Sprained Ankle

Sprained foot.jpgWhat is a Sprained Ankle?

A sprained ankle happens when your ankle ligaments are stretched beyond their normal limits, causing micro/partial-tears in the ligament. In some cases, full thickness tears or ankle fractures can happen too.

Ankle sprains can have different levels of severity, from the mild “twisted or rolled ankle” sprain through to severe complete ligament ruptures, avulsion fractures or broken ankle bones.

First Of All, What Causes a Sprained Ankle?

Ankle sprains can happen by simply by rolling your ankle on some unstable ground.

The most common examples of this is when you awkwardly landed/planted your foot when running, landing unbalanced from a jump or stepping onto an irregular surface.

Yeah, it’s really that easy to sprain your ankle unfortunately.

What are the Symptoms of a Sprained Ankle?

A history of your ankle rolling is the key ingredient to suspecting a sprained ankle.

At the time of the injury, you may sometimes feel or hear a popping, grinding or cracking sound and will notice swelling, bruising and ankle pain.

The inner and outer ligaments of the sprained ankle will typically be painful and tender over the injured ligament.

Depending on the severity of your ankle sprain, you may have trouble walking or standing on your foot.  In these cases, crutches, strapping or a walking boot may be necessary to help you to mobilise throughout the day.

In more severe cases, there may be sharp pain deep in the ankle joint associated with a talar dome fracture or pain between your lower shin bones, which may be a syndesmosis or high ankle sprain.

How is a Sprained Ankle Diagnosed?

Experienced and skilled physiotherapists are typically highly skilled in the assessment, diagnosis and management of ankle sprains. Your history and an in-depth thorough clinical examination will determine the severity of your sprained ankle.

Where required, you may be referred for an imaging such as

  • x-ray
  • CT scan or
  • MRI

to confirm or exclude specific ligament or bone injuries.  Typically x-rays are ordered first to rule out ankle fractures or avulsion fractures, and if the alignment of the ankle and/or foot bones look strange, then the doctor may order MRI too to check in on soft tissues such as tendon or cartilage tears.

Which Ankle Ligaments are Commonly Sprained?

Your ankle joint, known as the talocrural joint,is made up of three bones:

  1. the tibia (shin bone – inside ankle bone)
  2. fibula (outer lower leg – outside ankle bone)
  3. talus (deep ankle bone)

Underneath the talocrural joint lies the subtalar joint, which is the connection between the talus and the calcaneus (heel bone).  Your ankle ligaments attach from bone to bone and passively limit the range of motion that available at each joint.

On the outside of the ankle lie the lateral ligaments, which are the most frequently injured in an ankle sprain. These include the:

  • anterior talofibular ligament (ATFL)
  • calcaneofibular ligament (CFL)
  • posterior talofibular ligament (PTFL)

The main medial (inside of ankle) ligament is the much stronger deltoid ligament.

High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries and are often misdiagnosed as the more simple sprained ankle.

Treatment for Sprained Ankle

Unfortunately, a sprained ankle can increase your risk of re-injury as much as 40-70%, but the correct post-injury rehabilitation exercises will quickly and significantly decrease the risk.

There are essential treatment aims that need to be covered to effectively rehabilitate your sprained ankle and prevent recurrence.

Physiotherapy Treatment Aims

  • Injury Protection, Pain Relief & Control Inflammation
  • Regain Full Range of Motion
  • Strengthen your Ankle and Calf Muscles
  • Restore Joint Proprioception & Balance
  • Restore Normal Function
  • Speed & Agility
  • Sport-Specific Skills
  • Graduated Return to Training
  • Return to Competition

Sprained Ankle Treatment Progressions

There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation will be determined by many factors during your physiotherapist’s clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.

Phase 1 – Injury Protection: Pain Relief & Control Inflammation

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.

