Do you know what type of ankle sprain you have ?

Ankle sprains are one of the most common injuries, often occurring when you least expect it. Whether you’re stepping off a curb or making a quick move in a game, the ligaments around your ankle can easily stretch or tear, leading to pain, swelling, and discomfort.

While it may seem minor at first, a sprained ankle can significantly affect your mobility and, if not treated properly, lead to long-term instability. Therefore, understanding how to manage and prevent these injuries is key to staying active and on your feet.

What is the most common type of ankle sprain?

Lateral ankle sprains (on the “outside” of the ankle) making up about 85% of cases.

The lateral ankle ligaments complex consists of three main ligaments:

1. Anterior Talofibular Ligament (ATFL): This is the most commonly injured ligament in the ankle, especially in ankle sprains. It connects the talus (ankle bone) to the fibula (outer lower leg bone) and primarily resists excessive inversion and plantarflexion (downward pointing) of the foot.
2. Calcaneofibular Ligament (CFL): This ligament is longer and thicker than the ATFL and connects the calcaneus (heel bone) to the fibula. It resists inversion in both plantarflexion and dorsiflexion (upward pointing) and is the second most commonly injured ligament.
3. Posterior Talofibular Ligament (PTFL): The strongest of the three, this ligament provides stability when the ankle is dorsiflexed and is less commonly injured.

But, why does it so common happened in sport injuries? This is because of the unique characteristic of the ankle lateral ligaments.

Unique Characteristic of Lateral Ankle Ligaments:

• High Susceptibility to Injury: The lateral ligaments are prone to sprains, especially the Anterior Talofibular Ligament (ATFL), due to the common nature of inversion injuries. About 80% of ankle sprains affect these ligaments.
• Anatomic Arrangement and Function: The ligaments work together to limit excessive motion in specific directions. Their different lengths, locations, and insertion points allow them to stabilize the ankle during various activities, making them unique from other ligaments in the body.
• Healing and Recurrence Issues: These ligaments, especially the ATFL, are relatively thin, making them vulnerable to tearing. They also receive limited blood supply, which can affect healing and lead to a high rate of chronic instability if not treated properly.

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Therefore, without proper rehabilitation after an initial sprain, the risk of re-injury significantly increases

Signs and Symptoms of an Ankle Sprain (and How to Treat Them)

1. Sharp Pain
   • Symptoms: When an ankle sprain occurs, there is often a sudden, sharp pain. This can range from mild discomfort to more intense pain that limits movement.
   • Treatment: Rest the ankle immediately and avoid putting weight on it. Over-the-counter pain relievers like ibuprofen or acetaminophen can help reduce the pain and inflammation.
2. Swelling
   • Symptoms: Swelling typically occurs soon after the injury, as the body’s response to damage. This may make the ankle appear larger than usual.
   • Treatment: Apply ice to the swollen area for 15-20 minutes every 2-3 hours during the first 48 hours. Elevating the ankle above heart level can also help reduce swelling.
3. Bruising
   • Symptoms: Bruising may develop, ranging from mild discoloration to more severe purples and blues, depending on the severity of the injury.
   • Treatment: Use compression with an elastic bandage to control swelling and bruising. Be sure the wrap is snug but not too tight to avoid restricting blood flow.
4. Tenderness
   • Symptoms: The ankle may be tender to the touch, with pain increasing when pressure is applied.
   • Treatment: Protect the ankle by keeping it elevated and using compression wraps. Avoid putting pressure on the tender area, and continue using ice as needed.
5. Stiffness and Reduced Range of Motion
   • Symptoms: Ankle movement may be restricted, and the joint may feel stiff or difficult to move.
   • Treatment: After the initial swelling has gone down (usually after 48 hours), begin gentle range-of-motion exercises to help maintain flexibility. Avoid movements that cause pain, and gradually increase activity as the stiffness decreases.
6. Instability
   • Symptoms: The ankle may feel unstable or weak, making it difficult to walk or bear weight.
   • Treatment: Use a supportive brace or crutches to keep weight off the ankle. As part of rehabilitation, strengthening exercises and balance training can help restore stability.
7. Popping or Snapping Sound
   • Symptoms: Some people may hear or feel a “pop” or “snap” at the time of injury, which is often associated with more severe sprains.
   • Treatment: If a popping sound occurs, it’s important to seek medical attention, as it could indicate a more serious injury like a ligament tear. A doctor may recommend further treatment, such as a brace or even surgery in severe cases.
8. Difficulty Walking
   • Symptoms: Walking or standing may be painful or difficult, especially after a more severe sprain.
   • Treatment: Rest is essential. Avoid putting weight on the ankle and use crutches if needed. As the pain decreases, start rehabilitation exercises focusing on strength and balance to safely regain mobility.

  Recommended Exercises by Rehabilitation Phase

Phase 1: Inflammatory Phase (First 48-72 hours)

• Focus: Rest, reduce swelling, and control pain.
• Exercises: Avoid exercise. Focus on the RICE protocol(Rest, Ice, Compression, Elevation).

Phase 2: Proliferative Phase (3-7 days)

• Focus: Gentle movement to prevent stiffness and maintain flexibility.
• Exercises:
  • Ankle circles: Rotate your foot in both directions.
  • Alphabet writing: Using your toes, “write” the alphabet in the air to encourage movement.

Phase 3: Remodeling Phase (1-4 weeks)

• Focus: Strengthening the muscles around the ankle to support the joint and prevent further injury.
• Exercises:
  • Resistance band exercises(dorsiflexion, plantarflexion, inversion, eversion).
  • Calf raises: Strengthen the calf muscles.
  • Towel scrunches: Improve toe and foot control.
  • Toe walking: Walk on your toes to improve balance and calf strength.

Phase 4: Maturation Phase (4+ weeks)

• Focus: Return to full activity with advanced strength and balance exercises.
• Exercises:
  • Single-leg balancing: Improve ankle stability by balancing on one leg.
  • Heel-to-toe walking: Improve coordination.
  • Lunges: Progress to forward and lateral lunges to regain strength and mobility.
  • Jumping and agility drills(when pain-free): Incorporate plyometric exercises to simulate sports or high-impact activities.

After an ankle sprain, it’s important to continue exercises that improve strength, flexibility, and balance to prevent future sprains. Wearing supportive footwear and using ankle braces during activities can also help reduce the risk of re-injury.

Prepared by:

Your Physio Butterworth

Kong Mun Chun