One of the most common injuries in athletics is a lateral ankle sprain. This occurs when the foot is inverted (foot twists and inside arch is facing up) and one or more of the ligaments on the outside of the ankle is damaged. There are different grades of ankle sprains depending on severity as well as the ligament that is injured. The signs and symptoms of the injury help determine the grade, treatment and healing time of the sprain.
There are a couple reasons why lateral ankle sprains occur so often. First, the anatomy of the ankle provides a bony block on the inside, which forces the ankle to lean to the outside. Second, the musculature and ligaments on the inside of the ankle are much more secure and thicker than those on the outside. Finally, in a normal walking pattern, or gait, most of the weight is placed on the outside of the foot when it is placed on the ground, naturally causing an inversion at the ankle joint.
In a typical lateral ankle sprain, the most common ligament that is damaged is the anterior talofibular ligament. The
name describes exactly where it is; it connects the talus bone of the ankle to the fibula in the lower leg. In a more severe sprain, the calcaneofibular ligament may also be injured. Two other ligaments, the anterior and posterior tibiofibular ligaments, may be injured as well. When these ligaments are sprained it is known as a high ankle sprain. The deltoid ligament is located on the inside of the ankle and is stronger and less often injured than the other ligaments of the ankle.
Signs and Symptoms
There are generally 3 grading classifications of ankle sprains. However, different texts, clinicians, and physicians may have or use different scales. Commonly, most ankle sprains result in some amount of swelling and bruising, loss of range of motion, and moderate pain.
- Grade 1 Ankle Sprain– The ligament is stretched, causing microscopic damage to the tissue. There is generally only a limited amount of swelling and pain. Most patients can put some weight on the foot and don’t need crutches, however, they most likely will not be able to run or jump. On average grade 1 ankle sprains, with proper rehabilitation will heal in about 7 to 10 days.
- Grade 2 Ankle Sprain– This level of ankle sprain is more severe and there is a greater amount of pain. The injury results in a partial tear of one or more ligaments and causes moderate swelling and bruising in the area. Crutches are often needed because of the irregular gait and pain with weight bearing. Depending on the severity, a patient with a grade 2 ankle sprain can take anywhere from 2 to 4 weeks to heal and return to previous levels of activity.
- Grade 3 Ankle Sprain– A complete tear of one or more of the ankle’s ligaments. There may be severe bruising, swelling, and little or no range of motion in the ankle joint shortly after an injury. Patients that have completely torn the ligament sometimes need surgery. The ankle may be very unstable and crutches and/or a walking boot usually are needed. At least 4 to 6+ weeks of rehab and treatment will be required for proper healing.
It is extremely important to give the proper treatment immediately after an ankle injury occurs. Often an increase in swelling causes more pain and a longer healing time. To prevent ankle swelling, the “RICE” technique is used. ‘R’ stands for rest. The patient should refrain from activity for a minimum of one day to prevent more damage. Using crutches is a form of resting the ankle. ‘I’ is for ice. Ice is used to decrease blood flow, resulting in a decrease in swelling when used immediately. Ice should be used 20 minutes out of every 2 hours for at least the first 48 hours after injury. Never heat a freshly sprained ankle. The ice also helps to numb the area and decrease pain levels. ‘C’ is for compression. Putting pressure on the entire ankle will help prevent and push any swelling out of the area. Use an elastic bandage and wrap from the toes all the way to the calf. Overlap the elastic wrap and do not leave any holes in the heel or elsewhere, as swelling will occur in these spots. Finally, the ‘E’ is for elevation. Gravity plays a large role in the amount of ankle swelling that occurs. Keeping the ankle elevated, preferably above the heart, assists in keeping extra blood flow and fluid out of the area.
Over time, atrophy can occur in muscles if they are not used to move the ankle joint. Muscle atrophy and weakening can occur within days of injury so it is critical that the patient does rehabilitative range of motion exercises in the first few days after injury. Examples include spelling out words by making the shapes of letters with the foot, or basic up and down ankle pumps. In time, the pain will decrease and more rigorous strengthening exercises should be implemented, as well as continuing towards obtaining full range of motion. When returning to sports or fitness activities after rehabilitation is completed, an ankle brace, or daily ankle tapings can be beneficial to prevent re-injury. Research has shown that both of these preventative actions help decrease the patient’s chances of re-injuring the ankle.
By: Allison Fretthold, ATC
Allison graduated as a certified athletic trainer from the Mercyhurst University Sports Medicine Department in 2011. She has worked at various levels of athletics, varying from small high school settings to major Division 1 universities. She attended Ohio University for her master’s degree and currently works as an athletic trainer at River Valley High School in Gallipolis, Ohio.