An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
ANKLE SPRAIN MANAGEMENT
"It’s okay, it’s just an ankle sprain"
Ankle sprains are frequently brushed off as an insignificant injury and given the ‘she’ll be right’ treatment. We think this is because minor ankle sprains are normally only painful, swollen, and bruised for a couple of days – easy to ignore!
However, around 4 in 10 people can develop ankle instability after an untreated minor ankle sprain (1). This can mean a higher chance of another ankle sprain (possibly more severe) and osteoarthritis in the ankle joint.
Not all ankle sprains are the same
There are different type of ankle sprains and they can be simplified into categories:
A high ankle sprain involves damage to the ligaments that connect the bottom of the two shin bones (the tibia and fibula). It occurs in more serious cases of lateral or medial ankle sprains. It can take around twice as long to return to sport when compared to an isolated lateral ankle sprain.
Lateral ankle sprain
This is the most common type of ankle sprain and involves suddenly rolling your foot outwards. There is usually damage to one (or both) of two ligaments that attach at the bottom of the fibula (the outside shin bone) to other bones in the foot. They are called the anterior talofibular ligament and calcaneofibular ligament. A more serious lateral ankle sprain could result in bony damage to the fibula if the ligament has pulled at its attachment site too hard.
Medial ankle sprain
The inside of your ankle is the load bearing side with stronger ligaments and joint structures, so it isn’t as commonly injured. This type of sprain occurs when the ankle is rolled inwards with a major and sudden force. The deltoid ligament is a web of ligaments that help to stabilise the inside of your ankle and is stronger than the ligaments on the outside (lateral aspect) of the ankle. It supports other structures in the arch of the foot – these include the spring ligament and the tibialis posterior tendon. It’s important to strengthen and treat a medial ankle sprain because to make sure the load bearing part of the foot stays strong and supported.
What can a Podiatrist do for my ankle sprain?
Immobilisation of your ankle with a moon boot is only necessary if you have a more severe ankle sprain involving a break in the bone. Otherwise, we try and get you moving as soon as possible.
The three main things we want to restore after an ankle sprain that does not involve a bone break are:
When ligaments are injured with sudden ankle movement, other muscles and tendons can also be put under stress. It’s important to improve the strength of these ligaments, muscles, and tendons as soon as possible. We may put you on a progressive strengthening program, starting with simple movements without putting weight on the ankle.
As the pain levels decrease and you feel you can walk for longer and with less pain, we increase the difficulty of these strengthening exercises so they can be stronger for the activities you do. With strength of these soft tissues restored and conditioned, there is less risk of damage next time your ankle moves this way.
This can be achieved through ankle mobility exercises and hands-on mobilisation by your podiatrist.
The talus is one of the bones that sits in the centre of your ankle joint and has no muscle attachments – it’s held in position by the surrounding bones and ligaments. Its position can sometimes shift with an ankle sprain and may cause other impingements if left untreated. The end of the fibula (outside shin bone) and cuboid (one of the bones on the outside of the foot) can also shift with lateral ankle sprains.
Mobilising these joints can help with comfort, pain relief, and allows tendons and ligaments to glide through these areas efficiently.
We start off with easy balancing exercises. These exercises help to improve your confidence and re-train your brain to communicate with your feet (they’re a long way away!). Proprioceptive exercises easily translate into the sport or activity you are doing. For example, a lot of sports including running are single leg stance sports, so you need to be confident with balancing and moving on one leg without spraining your ankle again.
Whether they’re mild or severe, you will benefit from rehabilitation and treatment from your Podiatrist.
(1) Oded Hershkovich, M. M. (2014, August 16). A Large-Scale Study on Epidemiology and Risk Factors for Chronic Ankle Instability in Young Adults. The Journal of Foot and Ankle Surgery, 54(2), 183-187.
Katherine Newsham, P. A. (2019, May 1). The Ubiquitous Lateral Ankle Sprain: Time to Reconsider Our Management? The Journal for Nurse Practitioners, 15(5), 343-346.
Lisa Chinn, M. A. (2010). Rehabilitation of Ankle and Foot Injuries in Athletes. Clinical Sports Medicine, 157-167.
Ryan P McGovern, R. L. (2016). Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine, 33-42.
Wolf Petersen, I. V. (2013, May 28). Treatment of acute ankle ligament injuries: a systematic review. Arthroscopy and Sports Medicine, 1129-1141.