The Sprained Ankle
The ankle and foot comprises of a complex of ligaments connecting the bigger bones of the lower leg and the smaller bones of the foot. A sprain occurs as a result of damaged ligaments and can be successfully treated by a physiotherapist. A minor sprain is a result of the ligament being stretched. A more serious sprain is when the ligament is partially or completely torn. Ligament sprains can be classified into 3 types:
Type 1: The ligament is stretched but still intact. There will be pain and swelling can occur. There shouldn’t be any difficulty moving the ankle.
Type 2: This is a more severe injury to the ligament involving a partial tear of the ligament. Pain is moderate to severe and the ankle will become swollen and bruised. Weight bearing will be painful.
Type 3: This involves a complete tear of the ligament. This will cause a large inflammatory reaction. The area will become immediately painful, swollen and bruised. The result of the torn ligament means a loss of stability to the joint.
The most common ankle sprain is known as an ‘inversion injury’ where the foot ‘inverts’ or turns inwards in relation to the lower leg. This sudden movement overstretches the ligaments on the outside of the ankle. Less commonly an ‘eversion injury’ occurs where the foot turns outwards in relation to the lower leg, overstretching the ligaments on the inside of the ankle. A sprained ankle is a very common injury in sports that involve running and jumping, quick changes in direction and lots of stop-starts such as football or tennis. A sprain to the ankle ligaments may also occur when walking on an irregular surface, twisting the ankle when going up steps or if you lose balance when walking in high heeled shoes!
There is an increased risk of spraining your ankle if:
• The muscles around your ankle are weak
• The ligaments are loose
• You have previously sprained the same ankle and not allowed adequate recovery time.
A physiotherapist can also assist in appropriate rehabilitation to minimise the risk of re-spraining the ankle.
The most common symptoms are:
• A ‘giving way’ sensation in the ankle when the injury occurred
• Pain at the site of injury
• Difficulty moving the ankle (this can be due to pain and/or stiffness).
A physiotherapist can assess and examine the damaged ankle to determine how bad the sprain is. The physio will ask questions about how the injury happened which can help diagnose which ligaments are involved. In more severe cases where the ankle is very painful and swollen, a doctor may recommend an X-ray if there is a suspicion of a bony injury.
There are certain steps that can be taken by the injured person to limit the effects of inflammation after a sprain. As physiotherapists we recommend the RICE principle within the first 48 hours post-injury:
Avoid large movements of the ankle and try to avoid putting weight through that leg.
Apply an ice pack or bag of frozen peas to the area. Place a cloth between the ice pack and the skin and avoid icing the area for any longer than 20 minutes in every hour.
This can be applied in the form of an elastic support bandage. It should be firm but not so tight that it reduces circulation to the area.
Raise and support the ankle above the level of the heart to help reduce the amount of swelling. Over the counter anti-inflammatory and painkilling medicine such as ibuprofen can provide effective pain relief and help reduce the swelling. If the ankle remains very painful at rest and the swelling persists and it is still very painful to weight bear 24 to 48 hours after the injury a medical opinion is recommended.
After the first 2 to 3 days post-injury, the pain and swelling should decrease. At this stage we would advise that you start to move the ankle. Rehabilitation aims to regain full range of movement at the ankle and regain any lost strength. A visit to a physiotherapist will provide you with more information about your injury and specific exercises suitable for your needs can be administered.
The physiotherapist can also use other modalities such as ultrasound to facilitate soft tissue healing and also use rehabilitation tools to help retrain balance to prevent the injury occurring again.
For more information, book a consultation with the physiotherapist.
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