A sprained ankle is a condition characterized by damage and tearing to the soft tissue and ligaments of the ankle. The most commonly affected ligament in this condition is the lateral ligament.
A ligament is a strong band of connective tissue which attaches bone to bone. The lateral ligament of the ankle comprises of three bands of connective tissue and is responsible for joining the fibula to the talus and calcaneus.
Collectively, the lateral ligament acts to prevent the foot and ankle from turning inward excessively. When this movement is excessive and beyond what the ligament can withstand, tearing to the ligament occurs. This condition is known as a sprained ankle and may range from a small partial tear resulting in minimal pain, to a complete rupture resulting in significant pain and disability.
X-ray including A-P, lateral and at least one oblique view should be performed after ankle sprains in situations where instability is present or when acute bony tenderness is present on the malleoli or the medial or lateral dome of the talus. X rays of the ankle joint must include the base of the 5th metatarsal to exclude associated fracture.
An osteochondral fracture may not be apparent on initial X-ray. If significant pain and disability are present despite appropriate treatment 4 - 6 weeks after an apparent 'routine' ankle sprain, specialist sports physician or orthopedic surgeon referral is indicated. A radioisotopic bone scan may be performed to exclude an osteochondral fracture.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a sprained ankle. Investigations such as an X-ray, ultrasound, MRI or CT scan are often required to confirm diagnosis and rule out other injuries (particularly fractures).
Physiotherapy treatment is essential for all patients with a sprained ankle as inadequate rehabilitation can result in a poor outcome with a high likelihood of re-injury. Physiotherapy can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence.
- Treatment may comprise:
- Soft tissue massage
- Joint mobilization
- Dry needling
- Electrotherapy (e.g. ultrasound)
- Anti-inflammatory advice
- The use of crutches
- The use of heel wedges
- Ankle taping
- Ankle bracing
- Ice or heat treatment
- Exercises to improve flexibility, strength and balance
- Activity modification advice
- Biomechanical correction
- A gradual return to activity program
- Footwear advice
- The prescription of orthotics