Lateral Ankle Sprain

There are many muscles and ligaments in the ankle joint that work together to provide stability, strength, flexibility and movement. The ligaments of the ankle joint are categorised as either medial (inside) collateral ligaments or lateral (outside) collateral ligaments.

Although the ligaments of the ankle are strong fibrous bands, the lateral ankle ligaments are more susceptible to injury due to the movement available at the ankle joint during activity. The specific ligaments that might be affected are the anterior talofibular ligament, calcaneofibular ligament and the posterior talofibular ligament. The anterior talofibular ligament is reported to be the weakest of the three ligaments so is most often the ligament that is injured .

Ankle sprains are graded depending on how much damage has occurred to the ligaments.

Lateral ankle sprains commonly occur during activities involving jumping and landing, or activities requiring rapid changes in direction, especially on uneven surfaces. The usual mechanism of injury is a combination of turning the foot inwards, and pointing the foot and ankle downwards during weight-bearing activities, i.e. rolling the ankle inwards ⁽⁴⁾.

Acute ankle sprains are one of the most common musculoskeletal injuries and have a particularly high incidence among physically active individuals ⁽⁵⁾. More specifically, lateral ankle sprains are the most common lower limb musculoskeletal injury in people who participate in sports and recreational physical activities ⁽⁶⁾. It is estimated that 5000 new cases occur each day in the UK with about 302,000 annual visits to A&E ⁽⁷⁾.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like X-ray, MRI (magnetic resonance imaging) or ultrasound scans are usually not required to achieve a working diagnosis, but in unusual presentations, they may be warranted.

Self-management directly after a lateral ankle sprain is vital. In the early stage of management, good practice now involves the use of the peace-and-love ⁽⁹⁾.

Protect: the injury the first few days, avoid activities that increase pain.
Elevate: the leg higher than the heart as often as possible.
Avoid anti-inflammatories: they may reduce tissue healing in the early stage.
Compression: can help reduce swelling.
Education: your body knows best, avoid unnecessary treatments.
&
Load: let pain guide your return to normal activities.
Optimism: remain confident and positive.
Vascularisation: choose a pain-free exercise that elevates your heart rate.
Exercise: restore strength by adopting an active approach to recovery.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a musculoskeletal physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to the sport, a rehabilitation programme should incorporate plyometric based exercises; this might include things like bounding, cutting, and sprinting exercises.

Very rarely is surgery needed for an ankle joint sprain as the anatomy of the ligaments allow for successful healing with conservative (non-surgical) management. In the presence of more complex injuries that are occasionally associated with lateral ankle injuries, a further scan may be required. This may be used to evaluate for the presence of damage to the cartilage (protective substance) which lines the ankle joint. However, this is extremely rare ⁽⁸⁾.

Managing Ankle Sprains | RunningPhysio (running-physio.com)