Ankle Sprain

Ankle (Talocrural) Joint

• ankle mortise consists of talus bone rocking between ends, or 'malleoli', of tibia (major weight bearing bone of lower leg) and fibula (slender 'strut' or outrigger bone of lower leg)
• anterior talofibular ligament (ATFL) is most commonly injured ankle ligament due to anatomical configuration of bones at ankle

Ankle Sprain

• usual mechanism of injury is rolling onto outer aspect of foot (foot rolls inward)
• 'sprain' (grades I - III: stretch-slight tear; partial tear with a degree of directional instability; full tear, or rupture, +/-chip avulsion tip of fibula, with resulting gross instability) refers to ligament injury whereas 'strain' is that of muscle and/or tendon

Physical Therapy Treatment

• early therapeutic intervention is very important in promoting and expediting resolution of injury and subsequent full recovery of function
• assessment to identify primary affected tissue and concomitant injury (e.g., compromised or 'jammed' joint, damaged muscle/tendon)
• application of electrotherapeutic modalities and ice for control of inflammation, swelling, and pain
• heel lifts may facilitate return to activity in initial stage; removed later
• taping or bracing ankle is absolutely indicated with second degree (and resolving third degree) sprain and in situations in which physical demands of resumed activity are high and/or rapid return to activity is necessary
• custom-fabricated orthotic (insole) or prescription shoes or sandals may be prescribed to remedy faulty foot-ankle biomechanics
• muscle strengthening and balance retraining
• conditioning and functional re-training activities assigned if fitness or normal routine of daily living have been negatively impacted by this condition

Other Treatments

• anti-inflammatory medications
• surgery may be indicated to tighten lax ligaments where ankle is patently unstable; on occasion, bones may need to be plated and/or pinned

Prognosis

• First degree sprain may require only a few treatments; second degree sprain/tear typically requires 3 to 4 weeks of treatment; third degree tear may require up to 6 weeks treatment
• ligamentous laxity may persist for several months, or even indefinitely, especially following recurrent sprains

Physio Note: Immediate Self-Care

RICE (Rest, Ice, Compression, and Elevation) acute care strategy should be followed throughout the day for at least the first two days after injury)

Your physical therapist will give you a home exercise routine specific to the nature of the sprain. These will include exercises for range of motion as well as for strengthening

A variety of braces are available to facilitate a safe return to desired activity. Your therapist will assist you in selecting the appropriate brace given your particular injury and activity needs