The ankle is the joint between the lower parts of the tibia and fibula (shin bones) and the tarsal bones at the back of the foot. It is crisscrossed by a number of ligaments that can become injured when the ankle has a sudden twist that stretches the ligaments beyond their normal range. The most common type of ankle sprain occurs when the ankle rolls so that the sole of the foot faces inwards. This is called an inversion sprain; it involves the lateral ligaments of the ankle and is one of the most common injuries we treat as physical therapists.
It is important to get a professional diagnosis with every ankle sprain no matter how mild, since there may be damage to tendons, bones and other joint tissues in addition to ligament damage. Quite often associated fractures of the ankle bones are missed when an ankle is sprained, therefore x-rays are highly recommended.
Inversion ankle sprains occur due to the relative instability outside of the ankle and weakness of the ligaments which allow the ankle to roll. Ankle sprains occur most often with sport where there is a quick change in direction or if the person lands on someone else’s feet or on an uneven surface after a jump. Falling down stairs or curbs is another common way to sustain an inversion sprain.
Ankle sprains can be divided into three categories of severity:
- Minimal (Grade 1)
This involves some minor tearing of the ligament, little or no instability, mild pain and swelling on the outside of the ankle and some stiffness and difficulty walking.
- Moderate to severe (Grade 2)
There is moderate tearing of the ligament, some instability, moderate pain and swelling and stiffness and difficulty walking.
- Complete or severe (Grade 3)
There is total rupture of the ligament, gross instability of the joint and severe swelling. If the nerve fibers associated with the ankle are also ruptured, there may be no pain, or if they are intact but severely stretched then pain levels can be very high.
Physical therapy can help with pain management and treatment of the injury to restore your functional independence.
Intervention will involve the PRICE protocol.
- Protection of the ankle by taping, splinting or using a brace to immobilize the joint.
- Rest. Using crutches with partial weight bearing will rest the ligament and aid in the healing process.
- Ice. This reduces pain and inflammation and speeds up the healing process.
- Compression. This can be done either with taping or tube grip bandage and helps to control swelling.
- Elevation during rest periods also helps to control swelling and promote healing.
Once the swelling and pain are under control, stretching and strengthening exercises can begin and weight bearing will be increased. We will train you in the proper use of crutches and teach you how to bear weight gradually. Physical therapy treatment will also involve passive joint mobilization to regain full range of movement, deep massage to break up scarring caused by the sprain and specific functional exercises to help you return to full function will follow until the end of treatment.
For Grade 3 injuries, after a period of at least six weeks of conservative physical therapy management, if there is still a large degree of trauma to the ankle, surgery may be considered.
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