Ankle Sprains

Ankle sprains are common sports injuries treated by Podiatrists

An ankle sprain describes damage to the ligaments that stabilise your ankle joint. They are a relatively common and accidental injury, often occurring when you roll out on your foot and over-stretch or tear the ligaments. The pain is immediate, and you may quickly have difficulty bearing weight on the injured foot.

Relevant Anatomy

Types of sprains

There are two primary types of ankle sprains: inversion and eversion sprains. Inversion sprains occur when you roll out on the ankle, twisting the foot inwards. These occur much more frequently (>80%) than eversion sprains (<20%), where you roll in on the ankle and twist the foot outwards.

Injured ligaments

There are four primary ankle stabilising ligaments. The most commonly sprained ligaments, located on the outside of the ankle, are the:

Calcaneofibular ligament (CFL)
Anterior talofibular ligament (ATFL)
Posterior talofibular ligament (PTFL)

The ATFL is the most commonly injured ligament, followed by the CFL if the sprain is severe.

On the inside of the ankle, we have the strong deltoid ligament, which is comprised of the:

Tibiotalar ligament (TTL)
Tibiocalcaneal ligament (TCL)
Tibionavicular ligament (TNL)

One of the reasons that it is uncommon to sprain the ligaments on the inside of the ankle, aside from the strength of the deltoid ligament, is that the fibula (the thinner bone that runs alongside the shin bone - tibia) tends to prevent the excessive eversion of the ankle. It also means that when eversion sprains do occur, the head of the fibula may fracture from the impact.

What are the symptoms?

You’ll almost certainly know when you’ve sprained your ankle as the damaged ligaments quickly result in significant pain that may impair your ability to walk or bear weight on the injured foot. You may also experience:

Swelling
Bruising
Restricted movement in the ankle
Tenderness when touching the ankle or moving the foot from side to side
Instability when walking on the ankle, like it is giving way

If the ankle sprain is severe, or it was associated with a fall, there is a chance you may also have fractured or injured a bone in your foot. In this instance, x-rays will be useful to assess the extent of the bony damage, and ultrasounds can evaluate the integrity of the ankle ligaments.

What causes an ankle sprain?

Ankle sprains are an accidental injury caused by a force that causes the ankle to roll inwards or outwards. This may be from:

Walking on an unstable or unbalanced surface
Playing sports that have quick changes in direction, e.g. basketball, soccer and tennis
Awkwardly planting your foot on the ground following a jump
Getting hit on the inside of the ankle with a soccer ball (causing you to roll out and twist the ankle inwards, spraining the ligaments on the outside of the ankle)

If a previous injury has caused some weakening in your ankle ligaments, then you are more likely to have another ankle injury. It’s important to see your Podiatrist if this is the case.

Caring for your ankle sprain at home

When ankle sprains aren’t effectively managed, they can lead to long-term ankle weakness and chronic instability. If your sprain is causing you pain while walking, it is likely more severe and we recommend that you see your Podiatrist as soon as you’re able. Ideally, this will be within the first 24 - 48 hours.

When to see a Podiatrist

How your Podiatrist can help

Your Podiatrist will start by assessing the extent of your injury to know how to best direct treatment. If it is suspected that you have subsequently injured your fibula or another bone during the sprain, you may be referred for an x-ray and ultrasound to assess both the bony damage and the integrity of your ligaments. Your Podiatrist may then implement various best-practice techniques appropriate for the severity of your sprain, including:

Strap or brace the ankle
Discuss footwear options that will optimise and not impair your recovery
Provide a timely and appropriate exercise programme for your ankle. This has shown to produce effective results alongside taping or bracing when performed correctly under the supervision of your Podiatrist. These programmes should not be attempted unless under direct supervision as the injury has the potential to worsen if loaded incorrectly.
Help identify the cause of your sprain and discuss how you can help prevent it in the future, i.e. by using ankle braces during sport
Work to reduce the risk of complications like chronic ankle instability

Surgery should only be considered when the ankle sprain does not respond to the above treatments, and exercise-based treatments (strengthening programme) have been tried.

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