury, where the patient will report the symptoms already mentioned, a physical examination may show the following:

Negative Ottawa Ankle Rules

Pain on palpation of inside / outside of the ankle

Positive anterior draw / talar tilt/ squeeze test, depending on the structures involved.

Reduce range of movement and strength due to pain inhibition and swelling.

Education and advice

Symptom and swelling management, particularly in the early stages

Taping / Bracing

Progressive range of motion exercises

Manual therapy

Progressive strength based exercises

Proprioceptive and balance based exercises

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