An ankle sprain occurs when the ankle is forced too far in one direction resulting in a tear to the supporting ligaments. Due to the anatomy of the ankle, there are three classifications of ankle sprains, lateral (outside), medial (inside) and syndesmosis (high).
Lateral ankle sprains are the most common type of ankle sprain, they occur to the ligaments on the outside of the ankle. The lateral ankle is stabilised by three ligaments that run between the fibula and bones of the foot. A lateral ankle sprain occurs when the foot is forced into plantar flexion and inversion (down and inwards) relative to the lower leg. The most commonly injured ligament is the anterior talofibular ligament (ATFL) although multiple ligaments can be damaged depending on the exact direction of force.
Medial ankle sprains are less common, they occur when the foot is forced into eversion (outwards) relative to the lower leg placing the deltoid ligament under stress.
Syndesmosis sprains affect the ligaments that hold the tibia and fibula together at the ankle. These injuries usually occur when a torsional or rotational force is applied to the ankle. The most common method for this to occur is with the foot planted and the tibia and fibula rotates inwards.
Grade 1 ankle sprains are categorised as having less than 50% of each ligament torn. These may be painful, have mild bruising or swelling. These symptoms often settle within a few days with rest ice elevation and compression and the underlying sprain heals within about 6 weeks.
Grade 2 ankle sprains are categorised as having more than 50% of each ligament torn with some fibres remaining intact. You will often experience pain, moderate to severe swelling, bruising and difficulty walking initially. The ankle can feel unstable when moving in the direction of the sprain. Instability, reduced balance and confidence are often noticed as the sprain causes a loss of proprioception (how your brain knows where your ankle is in space). It can take 8-12 weeks for the sprain to heal and for balance and confidence to be restored.
Grade 3 ankle sprains are categorised as a full rupture as no fibres remain intact. These ankle sprains often have significant swelling, bruising and instability. It can take 12 or more weeks for healing and for function to be restored.
The vast majority of ankle sprains are managed conservatively, and most don’t require an x-ray. Should your physiotherapist suspect an ankle fracture they can refer you for an x-ray.
The initial phases of managing an ankle sprain are crucial as it often impacts the length of rehabilitation required. Staying off your ankle and reducing the swelling through compression and ice is a great way to manage an acute ankle sprain.
Taping or using an ankle brace to support and restrict your ankle movement to allow the ligament to heal is crucial in your rehabilitation. Moon boots are generally not recommended as this can alter your gait pattern and cause further issues later on in your rehabilitation. Taping or using an ankle brace are the best options as this restricts movement in the appropriate places without altering your walking mechanics.
Once your ankle is settled enough, your physiotherapist will be begin you on an exercise program designed to strengthen the affected muscles and tendons from your ankle sprain.
A good measure for how strong your ankle needs to be is the number of single leg calf raises you should be able to complete given your age and gender.
Once you have gained sufficient strength in your ankle your physiotherapist will then progress you to the plyometric phase on your rehab if deemed appropriate. A common reason to progress to this phase of rehab is if you would like to return to running.
Being able to hop on a single leg requires a high level of strength and control, having a poor hop can put you at significant risk of developing another ankle sprain, particularly with sporting activities. To assess your hopping ability, a commonly used test is the side hop test.
We have experienced senior clinicians with one of the best equipped facilities on Auckland’s North Shore. Our patients have access to a full gym and Pilates studio and a physiotherapist is always available during staffed hours to offer you additional support.