Ankle Sprains

BACKGROUND

Ankle injuries may be one of the most common sports-related injuries with about 23,000 inversion (inward motion) ankle sprains occurring each day in the U.S. (6). However, not all ankle sprains are created equal. Whereas a minor sprain may allow an athlete to continue to play through it, a more severe one could bench an athlete for months.

 

ANKLE ANATOMY

The ankle joint is comprised of three bones: tibia & fibula (leg bones), talus (foot bone). The

medial (inside) and lateral (outside) ankle ligament complexes connect the leg bones to the

foot bones and act as static stabilizers of the ankle joint, preventing excessive motion (2,5).

The lateral ankle ligaments (anterior talofibular ligament/ATFL, calcaneofibular ligament/CFL,

posterior talofibular ligament/PTFL) are weaker than the medial ones, which is why most ankle

injuries occur by inversion.

 

DIAGNOSING AN ANKLE SPRAIN

Many ankle sprains can be diagnosed by clinical exam with palpation over each ankle ligament.

X-rays are often ordered to help rule out a fracture and stressed radiographs can be performed to evaluate for instability of the ankle joint. In rare cases, an MRI is ordered to better evaluate the extent of ligamentous damage and to examine the other surrounding soft tissue structures.

TREATING ANKLE SPRAINS

Most ankle sprains are non-surgical and early functional rehab appears to be favored for optimal recovery. RICE protocol can be initiated to help with symptoms such as pain and swelling. Weight-bearing status is dependent on the severity of the injury and the patient’s symptoms. One athlete may be able to walk right after the injury with the use of an ankle brace, while another may have to start non-weight bearing in a cast or boot and slowly transition to weight-bearing before going back into tennis shoes. The timeline for recovery could be anywhere from no loss in activities, or play time, to months of rest and rehab. Ancillary treatment, such as physical therapy, massage therapy, and yoga, may also be performed in conjunction with other treatment modalities (4).

 

When pain and instability are still present after conservative care fails, there is recurrence, or return to sport with a more stable ankle is sought, surgical treatment to repair the ligaments is an option (1,7). Arthroscopy of the ankle joint can also be performed alongside ligament reconstruction to evaluate the ankle joint for osteochondral defects or other intra-articular pathology (3).
 

References:

1. Baumhauer, J. F., & O'brien, T. (2002). Surgical considerations in the treatment of ankle instability. Journal of athletic training, 37(4), 458.

2. Cain, T.D., Bernbacb, M. Lateral Ankle Injuries. The Podiatry Institute. Retrieved from http://www.podiatryinstitute.com/pdfs/Update_1992/1992_55.pdf.

3. Chronic ankle instability. OrthopaedicsOne Articles. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created Jun 06, 2010 11:26. Last modified Jul 12, 2012 14:29 ver.13. Retrieved 2017-05-08, from http://www.orthopaedicsone.com/x/AgsCAg.

4. Hambleton, L. (2013, November 11). Pro athletes recover faster than amateurs partly because they get superior medical care. Retrieved from https://www.washingtonpost.com/national/health-science/pro-athletes-recover-faster-than-amateurs-partly-because-they-get-superior-medical-care/2013/11/11/9da3385c-d291-11e2-8cbe-1bcbee06f8f8_story.html?utm_term=.b4659258e68f

5. Keene, D. J., Williams, M. A., Segar, A. H., Byrne, C., & Lamb, S. E. (2016). Immobilisation versus early ankle movement for treating acute lateral ankle ligament injuries in adults. The Cochrane Library.

6. Kemler, E., van de Port, I., Backx, F., & van Dijk, C. N. (2011). A systematic review on the treatment of acute ankle sprain. Sports medicine, 41(3), 185-197.

7. Kerkhoffs, G. M., Handoll, H. H., de Bie, R., Rowe, B. H., & Struijs, P. A. (2007). Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. The Cochrane Library.

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Should you have further questions or concerns related to your health, please contact the doctor or consult your own healthcare professional.

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