Lateral ankle sprains: a simple management plan to return to activity
Ankle sprains are a common injury where one or more of the ligaments in the ankle are partially or completely torn. The anterior talo-fibular ligament (ATFL) is one of the three ligaments that make up the lateral collateral ligament on the outside of the ankle. It originates from the lateral malleolus of the fibula and attaches to the talus.
The ATFL helps to resist inversion and plantar flexion of the ankle joint, movements commonly seen when rolling your ankle inwards. The injury usually occurs when the person’s centre of gravity is shifted over the outside of the weight bearing leg, causing the ankle to roll inward at a high velocity. The ATFL is the weakest of the lateral collateral ligaments and therefore, the first to be injured.
Acute Phase (0-3 days) - Reduction of pain and swelling and improve circulation and partial foot support
Grade 1 and 2 Sprains:
Rest - weight-bearing as tolerated
Ice therapy for 20 mins on/1 hour off throughout the day to reduce pain, edema, and secondary hypoxic damage to the injured tissues.
A lace-up style brace, or tape may be used to help provide support.
Electrical stimulation (TENs), pulsed ultrasound, antioedema massage may help in reducing inflammation.
Active Range of motion (ROM)- patient should be instructed to perform ankle pumps (10 to 20 an hour) within a pain-free range in order to decrease inflammation and increase circulation.
Soft tissue techniques- Active Release Techniques, muscle energy techniques applied directly to the ligament and surrounding soft tissue structures can be used to aid in early ligament healing.
Grade 3 Sprains: If upon initial examination, a patient is unable to bear weight and displays significant ankle pain and swelling then suspicion of a grade 3 sprain must be warranted. The use of crutches and functional walking orthosis is recommended. Patients should then be instructed to perform POLICE protocol (protection, optimal loading, ice, compression, and elevation) until MRI can be performed.
Proliferative phase (4-10 days) - Recovery of foot and ankle function and improved load carrying capacity
Joint mobilization/Passive stretching : Restore active and passive range of motion
Remodelling phase (11+ days) - Improve muscle strength, active (functional) stability, foot/ankle motion, mobility (walking, walking stairs, running).
Advance strength training
Multidirectional sports specific proprioceptive training
While the management of most ankle sprains will follow a similar progression, a thorough assessment of the foot and ankle is also important to determine the specific structures involved, tailor the management plan to each individual, and to address specific risk factors that may lead to chronic ankle instability.