(Active) Rest: In the early phase you’ll most likely be unable to walk on your sprained ankle. Your first aim is active rest from pain-provoking postures and movements. This means that you should stop doing the movement or activity that provokes the ankle pain. In most cases, you will need to be non-weightbearing. You may need to be placed in an ankle walking boot, a supportive ankle brace or utilise crutches.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Compression: A compression bandage, tubigrip compression stocking or kinesiology supportive taping will help to both support the injured soft tissue and reduce excessive swelling.

Elevation: Elevating your injured ankle above your heart will assist gravity to reduce excessive swelling around your ankle.

Your physiotherapist will utilise a range of helpful tricks including pain relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase.

Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reliever.

Phase 2: Regain Full Range of Motion

If you protect your injured ankle ligaments appropriately the torn ligaments will successfully reattach and heal a normal functional length. Mature scar formation takes at least six weeks. During this time period, you should be aiming to optimally remould your scar tissue to allow for full functional ankle movement and prevent a poorly formed scar that will re-tear in the future.

It is important to lengthen and orientate your healing scar tissue via massage and exercises designed to address your joint range of motion, muscle length and normal neural tissue motion.

IMPORTANT: Researchers have identifies that the history of a sprained ankle predisposes you to a stiff ankle joint that further predisposes you to an array of injuries including ankle sprains, foot pain, calf and leg injuries plus back pain.  Therefore, anyone who has suffered a sprained ankle should seek professional guidance to assess the amount of ankle joint motion you actually have. Please contact your physiotherapist for specific testing and advice.

Just as importantly, you should not overstretch ligaments and soft tissue, or you may develop a passively unstable ankle. Your physiotherapist will prescribe the exercises that are best suited to your needs.

Phase 3: Restore Muscle Strength

Your calf, ankle and foot muscles will require strengthening after an ankle sprain. It is important to regain normal muscle strength to provide normal dynamic ankle control and function. Your strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for your other leg, gluteal and lower core muscles depending on your assessment findings.

Your physiotherapist will guide you.

Phase 4: Normalise Foot Biomechanics

Sprained ankles can occur from poor foot biomechanics eg flat foot or high arch. In order to prevent a recurrence, your foot arch and its control should be assessed by your physiotherapist. In some instances, you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation Program.

Your physiotherapist will happily discuss the pros and cons of both options to you.

Phase 5: Restore High Speed, Power, Proprioception, and Agility

Most sprained ankle injuries occur during high-speed activities, which place enormous forces on your ankle and adjacent structures.

Balance and proprioception (the sense of the relative position of neighbouring parts of the body) are both known to be adversely affected by injuries such as a sprained ankle. To prevent a re-injury, both aspects need to be assessed and retrained.

In order to prevent a recurrence as you return to your sport, your physiotherapist will guide you through exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 6: Return to Sport

If you play sport and depending on the demands of your chosen sport, you may require sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame that sprained ankle recover. While we do know that the ligaments themselves will take at least six weeks to heal, your muscle strength, the range of motion, proprioception, and return to function can vary considerably. Here are some general guidelines.

Grade 1 – Mild

In mild cases, you can expect full ligament healing within 2 to 3 weeks, but it will take at least six weeks for full scar tissue maturation.

Despite most people being told to simply “rest” and it will recover, we find that these mild sprains often result in joint stiffness, ligament laxity, muscle weakness or tightness plus reduced proprioception (balance and joint awareness).

If not adequately treated these often cause your ankle and foot joints to compensate movement at adjacent joints, which can lead to several other injuries months or years down the track.

Grade 2 – Moderate

Grade 2 injuries occur when you have a significant ligament injury that allows the ligament to excessively stretch. In most cases, these injuries result in a recovery period of 4 to 6 weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive.

All Grade 2 injuries should be thoroughly rehabilitated to enable:

  • full range of motion and strength
  • full proprioception, power, and agility
  • full return to sport-specific drills

Grade 3 – Severe

Grade 3 ligament injuries are when the ligament is completely ruptured. More severe ankle sprain injuries can also include fractures of the bones or high ankle sprains, which will require additional rehabilitation time to a simple lower ankle sprain.

