Common Injuries: Ankle Sprain

Ankle is one of the most injured body parts if not the most. The most common ankle injury is ankle sprain. Sprain is an injury to ligaments which connect two(or more) bones. In the same way, athletes sprain their ankle, more serious injuries such as growth plate (physis) injuries, fractures, avulsion fractures, etc. can also happen. In growing athletes, it is important to rule out any of those injuries since it is often misdiagnosed.

1) Anatomy

The ankle joint consists of two lower leg bones (tibia and fibula) and talus (called ankle mortise). And there are ligaments that connect those bones on each side of the joint. They are anterior talofibular (ATF), calcanofibular (CF), and posterior talofibular (PTF) ligaments on the outside (lateral) of the ankle, There is strong deltoid ligament on the inside (medial side). It is a lot easier to roll an ankle inward than outward. This is due to the fact that fibula extends farther down the ankle and limits the motion.

There are also ligaments that connect tibia and fibula. Anterior tibiofibular (ATF) and posterior tibiofibular (PTF) ligaments are not to be confused with anterior and posterior talofibular ligaments. The muscles called peroneal brevis and longus run right behind the lateral malleolus and they may also be involved in a case of ankle sprain.

The major artery, vein, and nerve to the ankle and foot run behind the medial malleolus.

2) Mechanism Of Injury (MOI)

Ankle sprains usually happen when an athlete lands on the ankle awkwardly and twists it in. They may land on someone's foot or an object on a playing field or floor. It may also happen when he/she is trying to change directions quickly. The most ankle sprains are lateral ankle sprain.

3) Clinical Presentation

The most common symptoms of acute ankle sprain are pain and immediate swelling. Discoloration may be present in a more severe case. It is painful and tender to touch the ankle. The range of motion (ROM) may become limited due to pain and swelling. The injured athlete may or may not be able to stand on their feet right after the injury has happened.

In chronic ankle sprains, the athlete may feel like their ankle is giving away when they walk, run, etc. The ankle may not swell up.

4) Treatment

Treatment of an acute ankle sprain should include cessation of any activities, ice, compression, (and elevation). The earlier it is treated, the shorter the recovery time will be. An early attempt to keep inflammation down is important. Icing is an effective way to do so. NSAID's (non-steroidal anti-inflammatory medications) may also be useful. Once swelling and pain are controlled, the athlete may start rehabilitation, which should include regaining the range of motion and strength, balance, proprioception, strengthening of lower leg and hip musculature, core exercises, etc. It is proven that there may be a link between ankle and lower leg injuries and hip and core strength and proprioception.

Please remember that an ankle is a part of the kinetic chain and an simple injury will affect athletic performances.

When treating chronic ankle sprains, an focus is put on stabilizing the joint as well as getting rid of any symptoms that the athlete may have. In these cases, the athlete will suffer from the injury often times and they may be able to get up and stay active after getting injured. In severe cases of chronic ankle sprains, the athlete may not be able to participate in any athletic activities due to pain and/or instability. Rehabilitation of these athletes includes strengthening surrounding muscles and increasing proprioception to support the joint. If it fails, a surgical procedure to fix loose ligaments may be necessary.