Ankle sprain - Sports podiatry
Ankle sprains are common injuries that occur when ligaments are stretched or torn. The ankle sprain
is the most common athletic injury. Nearly 85% of ankle sprains occur laterally, or on the outside of ankle joints. Sprains on the inside ligaments are less common. Many sprains occur when participating in sports, or by twisting the ankle when walking on an uneven surface. Some individuals, due to their biomechanics , are more prone to ankle sprains.
ankle sprain anatomy
The ankle joint is made up of three bones. The bones are called the tibia, fibula, and talus.
These bones form a socket in which the ankle joint moves.
The tibia, fibula and talus are connected to each other by ligaments. Think of ligaments as thick rubber bands that hold bones together so that joints are stable and function properly. When an ankle is sprained, a ligament is stretched, partially torn or completely torn. Muscle and tendon structures surround the ligaments. These structures provide motion of the ankle joint for walking and running. Blood vessels, nerves and skin overlie the ligaments and tendons. The ankle joint moves the foot upward and downward. Just below the ankle joint is a ball and socket type joint that allows inward and outward motion. This is known as the subtalar joint
ankle sprain symptoms & classification.
Ankle sprain symptoms vary depending on severity.
Often, the ankle Is tender, swollen and discoloured. The ankle can be quite painful to touch. Walking
is usually hampered and may become difficult depending on the severity of the sprain.
A feeling of instability may occur, especially in severe ankle sprains when ligaments are torn.
Ankle sprains are classified by "types" and range from mild to moderate to severe.
Type I ankle sprain, the least severe, occurs when ligament fibres have been stretched or slightly torn.
Type II sprain occurs when some of these fibres or ligaments are completely torn.
Type III, the most severe, occurs when the entire ligament is torn and there is significant instability of the ankle joint.
Fractures of the ankle bone or outside the foot bone may be present. Fractures require immediate diagnosis and attention for appropriate treatment.
ankle sprain treatment in the acute phase
P - R - I - C - E
Protection - Your ankle may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
Ice - Place a plastic bag with ice on the ankle for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the ankle above heart level
IF SYMPTOMS PERSISTS OR NUMBNESS/ DISCOLOURATION OF THE FOOT OCCURS CONSULT A MEDICAL PROFESSIONAL IMMEDIATELY.
Bracing- Sprained ankle ligaments are at risk of rupture when inflamed. Supporting the area with an ankle brace will give the ligaments time to REST. These braces are designed to be worn under clothing and with normal footwear. On the left is the brace that our clinicians recommend. This can be worn continually in the initial phase of injury (to be taken off at night). Then once symptoms have subsided it can be worn during exercise and sporting activity to provide support to the damaged ankle ligaments. This support was worn by Andy Murray tennis star when he hurt his ankle at Wimbledon in 2008.
ankle sprain restoring normal tendon function
| Technique: | Sit with your knee straight and hold the foot position as long as possible. Do as frequently as possible for the first 3-10 days. |
| Pullback
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ankle sprain Flexibility (Stretching) Exercises
Loosen tight leg muscles. Tightness makes it hard to use stairs, walk, run and jump and puts stress on the ankle ligaments.
| Technique: | Hold each exercise 30 seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
| Calf Stretch Basic: Sit with your knee straight and towel looped around the ball of your foot.
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| Calf Stretch Advanced: Once you can stand, try stretching with your hands on a wall.
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| Heel Stretch Basic: Sit with your knee slightly bent. Loop a towel around the ball of your foot.
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Heel Stretch Advanced: Once you can stand, try placing your injured foot behind the other with your toes pointing forward.
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ankle sprain strengthening exercises
Frequency: | Three sets of 20 repetitions, 5-7 days per week |
| Front of Shin Basic - Push Out
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| Front of Shin Advanced - Band
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Inner Shin Basic - Push In
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Inner Shin Advanced - Band
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Front of Shin Basic - Push Up
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| Front of Shin Advanced - Band
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Video showing how to use rehab band (whole body).
To help prevent further ankle sprains
Remember that virtually all ankle sprains happen at the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to strengthen the ankle and control biomechanical forces
Golden rule- Don't ignore the problem, it won't go away!
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can be achieved by wearing a good shoe (see our shoe guide) with orthotics (foot beds), ankle strengthening and ankle support.
1. Check your footwear
Are your running shoes worn and in need of replacing? If so change them. ankle sprains are made worse by high impact forces so a good shock absorbing shoe is a must. The lack of stability of a worn shoe will also make the chances of an ankle sprain significantly worse. For more advice on running trainers our running shoe advice page is worth reading. Read more->
Below are a selection of trainers that are ideal for athletes.
Trainers for a neutral or under pronating foot type
Trainers for over pronators
2. rectify Poor biomechanics with orthotics
The way your foot strikes the ground and the forces that are placed on it can have a direct effect on causing ankle sprain and can also delaying healing times. Check our biomechanics page for detailed information. Read more->
3. Ankle strengthening
The single best exercise to improve the strength of the muscles around the ankle is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the foot and ankle in a controlled gentle manner. Whilst our clinicians have found it a brilliant way to strengthen ankle muscles, traditionally a wobbleboard was used to help balance (proprioception). Proprioception is the nerve connection from the brain to the foot. This is usually found to be very poor in patients with a history of ankle sprain. This is often damaged/ disrupted after injury and can increase the chances of injury from re occurring It can also significantly delay recovery.
Use of a wobbleboard therefore has a dual benefit in the treatment of ankle sprains.
4. Ankle support
Usually an athlete who has damaged their ankle only needs minimal support post injury, such as the support given by a neoprene brace. However it is our view that with ankle sprains, something more substantial should be worn when partaking in sporting activity. We recommend the air cast ankle support as it allows the patient to wear normal shoes/ running trainers and it can be worn when exercising.
Ankle sprain prevention checklist summary
Ankle sprains returning to sporting activity
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your ankle sprain injury, which could lead to permanent damage. Everyone recovers from ankle sprains at a different rate. Returning to your activity is determined by how soon your ankle recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.
Think you require treatment for your biomechanical problems?
Visit our Sports podiatry clinic directory pages for a clinic near you.