The rehabilitation of a Grade 3 ankle sprain normally takes 6 to 12 weeks but is quite variable depending on your specific injury. Your physiotherapist or surgeon will be able to provide you with more specific guidelines and advice.

For more specific advice about your sprained ankle, please ask your physiotherapist.

What Happens If You Leave a Sprained Ankle Untreated?

While the sprained ligaments most commonly heal within 6 to 12 weeks, it is actually the functional disability that is important in the long-term for a sprained ankle.

Stiff ankles that do not regain their full motion have been shown to not only hamper your ability to descend stairs or point your toes, which may hinder your ability to swim or dance. Ideally, stiff ankles should be loosened to regain full range of motion.

Loose ankles will feel unstable and can render you susceptible to re-sprain and further ankle joint damage, which can increase your likelihood of degenerative arthritis. Wobbly ankles can normally be strengthened to dynamically control your ankle. Weak ankles fall into a similar bracket.

At the end of the day, there is rarely a simple ankle sprain that doesn’t have an ongoing functional impact. Professional rehabilitation guidance cannot only accurately assess your ankle, but also promptly correct any deficits while the ankle injury is in the youthful tissue healing phase. Chronic ankle sprains are always harder to treat due to scar tissue stiffness, established muscle weakness, or reduced proprioception.

High ankle sprains involve ligament damage to the stabilising structures supporting your two weight-bearing shin bones (tibia and fibula). High ankle sprain are a far more disabling ankle injury and are often misdiagnosed as a simpler lower sprained ankle. Failure to treat an unstable high ankle sprain can quickly destroy your weight-bearing ankle joint surfaces and result in ankle joint destruction. Joint destruction will be both painful and functionally disabling. This often results in ankle/foot surgery to either fuse your ankle joint or total ankle joint replacement.  Neither are perfect outcomes if prevention is an option.

For more specific advice about your sprained ankle, please consult your physiotherapist or foot healthcare specialist.

Related Injuries

General Information

  • Heel Pain
  • Ankle Pain
  • Foot Pain

Heel Pain

  • Heel Spur

Traumatic Ankle Ligament Injuries

  • Sprained Ankle
  • High Ankle Sprain

Tendinopathies/Fasciopathies

  • Achilles Tendon Rupture
  • Achilles Tendinopathy
  • FHL Tendinopathy
  • Peroneal Tendinopathy
  • Tibialis Posterior Tendinopathy
  • Plantar Fasciitis

Foot Injuries

  • Bunion
  • Metatarsalgia
  • Morton’s Neuroma

Bone Injuries

  • Ankle Fracture (Broken Ankle)
  • Stress Fracture
  • Stress Fracture Feet
  • Severs Disease
  • Heel Spur
  • Shin Splints

Degenerative Conditions

  • Ankle Arthritis

Soft Tissue Inflammation

  • Retrocalcaneal Bursitis

Biomechanical Conditions

  • Anterior Ankle Impingement
  • Posterior Ankle Impingement
  • Pes Planus (Flat Feet)

Nerve-Related Sources

  • Tarsal Tunnel Syndrome
  • Sciatica
  • Pinched Nerve
  • Restless Leg Syndrome

Muscle Injuries

  • Cramps
  • Muscle Strain

Systemic Conditions

  • Fibromyalgia
  • Lupus
  • Rheumatoid Arthritis
  • Psoriatic Arthritis

General Information

  • Heel Pain
  • Ankle Pain
  • Foot Pain

Sprained Ankle Treatment Options

 

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Heel Cups
  • Orthotics
  • Soft Tissue Massage
  • Walking Boot
  • Ankle Strapping
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis

 

FAQs about Sprained Ankles

 

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • How Can You Prevent a Future Leg Injury?
  • How Do You Improve Your Balance?
  • How Much Treatment Will You Need?
  • How to Strap an Ankle
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What’s the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker