Ankle ligaments hold the joint and bones together in a joint called a talocrural joint. The bones that are held together here are lower tibia and fibula of the lower legs, as well as talus, a small bone that fits between them. This joint is like a hinge: it moves allowing the toes to lift off the ground (dorsiflexion) and swings down to plant the foot firmly on the ground (plantarflexion). The list of ligaments of the foot that are commonly injured can be found in the previous blog entry. If the foot is rotated outward during a sprain, it’s called an eversion sprain. It comprises 5-10% of all ankle sprains and takes much longer to heal than an inversion sprain. An inversion sprain is much more common.
Ankle sprains are classified into Grades 1, 2, & 3, depending on their severity. Grade 1 is a mild sprain. There is some pain and very little swelling because the ligament has been stretched but there is no deformity; return to normal function can be expected in 2 weeks. Grade 2 is when the ligament is partially torn. Some bleeding and bruising can occur and is often lower than the injury site due to gravity. Here rehabilitation is necessary and the person can return to normal activities within 2-6 weeks. Grade 3 sprain is a complete tear of a ligament. Pain is severe at first but then subsides quicker than a Grade 2 sprain. Surgery could be necessary and return to activity can take as long as 6 weeks or more.
Common testing includes Ottawa ankles rules: if pain is present near the malleoli (the two bones protruding on the inside and outside of the ankle) and the person cannot walk for 4 steps after injury, an X-ray should be ordered. Treatment includes avoiding HARM (heat, alcoholic beverages, running, and massage). Ultrasound can be indicated to reduce swelling only if the person is 18 years old or older. Casting a sprained ankle is not recommended. Use the acronym PRICE (protection, rest, ice, compression, and elevation).
There are many different types of ankle braces that can provide protection. An ankle can be taped to provide support short-term. If there is a severe sprain, a short-leg cast or a walking boot can be used to partially immobilize the leg but not completely. Elevate the ankle and apply ice-packs wrapped in a wet towel for 15-20 minutes every 2 hours for the first 2-3 days. Compressive wrap should be applied correctly to ensure adequate blood flow to the toes. Once the swelling begins to subside, your MD will refer you to a physiotherapist whose advice the client should follow as precisely as possible. Gradually begin to move the ankle 48 hours after the sprain as part of rehabilitation. Make sure footwear is roomy enough to accommodate swelling and it gives enough ankle support through a wide stable base. The soles of the shoes should not be worn down especially at the heel causing ankle instability.