Ankle Sprains
Almost everyone has rolled or sprained their ankle at some point in time. Ankle sprains usually settle down in a couple of days but sometimes it takes longer. Sports that attract these ankle injuries involve twisting and turning at speed. Football, soccer, rugby, basketball and netball come to mind. Players have their ankles strapped now before the game to prevent these injuries.
Sometimes the same ankle rolls again a short time later- surprisingly easily. Why does this happen? And why does it tend to roll in and not out? Let’s look at the anatomy first.
The ankle contains three joints. The talocrural (ankle) joint is formed between the lower ends of the tibia and fibula (leg bones) and talus (foot bone). This joint is a hinge joint and permits your foot to move up and down.
The subtalar joint is formed between the bottom of the talus and calcaneus (heel bone). It permits your foot to move sideways to the left and right.
The third joint is an almost immovable joint between the lower ends of the tibia and fibula. A bit of rotation occurs here. This joint is named the inferior tibiofibular joint.
Ligaments bind these joints together. Muscles and tendons move these joints and protect ligaments from injuries by checking excessive movement.
Let’s get back to that rolled ankle.
The ankle is looser, or more mobile, on the outside than the inside. This combined with the relative weakness of the ligaments that support the outside make it easier to injure.
The outside ankle ligaments are called the lateral ligament complex and have three parts. The anterior talofibularligament is easier to damage of the three. The calcaneofibular ligament and the posterior talofibular ligaments are injured in more severe cases. The inside ankle ligament is called the deltoid ligament and is a strong, fan shaped ligament. Stronger than the lateral ligament complex and much harder to damage.
So this is why you have a swollen, painful, bruised ankle after you have rolled your ankle in. If you have landed from a height and rolled your ankle you may have injured the inferior tibiofibular joint. This injury takes longer to heal than a lateral ligament strain and return to sport is delayed.
It is important to assess the severe of the damage first. The amount of swelling is not always a good indicator of severity of injury .X-rays taken in emergency departments of very swollen ankles often show no fractures. Being able to continue playing sport and the ability to weight bear should be noted.
Ligament laxity is important to determine. This means how far have the lateral ligaments overstretched. Like an elastic band too much stretching can cause a complete tear also known as a rupture. If ruptured the ankle may be unstable and ongoing pain, swelling and disability may follow. A thorough physiotherapy assessment is therefore very important. As is a thorough, comprehensive treatment plan.
Initially tape is used to protect the ligaments and allow weight bearing. Crutches may also be necessary. A compression bandage is used to reduce swelling.
RICE is followed in the first 72 hours. This is rest, ice, compression and elevation. Pulsed ultrasound is used to encourage healing. Following 72 hours ankle stretching, ligament massage, electrotherapy, and exercises to strengthen and stretch the ankle are given. Also balance exercises often involving a rocker board or wobble board.
In the absence of physiotherapy treatment, ankles may roll again due to excessive scar tissue, muscle weakness and loss of balance.
More serious ligament tears should have physiotherapy rehabilitation for up to six weeks. If athletes with Grade 3 injuries (lateral ligament rupture) can play with tape or an ankle brace with little problem, surgery is not required.
If after this time and with appropriate physiotherapy, the athlete complains of pain and instability of the ankle, surgical reconstruction of the lateral ligament may be necessary.
Excluding other causes of ongoing pain and disability may be needed. For example if the inferior tibiofibular joint is injured recovery is slower with regard to weight bearing activities that involve running.
Bone scans, CT or MRI scans may be needed to rule out subtle ankle fractures.
Ankle injuries respond very well to physiotherapy treatment. So if you have rolled your ankle or have ankle sprains and you want to get back to walking and sport quickly- see your physiotherapist.