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). Around the first week of May, alone, at least 4 professional athletes were in the news as a result of suffering from an ankle sprain, including Kyle Lowry (point guard for Toronto Raptors), John Wall (point guard for Washington Wizards), Brian Dozier (second baseman for Minnesota Twins), and Michael Brantley (outfielder for Cleveland Indians). 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.
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. It is important to evaluate other areas of the lower extremity during the examination, though, as there are several other injuries can that occur with the same mechanism as a sprained ankle. 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. Other surrounding soft tissue structures, such as the peroneal tendons, can also be examined at this time. In my opinion, an MRI should only be ordered if #1) the result may change your treatment plan; #2) conservative care fails; or #3) it is needed for surgical planning. I do not routinely order an MRI for an ankle sprain.
NOT ALL ANKLE SPRAINS ARE THE SAME – GRADING ANKLE SPRAINS
There are different ways to classify ankle sprains. One way to classify them is by determining which ligaments are injured. The other way is by the severity of the ligamentous injury. Knowing the grade, or severity, of the injury can help with treatment planning.
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).
Although ankle sprains are a common occurrence, the way in which they present and how to treat them may not be so straightforward. Therefore, it is important to not delay treatment and to see a healthcare professional for further work-up, as the injury may be more serious, or even a different issue, from what you think.
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.
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.