FIX with K 👩🏼 Lateral Ankle Sprain

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The ankle has a few structures on the lateral side that can be injured during an inversion ankle sprain. The main ligaments that are on the lateral side of the ankle include the calcaneofibular, anterior talofibular, and posterior talofibular ligament. The anterior talofibular ligament known as the ATFL is the most commonly injured ligament during a lateral ankle sprain.

There are some important ligaments on the medial side of the ankle as well, and during more severe lateral ankle sprains in addition to the damage to the lateral ligaments, the medial ones can also be damaged. This includes the deltoid ligament which is made up of a superficial and deep layer and plays a large part in the stability of the medial aspect of the foot.

What is a lateral ankle sprain?

A sprain is an injury to a ligament that involves stretching of the ligament past its capability and may or may not include tearing as well. When the ligaments are stretched beyond their limits they have tearing of the fibres within them which causes pain, swelling and inflammation.

A lateral ankle sprain is where there is an inversion injury to the ankle and beyond the limits of the ligaments. This is where the foot goes inward and stretching the ligaments on the outside of the ankle. You may have also heard of the lateral ankle sprain as a rolled ankle because the foot goes in and the body almost rolls over the top of it.          

What are the causes of a lateral ankle sprain:

Lateral ankle sprains are most commonly experienced during a change of direction mechanism, contact, stepping awkwardly on an uneven surface or landing from a jump onto someone elses foot. Usually the history of an ankle sprain is the largest risk factor for a repeat injury. Ligaments do not have a great blood supply and because they do not heal well and regain full elasticity and tautness they leave the joint susceptible to injury in the future.

What are the symptoms of a lateral ankle sprain:

The most common symptoms experienced after an inversion injury is pain over the lateral ankle which is usually felt immediately with a clear moment of injury. You can have minor ankle sprains that you may not really even notice in the moment, especially if you wear ankle braces or strapping and may not notice until after you remove the support and stop activity.

In addition to pain commonly you will see the well recognised swelling that can look like a golf ball on the outside of the ankle over the small palpable bone. This swelling may become pronounced very quickly with more severe injuries or over a few hours in more moderate instances.

In some cases you may experience visible bruising over the outside of the foot and ankle. This bruising is often associated with more severe ankle sprains however can be associated with moderate cases also.

Do you need to get an x-ray?

There are rules in place to help you determine if you need to go to emergency and get an x-ray immediately after injury and rule in more serious ankle injuries that require medical intervention. These rules are called the Ottawa ankle rules and include the following:

It is recommended that you get an x-ray if:

• There is any pain in the malleolar zone; and,

• Any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR

  • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR

  • An inability to bear weight both immediately and in the emergency department for four steps.

If this is not something you are comfortable assessing yourself, or you do not have access to a physiotherapist soon after your injury I would recommend following up with allied health if you can weight bare, and going to the ED if you cannot put any weight through your foot due to sharp pain.

Management of Lateral Ankle Sprain

Immediately after a lateral ankle sprain to help prevent swelling and reduce pain you can apply a compression bandage and elevate the foot as soon as possible.

Apply ice for 20mins on 20mins off to help reduce swelling and pain also. There has been some discussion in recent years around icing in the initial stage of injuries as the inflammation and inflammatory chemicals are very important in the healing of injuries.

In my experience I still believe that using ice in the first 24 hrs is extremely helpful to reducing swelling and pain to help promote and facilitate early movement and weight bearing.

Begin walking and putting weight through your foot and ankle as much as is comfortable. Limit pain but try to regain normal walking gait as quickly as possible to prevent compensatory patters becoming a habit.

Regain pain free full range of motion through the ankle, both up and down, and side to side. A little bit of pain/discomfort is to be expected as in the early stage there is still some aggravation and inflammation early on however try to avoid sharp pain. If there is sharp pain do not push through that but rather only up until this point.

Once you have regained full range movement you then need to increase the strength, endurance and the plyometric capability before going through a clearance testing scheme to return to sport or previous activity.

Services at RIGS to help manage Lateral Ankle Sprain:

Specialised Cryotherapy

Used daily in the first 4-6 days to help reduce the inflammation, swelling and help improve pain and progressive range improvements.

Compression therapy

Used on comfortable pressure to help flush out swelling, reduce tightness through muscles on the lower leg that get extremely tight in response to the trauma of the injury

CWT

Utilising the hot pool mostly to help reduce tension in the muscles around the ankle and promote mobility. Can be useful to do some gentle strength and mobility exercises while chest deep in the hot water to reduce load through the foot and ankle.

HBOT

If wanting to speed up the rate of healing of the tissues that may have been sprained and aggravated spending a few session per week in the first 2-3 weeks will encourage fast healing and recovery to help you progress through the stages of rehab and get onto the strength and plyometric work a little faster.

If you have any questions or would like help through the process of your ankle rehabilitation either conservatively or post op if you required it then please feel free to reach out via our complimentary injury management program or Krystal our physiotherapist.